Literature Review

Have you been overcharged for prescription drugs? We want to hear from you. - The New York TimesThe New York Times, by Reed Abelson and Rebecca Robbins; 1/9/24Most prescriptions in the United States are handled by one of three companies: CVS Caremark, Express Scripts or Optum Rx. These pharmacy benefit managers serve as middlemen between the drug companies that make the medications and the insurance plans that pay for your prescriptions. These relationships have been in the news because of the high cost of prescription drugs. We want to hear about your experiences with these companies, including whether your medications were covered and how much you paid for them. We’re also interested in hearing from pharmacists and doctors about their experiences and those of their patients.

Humana wins $360M in Walgreens drug price settlementModern Healthcare, by Lauren Berryman; 1/8/24Walgreens will pay Humana $360 million to resolve allegations the pharmacy chain overcharged the health insurer for prescription drugs.

NY healthcare orgs collab to deliver value-based hospice, palliative careTechTarget, by Victoria Bailey; 1/3/24Bassett Healthcare Network, a New York-based health system, has partnered with Helios Care to provide patients with value-based hospice and palliative care. ... Together, the two organizations will create an electronically driven referral process that will promote value-based contracting for hospice and palliative care services and establish a comprehensive palliative care and hospice service to treat patients in the hospital, in outpatient settings, and at home. In addition, the partnership will prioritize developing a transitional care program to provide in-home care for patients with serious illnesses, chronic diseases, and end-of-life needs.

The future of claims management: How payers can maximize payment integrityBecker's Payer Issues; 12/29/237 to 10 cents of every dollar spent on healthcare goes toward paying for fraudulent claims. Learn the latest strategies for boosting payment integrity here.

Hospital merger activity to increase in 2024Modern HealthcareDecember 26, 2023Hospital merger and acquisition activity is expected to increase next year as hospitals manage financial pressure, competitors combine and insurers grow. ... The number of announced hospital deals through the third quarter rose by more than 50%, to 53 proposed transactions from 35 last year, according to data from consultancy Kaufman Hall. Deal activity was particularly pronounced among midsized health systems ranging from $1 billion to $5 billion in annual revenue. ... Nearly 40% of the 18 proposed hospital deals announced in the third quarter were driven by financial distress, according to Kaufman Hall. 

After the chaotic closure of a St. Louis nursing home, will others also shut down?St. Louis Post-DispatchDecember 24, 2023St. Louis, MO—The north St. Louis nursing home that closed abruptly last weekend, setting off a chaotic relocation of residents and layoffs of workers without warning, had been in decline for several years. ... Other area nursing homes face similar financial pressures and lingering damage from the COVID-19 pandemic. ... “I think we’re going to see a lot of nursing homes close, that’s my prediction—I mean a lot of nursing homes,” [Harvey] Tettlebaum [a lawyer who for decades has represented the Missouri Healthcare Association, a group for long-term health care organizations] said. “I think it’s going to escalate next year.” Among the most vulnerable are providers that primarily serve residents who rely on Medicaid. 

Top 5 ‘Hidden Gem’ Palliative Care News Stories from 2023Palliative Care NewsDecember 18, 2023Reimbursement and regulation reigned in the news this year, but other important trends garnered attention as well. Below are top five under-the-radar stories that, while important, didn’t make our most read this year. The topics range from unmet staff and patient needs, financial and operational headwinds and research fueling innovative care delivery approaches.

22 states to increase minimum wage on Jan. 1McKnight’s Senior LivingDecember 13, 2023Almost half of the states, along with 40 local jurisdictions, are set to ring in 2024 with increases to minimum wage, according to Polsinelli law firm. The 22 states with minimum wage increases coming in the new year: Alaska, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, New Jersey, New York, Ohio, Rhode Island, South Dakota, Vermont and Washington. 

