Literature Review

WellSky acquires leading durable/home medical equipment software provider Bonafide, enhancing home care solutions Healthcare IT Today; by Healthcare IT News; 11/12/24 WellSky, a leading health and community care technology company, announced today that it has acquired Bonafide, an enterprise software solution for durable medical equipment (DME) and home medical equipment (HME) companies. With the addition of Bonafide, WellSky expands its footprint in DME/HME and will serve more providers with an integrated software platform that allows them to run their businesses compliantly, efficiently, and profitably. DME/HME is a rapidly growing segment in the healthcare industry, driven by the increasing demand for patient-centered care in the home. Bonafide has built a fully integrated enterprise workflow management platform that combines billing, revenue cycle management, resupply, supply chain, inventory management, mobile delivery, and more to help DME/HME providers accelerate growth. The company serves 200 clients, including some of the largest and fastest-growing DME/HME providers.

Palliative care, ACO collaborations fuel ‘historical savings’ in MSSP Program Hospice News; by Holly Vossel; 11/11/24 Palliative care providers that form collaborative partnerships with Accountable Care Organizations (ACOs) may be lending to a landmark downward trend in health care spending in the value-based payment landscape. The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced that its Medicare Shared Savings Program (MSSP) yielded more than $2.1 billion net savings in 2023 — the largest amount in the program’s inception more than a decade ago, according to the agency. ACOs participating in MSSP earned an estimated $3.1 billion in shared savings payments during the program’s 2022 to 2023 performance year, the highest dollar amount thus far, CMS reported. [Click on the title's link to continue reading.]

CMS finalizes 2.9% cut in physician payments for 2025, including for palliative care Hospice News; by Jim Parker; 11/4/24 The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized a nearly 2.9% cut for 2025 in physician payment rates used to reimburse palliative care care practitioners, among other professionals. The final rule also states that the telehealth flexibilities implemented during the COVID-19 public health emergency will expire at the end of this year unless Congress intervenes. Physicians and other professionals will have to follow pre-COVID restrictions on telehealth, with few exceptions. Industry organizations were quick to denounce the pay cut. “To put it bluntly, Medicare plans to pay us less while costs go up. You don’t have to be an economist to know that is an unsustainable trend, though one that has been going on for decades,” American Medical Association President Dr. Bruce Scott said in a statement.

Medicare Part D paid millions for drugs for which payment was available under the Medicare Part A Skilled Nursing Facility Benefit HHS Office of Inspector General; Report Highlights; 10/27/24 What OIG Found: ... On the basis of our sample results, for 2018 through 2020, we estimated that up to the entire Part D total cost of $465.1 million was improperly paid for drugs for which payment was available under the Part A SNF benefit. Of that amount, we estimated that approximately $245.4 million was for drugs that the medical records showed were administered to Part D enrollees during their Part A SNF stays.What OIG Recommends: We made five recommendations, including that CMS work with its plan sponsors to adjust or delete PDEs, as necessary, and determine the impact to the Federal Government related to the Part D total costs of $953,370 for drugs associated with our sample items for which payment was available under the Part A SNF benefit; work with its plan sponsors to identify similar instances of noncompliance that occurred during our audit period and determine the impact to the Federal Government, which could have amounted up to an estimated $465.1 million in Part D total cost; and provide plan sponsors with timely and accurate information, such as dates of covered Part A SNF stays, to reduce instances of inappropriate Part D payment for drugs for which payment is available under the Part A SNF benefit. ... CMS concurred with all five recommendations.

HealthRev Partners and Trella Health announce partnership to empower home health and hospice agencies The Warren Record; by Trella Health; 10/17/24HealthRev Partners, [a] revenue cycle management partner specializing in innovative, tech-driven solutions for home health and hospice agencies, and Trella Health, [a] provider of market intelligence and Customer Relationship Management (CRM) solutions for the post-acute care industry, have announced a new partnership. HealthRev Partners and Trella Health will collaborate to help agencies reach their full potential by cultivating stronger relationships with referral sources and optimizing their revenue cycle through complementary solutions.

Spending on home healthcare outpaces others for 4th consecutive month McKnights Senior Living; by Kathleen Steele Gaivin; 9/26/24 Spending on home healthcare continued to outpace the rest of the sector in August, according to Altarum’s monthly Health Sector Economic Indicators brief, released Wednesday. “This is the fourth successive month in which we have observed such rapid growth. Year-over-year home healthcare spending growth for the four-month period from April through July was 19.7%,” George Miller, PhD, Altarum fellow and research team leader, told the McKnight’s Business Daily. Overall, healthcare costs were 2.7% higher last month than they were in August 2023 and 0.2% percent lower than they were in July, according to Altarum. ... Nursing and residential care employment, however, declined by 2,600 jobs in August. ...

