Literature Review

Medicare Administrative Contractors [MACs] did not consistently meet Medicare Cost Report Oversight Requirements HHS-OIG; Issued on 3/18/25, posted on 3/19/25 ... What OIG Found: MACs did not consistently meet Medicare cost report oversight requirements.

Evaluation of the Medicare Advantage Value-Based Insurance Design model test: 2020 to 2023  RAND Health Care, prepared for the Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation Under Research, Measurement, Assessment, Design, and Analysis Contract Number 75FCMC19D0093, Order Number 75FCMC20F0001; by Christine Eibner, Dmitry Khodyakov, Erin A. Taylor, Denis Agniel, Rebecca Anhang Price, Julia Bandini, Marika Booth, Lane F. Burgette, Christine Buttorff, Catherine C. Cohen, Stephanie Dellva, Michael Dworsky, Natalie C. Ernecoff, Alice Y. Kim, Julie Lai, Monique Martineau, Nabeel Qureshi, Afshin Rastegar, Max Rubinstein, Daniel Schwam, Joan M. Teno, Anagha Tolpadi, Shiyuan Zhang; March 2025 This report presents RAND researchers’ findings from their evaluation of the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model test for 2020 through 2023, initiated by the Center for Medicare and Medicaid Innovation (Innovation Center). The VBID Model allows participating MA parent organizations (POs) to offer supplemental benefits, financial and nonfinancial incentives to beneficiaries, hospice benefits (the Medicare Hospice Benefit, Palliative Care, Transitional Concurrent Care, and Hospice Supplemental Benefits), and Wellness and Health Care Planning through their MA plans.

Bringing palliative care to every patient with cancer: A conversation with Janet L. Abrahm, MD, FACP, FAAHPM, FASCO The ASCO Post, in partnership with the American Society of Clinical Oncology; by Jo Cavallo; 3/25/25 Janet L. Abrahm, MD, FACP, FAAHPM, FASCO, ... has become a widely recognized leader in the field of supportive care and palliative medicine, serving for nearly a decade on the leadership team of the American Academy of Hospice and Palliative Medicine and helping to craft the first Hospice and Palliative Medicine certifying examination offered by the American Board of Internal Medicine. ... In a wide-ranging interview with The ASCO Post, Dr. Abrahm discussed the importance of providing every patient with cancer access to palliative medicine throughout survivorship, how oncologists can become more effective communicators, and strategies to alleviate patients’ suffering at the end of life.

More care doesn't equal happier patients in traditional Medicare American Journal of Managed Care (AJMC); by Maggie L. Shaw; 3/17/25 The extremes of health care contact days—having too few or more than average—among community-dwelling beneficiaries 65 years and older of traditional Medicare have been associated with unnecessary care, misdirected care coordination, and excessive care outside the home, according to new research published online today in JAMA Internal Medicine. Health care contact days are days spent receiving care outside of the home. ... “Clinicians, researchers, and policymakers could use contact days to evaluate interventions and reduce excess contact days for patients,” the authors conclude, “by avoiding unnecessary care, improving care coordination, and shifting care to the home.”

MedPAC recommends Congress tie physician pay to inflation for 2026 Healthcare Dive; by Susanna Vogel; 3/17/25 Dive Brief:

2010 to 2019 saw early palliative care billing up for advanced cancer HealthDay News; by Elana Gotkine; 3/17/25 For patients with distant-stage cancers, there was an increase in early palliative care (PC) billing from 2010 to 2019, but the level remained low, according to a study published online March 7 in the Journal of Clinical Oncology. ... The researchers found that in 2010 to 2019, there was an increase in the percentage with early PC billing among 102,032 patients treated by 18,908 unique physicians, from 1.44 to 10.36 percent. The likelihood of early PC billing was increased in association with treating physician's early PC referrals in the previous year and organizations' employment of any HPM specialist (3.01 and 4.54 percentage points, respectively). 

House sets up potential Medicaid cuts with budget bill passage Modern Healthcare; by Michael McAliff; 2/25/25 Republicans in the House took the first step Tuesday [2/25] toward steep potential healthcare cuts, passing a budget resolution that aims to trim spending by at least $1.5 trillion while also adding trillions to the debt to fund tax cuts. The House voted 217-215 on nearly party lines to begin what is known as budget reconciliation, passing a budget resolution that instructs committees to come up with cuts or extend tax cuts that largely benefit the wealthy. The bill mandates the House Energy and Commerce Committee, which oversees Medicaid and Medicare, come up with the majority of the savings, and cut $880 billion.

