Literature Review

HHS Secretary Becerra: We’re with you on telehealth flexibilities Hospice News, by Jim Parker; 3/21/24 Telehealth flexibilities must become permanent U.S. Health and Human Services (HHS) Secretary Xavier Becerra indicated in a congressional hearing [Wed]. At the end of this year, telehealth flexibilities implemented during the pandemic are slated to expire. In a hearing before the U.S. House Ways and Means Committee Becerra said that HHS was willing to make them permanent. However, he said this would require closer collaboration with state governments. “We’re with you. We can’t allow those flexibilities to expire, and we need to work closer with our state partners, because much of the flexibility that comes from telehealth means being able to go over state lines,” Becerra said.

$4.25 million gene therapy for kids becomes world's priciest drug NBC LEX18, by Alex Arger; 3/20/24 A lifesaving gene therapy for children born with a rare and debilitating disease has just been approved by the U.S. Food and Drug Administration. The catch? Its wholesale cost has been set at $4.25 million, making it the most expensive medicine in the world. Orchard Therapeutics announced the hefty price for Lenmeldy Wednesday, two days after the FDA approved the therapy as the only treatment for kids with metachromatic leukodystrophy, or MLD. 

Insurer responses to Change outage fail to impress provider Modern Healthcare, by Nona Tepper and Lauren Berryman; 3/18/24Insurers have modified claims and payment operations amid the Change Healthcare network outage, but providers contend the moves are not enough to address their financial challenges.

The benefits of integrating palliative care into home-based care programs Home Health Care News, by Patrick Filbin; 3/18/24 Navigating new service lines can be daunting, especially when integrating palliative care into existing service lines. Yet, as some providers can attest, embracing change can also yield significant benefits. ... “It’s easier to remain in your own silo,” Tiffany Hughes, COO PalliCare Inc., said at the Hospice News/Palliative Care News Palliative Care Conference in Tampa, Florida. “I saw that [mindset] coming from hospice where it’s the perfect model of care because you control everything. When you start adding in different elements and add more hands into the pot, it gets more complicated.” Providers who are integrating more models of care into their operations are showing that – in general – the juice is worth the squeeze.

CMS.gov: ACO Primary Care Flex ModelCMS.gov; 3/19/24The ACO Primary Care Flex Model (ACO PC Flex Model) is a voluntary model that will focus on primary care delivery in the Medicare Shared Savings Program (Shared Savings Program). It will test how prospective payments and increased funding for primary care in Accountable Care Organizations (ACOs) impact health outcomes, quality, and costs of care. The flexible payment design will empower participating ACOs and their primary care providers to use more innovative, team-based, person-centered and proactive approaches to care. The model, which starts January 1, 2025, aims to grow participation in ACOs and the Shared Savings Program and increase the number of people with Medicare in an accountable care relationship.

Accountable Care Organization leader perspectives on the Medicare shared savings program - A qualitative study

Use of machine learning to optimize referral for early palliative care: Are prognostic predictions enough  Journal of Clinical Oncology - Editorials; by Gary E. Weissman, MD, MSHP; Joseph A. Greer, PhD; and Jennifer S. Temel, MD; 3/15/24  The Takeaway In the article that accompanies this editorial, [Weissman] et al used a machine learning (ML) algorithm to identify patients with advanced cancer who were receiving non–curative-intent treatment and at risk of death within 1 year to allocate early palliative care services at least 6 months before death as a means to increase use of early palliative care in the context of limited resources. While ML prognostic models are one promising strategy for triaging palliative care services, initiation of palliative care based exclusively on estimated survival and in the months before death likely excludes patients who would benefit from early palliative care initiated at the time of diagnosis, regardless of their estimated survival.

CMS Statement on continued action to respond to the cyberattack on change healthcareCMS.gov Press Release; 3/9/24 The Centers for Medicare & Medicaid Services (CMS) is continuing to monitor and assess the impact that the cyberattack on UnitedHealth Group’s subsidiary Change Healthcare has had on all provider and supplier types. Today, CMS is announcing that, in addition to considering applications for accelerated payments for Medicare Part A providers, we will also be considering applications for advance payments for Part B suppliers. 

How NYC Health + Hospitals is reining in travel nurse expenses Becker's Hospital CFO Report, by Mackenzie Bean; 3/7/24 NYC Health + Hospitals has made progress in decreasing its dependence on travel nurses, though staffing expenditures still exceed the public health system's allocated budget, executives told New York City Council leaders during a preliminary budget hearing March 5.

Nursing homes bury 63 percent of profits in related-party tunnels, but not all play the game: study McKnights Long-Term Care News, by Josh Henreckson; 3/8/24 As much as 63% of nursing home profits in Illinois were hidden from state regulators using related party transactions in 2019, according to the results of a new study from UCLA and Lehigh University researchers. Those results are likely indicative of a nationwide trend that has continued through the pandemic and into 2024, experts told McKnight’s Long-Term Care News Thursday.

UnitedHealthcare, Humana, Aetna continue to outgain peers in Medicare Advantage Home Health Care News, by Andrew Donlan; 3/6/24In 2023, Medicare Advantage (MA) plan members represented more than half of all Medicare beneficiaries for the first time. In 2024, while penetration continues, there are other trends within MA that home-based care providers should be paying attention to. ... A few of the top companies continue to gain market share. Specifically, UnitedHealth Group (NYSE: UNH), Humana Inc. (NYSE: HUM) and CVS Health (NYSE: CVS) – through Aetna – continue to outpace competitors. 

Health systems invest in productivity Becker's Hospital Review, by Laura Dyrda; 3/6/24 Productivity is a buzzword for most workplaces today, and healthcare is no different. U.S. productivity measures showed big increases for the first time in years, according to a report in The New York Times, as organizations leverage artificial intelligence and aim to do more with less. For [health systems], many experiencing staffing shortages and tight margins, developing a culture of increased productivity is imperative.