Literature Review

‘Are nursing homes our only option?’ These centers offer older adults an alternative. Rhode Island Current, by Anna Claire Vollers; 4/12/24PACE centers attract bipartisan interest and, in some states, scrutiny. ... PACE (Program of All-Inclusive Care for the Elderly) centers provide government-funded medical care and social services to people older than 55 whose complex medical needs qualify them for nursing home care, but who can live at home with the right sort of help. ... Nationally, PACE centers are owned by a variety of health care organizations, including nonprofits, for-profit companies, large health care systems and religious organizations. ... [The] explosive growth has come with challenges ...

AMA, AHIP, NAACOS outline value-based care best practices Modern Healthcare, by Nona Tepper; 4/10/24 Health insurers, physicians and accountable care organizations issued recommendations Wednesday outlining what they see as the best ways to boost value-based care initiatives. The report from the health insurance trade group AHIP, the American Medical Association and the National Association of ACOs focuses on total-cost-of-care contracts, ACOs that typically span three to five years and have demonstrated success improving quality and reducing costs, according to the organizations.

How MA Plan design affects utilization, health equity MedCity News, by Marissa Pescia; 4/8/24 A new study found that enrollees with zero-premium MA plans are three times as likely to be non-White compared to other MA enrollees and traditional Medicare enrollees. ... The study was published by Harvard Medical School and Inovalon, a provider of cloud-based software solutions. It used Inovalon’s Medical Outcomes Research for Effectiveness and Economics Registry dataset, which “tracks demographic characteristics and outcomes for about 30% of all MA members at any given point in time,” according to the report.

Medicaid expansion and palliative care for advanced-stage liver cancer Journal of Gastrointestinal Surgery; by Henrique A Lima, Parit Mavani, Muhammad Musaab Munir, Yutaka Endo, Selamawit Woldesenbet, Muhammad Muntazir Mehdi Khan, Karol Rawicz-Pruszyński, Usama Waqar, Erryk Katayama, Vivian Resende, Mujtaba Khalil, Timothy M Pawlik; dated 4/24/28 (for print) Conclusion: The implementation of ME [Medicaid expansion] contributed to increased rates of palliative treatment for patients residing in ME states after expansion. However, racial disparities persist even after ME, resulting in inequitable access to palliative care. 

Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements Federal Register; A Proposed Rule by the Centers for Medicare & Medicaid Services on 4/4/24This document has a comment period that ends in 53 days, 5/28/24.This proposed rule would update the hospice wage index, payment rates, and aggregate cap amount for Fiscal Year (FY) 2025. This rule proposes changes to the Hospice Quality Reporting Program. This rule also proposes to adopt the most recent Office of Management and Budget statistical area delineations, which would change the hospice wage index. This rule proposes to clarify current policy related to the “election statement” and the “notice of election”, as well as to add clarifying language regarding hospice certification. Finally, this rulemaking solicits comments regarding potential implementation of a separate payment mechanism to account for high intensity palliative care services.

CMS: Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F)CMS, Medicare Part D, Policy; 4/4/24On April 4, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the Medicare Advantage Program, Medicare Prescription Drug Benefit Program (Medicare Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications. Additionally, this final rule addresses several key provisions that remain from the CY 2024 Medicare Advantage and Part D proposed rule, CMS-4201-P, published on December 14, 2022. ... This fact sheet discusses the major provisions of the 2025 final rule which can be downloaded here: https://www.federalregister.gov/public-inspection/2024-07105/medicare-program-medicare-advantage-and-the-medicare-prescription-drug-benefit-program-for-contract

Nursa Survey finds 98% of hospital CFOs view nurse staffing as top challenge Morningstar, provided by Business Wire; 4/2/24Survey results offer insight into C-suite perspectives on workforce trends and financial impact. Nursa, a nationwide platform that exists to put a nurse at the bedside of every patient in need, today released the results of a survey with healthcare decision-makers that examines their perspectives on the evolving social contract of employment, opinions on the 1099 workforce, and reflections on what makes a nurse truly valuable to an organization. Key findings from the survey include:

CMS finalizes 2025 Medicare Advantage rates Becker's Payer Issues, by Rylee Wilson; 4/1/24 CMS finalized a slight decrease in Medicare Advantage benchmark payments for 2025. The agency published its final rate notice for 2025 April 1. The final rule was largely similar to CMS' proposed payment rates issued in January. The agency will cut benchmark payments by 0.16% from 2024 to 2025. CMS estimated plans will see 3.7% higher revenue overall in 2025. MA risk score trend of 3.86% — the average increase in risk adjustment payments year over year — will offset risk model revisions that will lead to a 2.45% decline in revenue and a projected decline in star rating bonuses, according to the agency. 

Palliative care bill a win for South Dakota, Amendment F looms as possible major setback for cancer community American Cancer Society / Cancer Action Network Press Release; 3/28/24 When Gov. Kristi Noem signed Senate Bill 147 into law it improved access to palliative care and allowed the state’s health care providers to better serve individuals with serious illnesses. ...  SB 147 adds the definition to statute, allowing for improved access to and reimbursement for palliative care services as well as providing for the distribution of education materials on palliative care.  ... SB 147 was the health care high point for the 2024 Legislature, which missed an opportunity to improve coverage for breast cancer diagnostic tests for South Dakotans by not advancing House Bill 1122 and passed the problematic Senate Joint Resolution 501 [will be Amendment F on November ballot] ... 

4 ways to drive transformational change in sustainabilityAmerican Hospital Association; 3/26/24Like a growing number of health care organizations, New Jersey’s Hackensack Meridian Health (HMH) system has been on a journey for some time now to reduce its environmental impact and boost sustainability practices. Recent achievements include:

Medicare, Medicaid made $100B in improper payments in 2023 Becker's Hospital Review - Legal & Regulatory Issues, by Andrew Cass; 3/27/24 The federal government reported an estimated $235.8 billion in improper payments in fiscal year 2023, with more than $100 billion coming from Medicare and Medicaid, according to a March 26 report from the U.S. Government Accountability Office. The $235.8 billion in improper payments reported by 14 agencies across 71 programs is a decrease from the $247 billion reported in 2022, but the figure remains higher than pre-pandemic levels, according to the report. 

Nearly half of health systems are considering dropping Medicare Advantage plans Becker's Hospital CFO Report, by Andrew Cass; 3/22/24 ... "HFMA Health System CFO Pain Points Study 2024" is based on a survey of 135 health system CFOs conducted in January.  According to the report, 16% of health systems are planning to stop accepting one or more Medicare Advantage plans in the next two years. Another 45% said they are considering the same but have not made a final decision.