Literature Review

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. 

Regulatory reference links for home health care, hospice and durable medical equipment National Association for Home Care & Hospice; per email 3/25/24 Includes reference descriptions and links to the following:

Is cybersecurity spending too low to prevent another Change breach? Modern Healthcare, by Brock E.W. Turner; 3/19/24 On Feb. 21, Change Healthcare, which processes 15 billion transactions a year, suffered a ransomware attack that has caused ripple effects throughout the healthcare system, hampering operations and finances for hospitals, physician offices, pharmacies, insurers and patients. Cybersecurity professionals are sounding the alarm on future attacks if healthcare organizations don't start putting more financial resources into protecting their data. 

$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.

Medicare Advantage prior authorization: The impact - increased access to care HHS-OIG; 3/19/24 HHS-OIG’s work on this issue drew national attention to the problem spurring the Centers for Medicare & Medicaid Services, the Industry, and Congress to action.  Editor's Note: You can download the "Impact Brief" from this site. Click on the title's link.

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.

Can we make more accurate prognoses during last days of life?Journal of Palliative Medicine; by Sylvie Bouchard, Andreea Paula Iancu, Elena Neamt, François Collette, Sylvie Dufresne, Patricia Maureen Guercin, Suganthiny Jeyaganth, Desanka Kovacina, Taliá Malagón, Laurie Musgrave, Marilisa Romano, Jenny Wong, Sybil Skinner-Robertson; 3/8/24Background: ... Established methods (Palliative Performance Scale [PPS], Palliative Prognostic Index [PPI]) have been validated for intermediate- to long-term prognoses, but last-weeks-of-life prognosis has not been well studied. Patients admitted to a palliative care facility often have a life expectancy of less than three weeks. Reliable last-weeks-of-life prognostic tools are needed. Conclusions: ... Using SPS [Short-Term Prognosis Signs] along with PPS and PPI during the last weeks of life could enable a more precise short-term survival prediction across various end-of-life diagnoses. The translation of this research into clinical practice could lead to a better adapted treatment, the identification of a most appropriate care setting for patients, and improved communication of prognosis with patients and families.

Palliative care cuts costs for metastatic cancer

Smaller wage increases predicted for 2024: surveyMcKnights Senior Living, by Kathleen Steele Gaivin; 3/8/24Wage increases for senior living and care employees are predicted to dip from 4.43% in 2023 to 3.64% this year, according to responses to a newly released Ziegler CFO Hotline survey.  The news comes as providers continue to be challenged in recruiting and retaining workers, with compensation as one strategy. 

CMS to end Hospice MA Carve-In: Insights for home-based care providers Home Health Care News, by Andrew Donlan; 3/7/24Grand opening, grand closing. Hospice providers began to work with Medicare Advantage (MA) via the Value-Based Insurance Design (VBID) demonstration in 2021. At the end of 2024, the “hospice carve-in” model will cease. ... In this week’s exclusive, members-only HHCN+ Update, I dive into what CMS’ ditching of the hospice carve-in means for home health and hospice providers generally. I’ll also get into what it may mean for that space between home-based care providers and MA plans moving forward.