Literature Review

Extra: CMS publishes rule outlining final staffing requirements McKnights Long-Term Care News, by Kimberly Marselas; 4/22/24 The Centers for Medicare & Medicaid Services said it would exempt nursing homes from having registered nurse coverage for up to 8 out of 24 hours a day “under certain circumstances,” unveiling a critical new detail in the second part of today’s staffing rule rollout. A director of nursing also can count toward the rule’s 24/7 RN requirement, CMS said, noting a change that providers will likely appreciate given their persistent challenges hiring RNs across the country. “The RN onsite 24 hours a day, seven days a week requirement ensures that there is an RN available to help mitigate, and ultimately reduce, the likelihood of preventable safety events, particularly during evenings, nights, weekends, and holidays,” CMS said. ...

What the ‘fundamentally contradicting’ Medicaid Access Rule includes Home Health Care News, by Andrew Donlan; 4/22/24 The White House teased the finalized Medicaid Access Rule early Monday, and the Centers for Medicare & Medicaid Services (CMS) later revealed more intricate details attached to the rule. [The] timeline of the rule is now clear. Specifically: ... [Click on the title's link for more]

Support mounts for increased hospice accreditor oversightHospice News; by Holly Vossel; 4/16/24Calls are growing louder in support of increased accreditation organization oversight that could help curb fraudulent activity in the hospice space. In a proposed rule released in February the U.S. Centers for Medicare & Medicaid Services (CMS) introduced a number of provisions aimed at addressing conflicts of interest and establishing more consistent standards, processes and definitions among accreditation entities. The proposed increased oversight would be an important step forward in addressing instances of fraud, waste and abuse in hospice, according to members of the California Hospice and Palliative Care Association (CHAPCA). Regulatory changes such as these would be particularly significant in detecting maleficence in regions like California, which have a rise in program integrity challenges, the organization stated in a recent letter to Congress shared with Hospice News.Notable mentions: Sheila Clark, California Hospice and Palliative Care Association.

Telehealth Accreditation Program The Joint Commission; 4/20/24The Joint Commission has developed a new Telehealth accreditation program (TEL) that will be effective July 1, 2024. This program is intended for health care organizations that exclusively provide care, treatment, and services via telehealth and for health care organizations that provide services via telehealth to another organization’s patients.

5 ways the AMA is fighting for physicians in 2024 AMA - American Medical Association; by Kevin B. O'Reilly; 4/18/2024 ... Physicians face far too many challenges that interfere with patient care. That’s why the AMA is advocating to keep doctors at the head of the health care team, reform the Medicare physician payment system, relieve the burden of overused prior authorizations and so much more. These advocacy initiatives are part of the AMA Recovery Plan for America’s Physicians, which includes:

Examining how improper payments cost taxpayers billions and weaken Medicare and Medicaid HHS-OIG; by Christi A. Grimm, Inspector General, Office of Inspector General, U.S. Department of Health and Human Services; 4/16/24 HHS Inspector General Christi A. Grimm Testifies Before the U.S. House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations on April 16, 2024. IG Grimm briefs members on HHS-OIG's work to address improper payments in Medicare and Medicaid managed care programs. Click here to watch the testimony.

CMMI’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.

Central Oregon hospice sues feds over challenged Medicare claims The Lund Report, by Nick Budnick; 4/11/24 One of a declining number of nonprofit hospice providers, Partners In Care leaders have successfully defended the vast majority of disputed claims, but have sued to erase the rest while challenging government methods. The case could have 'huge ramifications' and will be closely watched.

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.

New study calls home health star ratings into question McKnights Home Care, by Adam Healy, 4/11/24A comparison of agency-reported functional measures and claims-based hospitalization measures raises doubts about the value of star ratings as a means of evaluating home health agency (HHA) quality. The study, published Wednesday in JAMA Network Open, analyzed differences between claims-based and agency-reported outcomes for nearly 23 million patient episodes before and after the introduction of the star ratings system to compare changes over time. 

5 most challenging requirements in 2023 [for hospitals]: Joint Commission Becker's Clinical Leadership, by Mackenzie Bean; 4/3/24Maintaining infection prevention and control during disinfection and sterilization activities was the most challenging compliance standard for hospitals in 2023, according to The Joint Commission. The organization identified the top five requirements for which hospitals were most frequently out of compliance, based on surveys and reviews from Jan. 1 through Dec. 31. ... [Click on the title's article for the 5 top challenges.]

Elevating quality, outcomes, and patient experience through Value-Based Care: CMS Innovation Center’s Quality PathwayNEJM Catalyst; by Susannah M. Bernheim, MD, MHS; Noemi Rudolph, MPH; Jacob K. Quinton, MD, MPH; Julia Driessen, PhD; Purva Rawal, PhD; and Elizabeth Fowler, PhD, JD; 4/3/24The U.S. Center for Medicare and Medicaid Innovation is launching a new Quality Pathway to elevate patient-centered quality goals in the design and evaluation of alternative payment models. The Quality Pathway will align model design around quality goals; elevate outcomes and experience measures, particularly patient-reported outcomes; and ensure that evaluations have the ability to assess the impact of models on primary quality goals. These determinations will help the Innovation Center make critical decisions about which models to scale or expand in the pursuit of improving the quality of care for people with Medicare and Medicaid.

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.