Home Health Spending Begins To Climb Again Post-PandemicHome Health Care NewsDecember 13, 2023After stalling in 2021, spending on home health care returned to a more normalized growth rate in 2022, according to a new analysis from the Office of the Actuary at the Centers for Medicare & Medicaid Services. Specifically, national health expenditures on home health care increased by 6% to $132.9 billion in 2022. 

Palliative Care Yield Cost Savings Lymphoma Patients, But Racial Disparities ExistPalliative Care NewsDecember 12, 2023Lymphoma patients who receive palliative care have fewer hospitalizations that those who do not, but racial and ethnic disparities persist. ... The study found that on average palliative care generated cost savings of $24,269 per patient. However, patients that identified as Black or Hispanic were much less likely to receive palliative care than white patients, reflecting widespread inequities in palliative care and the health care system at large, the research found. 

Operating in the redPuget Sound Business Journal (Seattle, WA)December 10, 2023... Across Washington, health systems representing 93% of the state’s beds have incurred more than $750 million in operational losses in the first half of 2023, according to data from the Washington State Hospital Association. ... Those losses were much steeper in 2022, but a majority of Washington hospitals are still operating at a deficit, burning through cash reserves to keep their doors open. Statewide, 17 hospitals have less than three months of operating costs in their reserves, per WSHA. ... “Folks have probably heard the term ‘no margin, no mission.’ So, no matter how foundational your mission statement is, if you don’t have the finances to run the organization, then there really can’t be a mission for you,” [EvergreenHealth Chief Medical and Quality Officer Dr. Ettorre] Palazzo said. ... As hospitals look for ways to stave off financial losses, they’re faced with another crisis—a population that is demonstrably sicker than it was prior to Covid 19. That’s leading to high hospital censuses and clogged emergency departments, further stressing hospital systems, employee well-being and financial viability.

MedPAC draws fire with draft recommendations for massive home health cut, hospice rate freezeMcKnight’s Home Care DailyDecember 12, 2023The Medicare Payment Advisory Commission offered initial recommendations for Congress to cut home health reimbursement by 7% and pause hospice payment updates in 2025. “The 2022 [home health] margins remain above 20%, higher than the long-run average of 16.8% since 2001,” Evan Christman, senior analyst at MedPAC, said during last Friday’s public meeting, according to a transcript. “Overall, these margins indicate that Medicare fee-for-service continues to pay well in excess of cost.” Part of the reason home health agencies reportedly saw margins of 22.2%, on average, according to Christman, is a decline in the number of visits per 30-day period. Since the implementation of the Patient-Driven Groupings Model in 2020, these visits have declined more than 15%; between 2021 and 2022, visits per 30 days declined 3.5%. Home health advocates were quick to dispute MedPAC’s claims. “There are many shortfalls in MedPAC’s home health margins report—starting with the fact that MedPAC’s analysis only captures a declining fraction of the Medicare home health population, ignoring that overall margins are low,” Joanne Cunningham, chief executive officer of the Partnership for Quality Home Healthcare, said in a statement. ... The Partnership and National Association for Home Care & Hospice cited poor methodology and data in the recent home health final rule, which contained a Medicare cut related to PDGM. MedPAC also recommended that Congress eliminate any payment updates for hospice providers in 2025. 

Forced to work in a vacuum, MedPAC recommends another Medicare cutMcKnight’s Long Term Care NewsDecember 11, 2023A Congressional advisory group appears ready to recommend a 3% Medicare pay cut for nursing homes in 2025. In what has become an annual tradition, members of the Medicare Payment Advisory Commission voiced ongoing concerns Friday about the use of Medicare Fee for Service reimbursement to effectively subsidize Medicaid rates and Medicare Advantage payments. With official data indicating that patients still have plenty of access to care, panel staff recommended MedPAC tell Congress that it should pursue a cut to Chair Michael Chernew, PhD, a healthcare policy professor at Harvard, said the 3% cut could be steeper given the reported margins. But the commission—tasked only with considering Medicare policy—remains cognizant of the pressures faced by providers accepting Medicaid and being increasingly low balled by managed care plans.