Literature Review

This test tells you more about your heart attack risk KFF Health News; by Paula Span; 8/1/25 A long list of Lynda Hollander’s paternal relatives had heart disease, and several had undergone major surgeries. ... A cardiologist told Hollander that based on factors like age, sex, cholesterol, and blood pressure, she faced a moderate risk of a major cardiac event, like a heart attack, within the next 10 years. ... Her doctor explained that a coronary artery calcium test, ... could provide a more precise estimate of her risk of atherosclerotic heart disease. “The test is used by more people every year,” said Michael Blaha, co-director of the preventive cardiology program at Johns Hopkins University. Calcium scans quadrupled from 2006 to 2017, his research team reported, and Google searches for related terms have risen even more sharply. Yet “it’s still being underused compared to its value,” he said. One reason is that although the test is comparatively inexpensive ...Editor's Note: Good news. This test predicts and protects heart health, potentially providing extra years of good (or at least better) quality of life. Bad news. It is "being underused compared to its value," partly because "the test is comparatively inexpensive"? Bad news. What does the low-cost factor say ethics, choices, and quality of life? Good news. Because of my family's cardiac history, my physician recently recommended I take this test. I did, and received great results! I move into the future with greater confidence, less fear, and more gratitude for the some 100,00 heartbeats we each experience, each day.

The state of pediatric concurrent hospice care in the United States American Academy of Pediatrics; by Meaghann S. Weaver, MD, PhD, MPH, HEC-CCorresponding Author; Steven M. Smith, MD; Christy Torkildson, PhD, RN, PHN; Deborah Fisher, PhD, RN, PPCNP; Betsy Hawley, MA; Alix Ware, JD, MPH; Holly Davis, MS, APRN; Conrad S. P. Williams, MD; Lisa C. Lindley, PhD, RN, FPCN, FAAN; 8/1/25 The Patient Protection and Affordable Care Act (ACA) required all state Medicaid programs to pay for both curative and hospice services for children and adolescents. The purpose of this Special Article report is to quantify and describe the use of concurrent care for children, including a depiction of the barriers and benefits according to community-based hospice organizations in the United States. A total of 295 hospice organizations from 50 states and Washington, DC responded to the National Alliance for Care at Home call for engagement.

Glendale woman sentenced to 9 years in federal prison for $10.6 million hospice fraud scheme involving kickbacks for patients United States Attorney's Office - Central District of California, Los Angeles, CA; Press Release; 8/5/25 A Glendale woman was sentenced today to 108 months in federal prison for participating in a scheme in which hundreds of thousands of dollars in illegal kickbacks were paid and received for patient referrals that resulted in the submission of approximately $10.6 million in fraudulent claims to Medicare for purported hospice care. Nita Almuete Paddit Palma, 75, of Glendale, was sentenced by United States District Judge Dolly M. Gee, who also ordered her to pay $8,270,032 in restitution. 

Hospice Honors 2025 - 2025 CAHPS Honors and Honors Elite Award winnersMatrixCare by ResMed; retrieved from the internet 7/29/25 214 CAHPS Honors and 53 Elite Award Winners are listed. These national recognitions are presented by HealthCare First, a part of MatrixCare. These awards are based on satisfaction scores from the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. "Honors Elite" status is awarded to those hospices that score above the national performance score on 100%, or all twenty four, of the evaluated questions. Editor's Note: We celebrate these significant achievements and thank you for the quality, expert care you provide each day! 

HHS sets its sights on $50b in cost savings: Medicare payments to nonhospice providers potentially under fire JD Supra; by Taylor Henderson, Callan Stein, Rebecca Younker; 7/31/25 In May 2025, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a review, titled " Potential Cost Savings HHS Programs – HHS Actions," which provided some insight into the OIG's direction to accomplish the Trump administration's stated goal of cutting federal spending. This review spans 35 reports, adding up to $50 billion in potential cost savings — including a reported $6.6 billion in potential savings by preventing Medicare payments for nonhospice items or services furnished to active hospice beneficiaries (nonhospice payments). When a beneficiary qualifies for and elects hospice benefits, the beneficiary signs a statement choosing hospice care over other Medicare-covered treatments for their terminal illness, and the hospice provider is paid a daily, per diem rate to provide these comprehensive services. With nonhospice payments accounting for a significant portion of HHS's potential savings, providers across the health care industry — including nursing and long-term care facilities, hospice and home health agencies, hospitals, individual providers, pharmacies, and medical equipment distributors — will need to be ready for the OIG's possible next steps.

