Literature Review

2024 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. 

What 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.

Cancer 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 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?

Home 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. ... 

Hospice & Palliative Care Handbook: Quality, Compliance, and Reimbursement, 4th Edition McGraw Hill - Access APN; textbook by Tina M. Marrelli and Jennifer Kennedy; 3/28/24 “Hospice & Palliative Care Handbook, Fourth Edition, is an invaluable resource for timely hospice regulatory and compliance information, documentation, care planning, and case management. It provides clear guidance for hospice managers, clinicians, and interdisciplinary group members. I have utilized Tina Marrelli’s home health and hospice handbooks to support training new clinical staff and students for decades and consider these resources to be the gold standard.” – Kimberly Skehan, MSN, RN, HCS-D, COS-C, Vice President of Accreditation - Community Health Accreditation Partner

The Hospice Special Focus Program: What it is & why it is importantFORV/S, by Angela Huff; 3/25/24 The CMS Hospice Special Focus Program (SFP) aims to shed light on poorly performing hospices. CMS has publicly stated it is looking closely at the hospice industry due to increasing concerns regarding fraud, waste, and abuse. The Hospice Special Focus Program (SFP) is a new CMS program that identifies poor-performing hospices, takes action to inform the public, and engages those hospices to either improve their performance or terminate the hospice from the Medicare program. 

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