The ‘Holy Grail’ of palliative care payment through ACOs Hospice News; by Jim Parker; 9/11/24 As opportunities to provide palliative care through Accountable Care Organization (ACO) relationships continue to arise, operators will likely need to understand the varying types of reimbursement that exist in that arena. ACOs are groups of physicians, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients. Hospices and palliative care providers can collaborate with ACOs by becoming members of those organizations themselves, or by contracting with them through a preferred provider network. Community-based palliative care’s track record of reducing costs and hospitalizations could make providers of those services attractive to ACOs, according to Edo Banach, partner at Manatt Health, a division of the law firm Manatt, Phelps & Phillips, LLP.

Editorial: Palliative care can drive change via new payment models Hospice News; by Jim Parker; 8/27/24 A range of emerging payment model demonstrations are integrating principles traditionally associated with “palliative care” into their structures, but without using that term. The Center for Medicare & Medicaid Innovation’s (CMMI) has unveiled a series of models that incorporate elements designed to provide patient-centered care to improve seriously ill patients’ quality of life. Examples include the Guiding an Improved Dementia Experience (GUIDE), the Kidney Care Choices and Enhancing Oncology models. The GUIDE model, for example, includes language requiring “person-centered care meant to improve quality of life, delivered by interdisciplinary teams.” Thus, one could argue that palliative care principles are becoming more integrated into the larger system, even if stakeholders are not using the same terminology. ...

Capitalizing palliative care startups Hospice News; by Jesse Floyd; 8/14/24 As a sector, most standalone palliative care providers are still maturing from startups into long-term, sustainable businesses. ... This means gathering the necessary startup capital to take a new palliative care provider from idea to execution is often the first tangible goal for hopeful entrants into the space. When Jonathan Fluhart and Tiffany Hughes set about getting PalliCare, their Texarkana, Texas-based palliative care provider from theory to reality, they ran headlong into this obstacle. ... “Initially, what we thought we would do is build a palliative program that would nest between the home health and hospice,” Fluhart said. “We started to go into the community to talk with facilities and places that we felt would benefit from our services. Once they learned that we were tied to a home health provider, especially a hospice, it turned them off.” They decided the answer was two-fold: Sever ties with the hospice care provider they worked for; then start casting about for investors. ... 

Hospice market surge: Expected to hit $182.1 billion by 2033 Market.us Media; by Trishita Deb; 7/29/24 The global hospice market is projected to grow significantly from USD 72.8 billion in 2023 to around USD 182.1 billion by 2033, achieving a CAGR of 9.6%. This expansion is primarily driven by an aging population requiring increased palliative and end-of-life care. The demographic shift necessitates services that address chronic illnesses and provide compassionate care, predominantly offered by hospices. Additionally, technological advancements, particularly in telemedicine, facilitate broader access to comprehensive care, especially in remote areas. Interdisciplinary approaches in palliative care are also pivotal, involving collaborative efforts from doctors, nurses, social workers, and chaplains. This holistic method not only enhances the quality of care but also boosts patient and family satisfaction, key metrics in healthcare evaluations. 

Why home health providers should expect to see a ‘less draconian’ final payment rule Home Health Care News; by Joyce Famakinwa; 7/22/24 As home health providers continue to digest the proposed payment rule for 2025, National Association for Home Care & Hospice (NAHC) President William A. Dombi believes that the industry will ultimately see a comparatively toned down final rule. “We believe we will not end up with this proposed rule as a final rule,” he said during the opening presentation at NAHC’s Financial Management Conference in Las Vegas on Sunday. “We will end up with something less draconian. The cuts will be reduced because, No. 1, that’s what they’ve done for the last several years, and, No. 2, it’s an election year.” Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies.

Keys to negotiating ACO palliative care contracts Hospice News; by Molly Bookner; 7/22/24 Accountable Care Organizations (ACOs) are key for scaling palliative care through value-based models. Hospices and palliative care providers can collaborate with ACOs by becoming members of those organizations themselves, or by contracting with them through a preferred provider network. These arrangements allow for the negotiation of mutually beneficial terms that are tailored to the needs and characteristics of patient populations. However, successfully negotiating such contracts requires a strategic approach and a deep understanding of ACOs’ priorities. As the U.S. Centers for Medicare & Medicaid Services (CMS) moves to align all Medicare beneficiaries with an accountable care relationship, these negotiations will become even more paramount.