Literature Review
All posts tagged with “Palliative Care Provider News | Operations News | Financial.”
What home health providers can learn from CMS’ other proposed rules for 2025
04/22/24 at 02:30 AMWhat home health providers can learn from CMS’ other proposed rules for 2025Home Health Care News, by Joyce Famakinwa; 4/19/24... CMS released the 2025 proposed payment rules for hospice and skilled nursing facilities (SNFs) in March. On the hospice side, the proposed rule included a 2.6% increase in the per diem base rate. Aside from the pay raise for hospices, the proposal also included a market basket index update, and notable changes to some of the geographic areas subject to particular indices. “There are rural areas that became urban and urban areas that became rural in the new CBSs — core based statistical areas,” William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News.
One-third of West Virginians may soon have a harder time getting health care after lawmakers declined to fully fund Medicaid
04/19/24 at 03:00 AMOne-third of West Virginians may soon have a harder time getting health care after lawmakers declined to fully fund Medicaid Mountain State Spotlight, by Erin Beck; 4/18/24Across West Virginia, it’s already hard for many people to access health care. And unless state lawmakers change the budget they passed last month, it’s about to get even more difficult, especially for people who live in the most rural areas and those considered lower income. Starting in July, at the start of the next fiscal year, West Virginia officials will be forced to dramatically cut the state’s Medicaid budget. Roughly one-third of the state’s population relies on the government health insurance program. ... [Lawmakers] gave the program about $150 million less than was needed.
Mississippi Capitol sees second day of hundreds rallying for ‘full Medicaid expansion now’
04/19/24 at 03:00 AMMississippi Capitol sees second day of hundreds rallying for ‘full Medicaid expansion now’Mississippi Today - Legislature; by Bobby Harrison and Geoff Pender; 4/17/24Hundreds of people rallied at the Mississippi Capitol for a second day Wednesday, urging lawmakers to expand Medicaid to provide health coverage for an estimated 200,000 Mississippians. ... Speakers recounted their struggles with access to affordable health care in Mississippi and chanted for the Legislature to, “Close the coverage gap now,” and for “Full Medicaid expansion now.” ... [Dr. Randy] Easterling recounted a story of two of his friends diagnosed with similar cancers. One was uninsured and self-employed, and did not get early diagnosis or treatment. He’s now in hospice and on death’s door. The other friend, with insurance, received an early diagnosis and treatment and is now cancer free.
Home care sees largest price jump in history, BLS report finds
04/18/24 at 03:00 AMHome care sees largest price jump in history, BLS report finds McKnights Home Care, by Adam Healy; 4/15/24The cost of home care rose faster than ever in the last year, far outpacing inflation across every other healthcare spending category, according to the Bureau of Labor Statistics’ latest Consumer Price Index report. Home care costs rose 14.2% between March 2023 and March 2024 — its most rapid growth since BLS began tracking data for the segment in 2005, according to the CPI. ... During the same period, standard inflation for all medical care services was 2.1%. The costs of hospital services — outpatient hospital services (8.3%), general hospital services (7.5%) and inpatient hospital services (6.9%) — saw the next-highest inflation rates since March 2023, eclipsed only by home care services. Meanwhile, prices for nursing home and adult day service rose by about 3.9%.Editor's Note: This article did not report cost changes for hospice care.
CMMI’s proposed TEAM Model offers another risk-based opportunity for home health providers
04/17/24 at 03:00 AMCMMI’s proposed TEAM Model offers another risk-based opportunity for home health providers Home Helath Care News, by Andrew Donlan; 4/15/24Last week, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new proposed model that will undoubtedly affect home health providers, and also allow them the opportunity to get more involved in value-based care initiatives. The Transforming Episode Accountability Model (TEAM), which would eventually be mandatory if finalized, would have selected acute care hospitals put under full responsibility for the cost – and quality – of care from surgery up until the first 30 days after hospital discharge.
‘Are nursing homes our only option?’ These centers offer older adults an alternative.
04/16/24 at 03:00 AM‘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 ...
AHA seeks federal probe of MultiPlan, insurers
04/15/24 at 03:00 AMAHA seeks federal probe of MultiPlan, insurers Modern Healthcare, by Michael McAuliff; 4/9/24 The American Hospital Association wants the Labor Department to investigate the analytics company MultiPlan and its large insurer clients to determine whether they engage in business practices that disadvantage patients and providers. According to a New York Times investigation published Sunday, MultiPlan and customers such as UnitedHealth Group subsidiary UnitedHealthcare, CVS Health subsidiary Aetna and Cigna boost their finances by dispensing low payments to out-of-network providers and burdening patients with large bills.
AMA, AHIP, NAACOS outline value-based care best practices
04/15/24 at 02:00 AMAMA, 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.
Report: How MA Plan design affects utilization, health equity
04/12/24 at 03:00 AMHow 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.
Providers still navigating Change outage as systems are restored
04/12/24 at 03:00 AMProviders still navigating Change outage as systems are restored Modern Healthcare, by Lauren Berryman; 4/10/24 Providers are seeing some improvements following the Change Healthcare cyberattack nearly two months ago, but not necessarily because they are reconnecting to restored systems. Hospitals and medical groups are submitting claims to payers through alternate vendors, allowing them to generate cash. But the level of claims and payments moving among healthcare organizations that had heavily relied on Change Healthcare is still far from normal.