Palliative care’s most disruptive forces in 2025 Hospice News; by Holly Vossel; 2/25/25 Palliative care providers are taking varied routes to address the most disruptive forces they are encountering this year, rising to challenges that have been persistent across the sector. Mounting workforce pressures mark the most significant of concerns for palliative care providers, according to Dr. Martha Twaddle, The Waud Family Medical Directorship’s palliative medicine and supportive care clinical professor of medicine at Northwestern Medicine. The nation lacks a sufficient supply of palliative care professionals amid a swelling population of seriously ill patients, driving up demand. Current reimbursement streams are challenging the staffing issues even further, Twaddle stated. ... Workforce shortages and lack of sustainable reimbursement are indeed the largest obstacles to palliative care growth, according to Center to Advance Palliative Care (CAPC) CEO Brynn Bowman.

Navigating palliative care models in ACO partnerships Hospice News; by Markisan Naso; 2/14/25 Partnerships between health care providers and Accountable Care Organizations (ACOs) can help to create effective, value-based palliative care models for patients, but navigating the development of those relationships requires communication and a true commitment to collaboration. ... “ACOs are looking for high-quality care that reduces avoidable crises, and specialty palliative care has been proven to do just that,” Allison Silvers, chief of health care transformation at the Center to Advance Palliative Care (CAPC), told Palliative Care News. ... 

Living Well New York: Compassionate care for a better quality of life Mid Hudson News, Hudson Valley, NY; by Mid-Hudson News Staff; 2/12/25 United Hospice ... is proud to introduce Living Well New York, a groundbreaking program designed to enhance the lives of patients facing serious illnesses. By providing in-home palliative care through a combination of home visits and telehealth support, Living Well New York ensures that patients and their families receive the highest level of comfort, care, and guidance when they need it most.

Medicare's 2025 physician pay cut, explainedBecker's Hospital CFO Report; by Stefanie Asin; 2/5/25 As of Jan. 1, Medicare is paying physicians almost 3% less than last year for services provided to the country's 66 million Medicare patients. The decreased payments aren't a surprise or anything new, as CMS, by law, must keep physician payments budget neutral (cannot raise total Medicare spending by more than $20 million in a year). As a result, since 2020, Medicare has cut physician pay each year ... [Click on the title's link to continue reading these items.]

Palliative care is essential for seriously ill patients—at any ageAMA (American Medical Association); by Kevin B. O'Reilly; 1/27/25 The AMA House of Delegates has adopted new policies outlining physicians’ ethical obligation to provide or seek optimal palliative care for patients with serious illnesses who can benefit from comprehensive management of pain and other distressing symptoms—not only those with terminal illnesses or on the precipice of death. “Physicians have clinical ethical responsibilities to address the pain and suffering occasioned by illness and injury and to respect their patients as whole persons,” says one of the new policies adopted at the latest AMA Interim Meeting, held in Lake Buena Vista, Florida. “These duties require physicians to assure the provision of effective palliative care whenever a patient is experiencing serious, chronic, complex or critical illness, regardless of prognosis.” 

U.S. health care spending reaches $4.9 trillion Hospice News; by Jim Parker; 12/20/24 The nation’s total health expenditures rose 7.5% to $4.9 trillion in 2023, a new analysis by the U.S. Centers for Medicare & Medicaid Services (CMS) found. This growth took place at a faster pace in 2023 than prior years. In 2022, health care spending rose at a rate of 4.6%. Total Medicare hospice spending accounted for $25.7 billion last year, according to a separate report from the Medicare Payment Advisory Commission (MedPAC). ... About 21% of U.S. health care spending in 2023 was via Medicare, with private insurance representing a 30% share. Medicaid accounted for 21%, and the remaining 10% were out-of-pocket costs. “Hospital care, physician and clinical services, and nursing care facilities and continuing care retirement communities, which collectively accounted for 33% of all out-of-pocket spending in 2023, were the main contributors to the faster growth in 2023,” CMS indicated.