Insurers’ response to the Change breach failed providers
04/10/24 at 02:30 AMInsurers’ response to the Change breach failed providers Modern Healthcare, by Chip Kahn and Dr. Bruce Siegel; 4/8/24 ... The Feb. 21 attack on Change Healthcare, a subsidiary of UnitedHealth Group’s Optum unit, severed the electronic ties that connect patients, providers and insurance companies. The attack robbed patients of the certainty they could seek and receive care, and it robbed physicians, pharmacists and hospitals of the resources necessary for patient care. ... Overlooked in this crisis, is that insurance companies failed to act decisively and collectively to protect patients and providers. ... Here’s what should have happened immediately when the threat facing patient care became painfully obvious.
Medicaid expansion and palliative care for advanced-stage liver cancer
04/09/24 at 03:00 AMMedicaid 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.
Hospitals cash in on a private equity-backed trend: Concierge physician care
04/09/24 at 03:00 AMHospitals cash in on a private equity-backed trend: Concierge physician care KFF Health News, by Phil Galewitz; 4/1/24 Nonprofit hospitals created largely to serve the poor are adding concierge physician practices, charging patients annual membership fees of $2,000 or more for easier access to their doctors. It’s a trend that began decades ago with physician practices. Thousands of doctors have shifted to the concierge model, in which they can increase their income while decreasing their patient load. ...
Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements
04/08/24 at 03:00 AMMedicare 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.
Telehealth effective in supporting rural caregivers
04/08/24 at 03:00 AMTelehealth effective in supporting rural caregivers Hospice News, by Jim Parker; 4/3/24Palliative care delivered via telehealth is effective at improving access to caregiver support. Moreover, these services can also be cost-effective, recent research has found. ... “[Technology-enhanced transitional palliative care] is a feasible, low cost and sustainable strategy to enhance [family caregiver] support in rural areas,” researches indicated in the study. “Potential reimbursement mechanisms are available to offset the costs to the health system for providing transitional palliative care to caregivers of patients recently hospitalized.”
CMS: Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F)
04/08/24 at 03:00 AMCMS: 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
What home health providers need to know about the Medicare TPE Audit Process
04/04/24 at 03:00 AMWhat home health providers need to know about the Medicare TPE Audit ProcessHome Health Care News, by Joyce Famakinwa; 4/2/24... TPE is a medical review program that began for the home health and hospice settings in December 2017. The goal of the program is to weed out improper payments by zeroing-in on providers with high claims denial rates or unusual billing practices. ... TPE has three pillars. Target refers to errors or mistakes that are identified through data in comparison to providers or peers. Probe is the examination of 20 to 40 claims. ... Education means helping providers reduce claim denials and appeals through one-on-one individualized education.
Nursa Survey finds 98% of hospital CFOs view nurse staffing as top challenge
04/04/24 at 03:00 AMNursa 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:
2024 budget and paylines update: [$12.5 million for palliative care research]
04/04/24 at 03:00 AM2024 budget and paylines update: [$12.5 million for palliative care research]National Institute on Aging, by Kenneth Santora; 3/28/24The recently signed into law H.R. 2882, the Further Consolidated Appropriations Act, 2024, includes full-year NIH funding through Sept. 30, 2024. ... The budget designates a $100 million increase for Alzheimer’s disease and related dementias (AD/ADRD) research, including $90 million for NIA and $10 million for the National Institute of Neurological Disorders and Stroke; as well as $12.5 million for palliative care research.
CMS finalizes 2025 Medicare Advantage rates
04/03/24 at 03:00 AMCMS 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.
Cancer patients often want ‘one more round.’ Should doctors say no?
04/02/24 at 03:00 AMCancer patients often want ‘one more round.’ Should doctors say no? The Washington Post, by Mikkael A. Sekeres, MD; 3/31/24 My patient was in his early 30s and his leukemia had returned again following yet another round of treatment. He was a poster child for the recently reported rise in cancer rates in the young, and had just asked me what chemotherapy cocktail I could devise for him next, to try to rid him of his cancer. I hesitated before answering. Oncologists are notorious for always being willing to recommend to our patients one more course of treatment, even when the chances of success are negligible.
[Rural Hospitals] A popular healthcare myth debunked
04/01/24 at 03:00 AM[Rural Hospitals] A popular healthcare myth debunked Becker's Hospital CFO Report, by Laura Dyrda; 3/28/24Many in the healthcare industry assume rural hospitals are inherently worse off financially than urban hospitals. It's easy to see why. ... But a February Kaufman Hall report refutes the financial divide between rural and urban hospitals. When comparing rural and urban hospitals as a collective, the firm found no statistically significant difference in average operating margin. Rural and urban hospitals on average have similar operating margins and financial performance. So why do we often associate more dire financial struggles with rural hospitals over urban ones?
Palliative care bill a win for South Dakota, Amendment F looms as possible major setback for cancer community
04/01/24 at 03:00 AMPalliative 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 sustainability
03/29/24 at 03:15 AM4 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:
Home care providers’ creative benefit packages are paying off
03/29/24 at 03:00 AMHome care providers’ creative benefit packages are paying off Home Health Care News, by Joyce Famakinwa; 3/26/24 ... Amid a persistently challenging labor market, home care companies are still constantly working on configuring the best possible employee benefits package for caregivers. Companies like Right at Home San Gabriel Valley, Devoted Guardians and Family Tree Private Care have emerged as standouts when it comes to crafting impressive benefits packages. ...