CMS FY 2026 Hospice Wage Index FINAL Rule posted in Federal Register

5 top types of quality data hospices should be watching Hospice News; by Jim Parker; 7/31/25 ... To attract payers and other potential business partners, hospices should focus on tracking live discharges, levels of care and care settings, visit frequency and timeliness, patient and caregiver experience and length of stay. This is according to a new report, Measures That Matter, which was prepared by a team of hospice leaders and experts. These experts, who convened multiple times between July 2023 and December 2024, sought to identify the indicators of quality that matter most to payers and referral organizations, particularly in the context of value-based care. “The best way hospices can leverage these data is to be excellent. This is where things are moving,” Dr. Ira Byock, hospice and palliative care physician and founder of the Institute for Human Caring at Providence St. Joseph Health, told Hospice News. 

Medicare Advantage growth drives changes in post-acute care Managed Healthcare Executive; by Briana Contreras; 7/28/25 A new report released today by Trella Health revealed major shifts are underway in post-acute care as Medicare Advantage (MA) enrollment grows, care transitions evolve and providers navigate the challenges of value-based care. The Post-Acute Care Industry Trend Report looked at national and state-level trends in home health, hospice and skilled nursing using the latest Medicare claims and enrollment data. One of the most significant shifts is the continued rise of MA enrollment. The report shared that as of February 2025, more than half of Medicare beneficiaries (55.4%) are enrolled in MA plans, with 30 states reporting MA enrollment over 50%. This shift is changing how patients access care—more so in home health.

Georgia may be next for enhanced hospice oversight, regulatory affairs expert predicts McKnights Home Care; by Adam Healy; 7/29/25 Warning, hospice providers in Georgia. Your state may be the next target for the Centers for Medicare & Medicaid Services’ Provisional Period of Enhanced Oversight (PPEO). “If you are from Georgia, do not be surprised if something like this comes to your town soon,” Katie Wehri, vice president of regulatory affairs, quality and compliance for the National Alliance for Care at Home, said on the closing day of the Alliance’s Financial Management Summit Tuesday. “The reason is that the Medicare Payment Advisory Commission and CMS have both mentioned Georgia as an area where there’s a high number of new hospices.” Four states are currently the subject of PPEO: California, Arizona, Nevada and Texas. California — and specifically Los Angeles County — has been a hotbed of hospice fraud in recent years. 

Palmetto GBA Home Health and Hospice Coalition Meeting Minutes June 16, 2025Palmetto GBA communication; 7/22/25Hosted by Tim Rogers, President and CEO, Shannon Pointer, DNP, RN, CHPN, Senior VP, Hospice and Home Health Services and Professional Development Director, AHHC of NC and SCHCHA, this meeting included questions and answers for several regulatory topics.

Home-based hospice operators welcome CMS anti-fraud efforts Home Health Care News; by Joyce Famakinwa; 7/24/25 In an effort to combat fraud, the hospice industry may see increased scrutiny from the U.S. Centers for Medicare & Medicaid Services (CMS). Home-based care providers that offer hospice services, including AccentCare and Elara Caring, told Home Health Care News they hope that CMS will act on their statements about bad actors in the industry – and that a crackdown would protect “high-integrity” providers. ... Companies like AccentCare, which offer both home health and hospice services, welcome CMS’s active approach to rooting out fraud. “We hope it materializes,” Dr. Balu Natarajan, chief medical officer at AccentCare, told HHCN. ... Similar to AccentCare, Elara Caring believes that this would be a step in the right direction. “We fully support CMS’s efforts to crack down on fraud in hospice and home health,” an Elara Caring spokesperson told HHCN in an email.  

Hospital decision-making and adoption of health-related social needs programs in US hospitalsJAMA Network Open; by Dina Zein, Cory E. Cronin, Neeraj Puro, Berkeley Franz, Elizabeth McNeill, Ji E. Chang; 6/25In response to health disparities in the US, the Centers for Medicare & Medicaid Services (CMS) released a Framework for Health Equity recommending increased hospital commitment and leadership engagement around screening for health-related social needs (HRSNs). This cross-sectional study found that hospitals with multiple layers of management engagement tended to adopt multifaceted strategies that address patients’ social needs, which are critical components of health equity frameworks. Interestingly, hospitals where only senior management was involved were more likely to offer specific programs like food insecurity and transportation services, although these associations were generally smaller compared with when both senior and other management were engaged.

Humana renews challenge to downgrade of US Medicare 'star' ratings Reuters; by Daniel Wiessner; 7/21/25 Humana ... filed a new lawsuit over the U.S. government's reduction in the health insurer's star ratings for government-backed Medicare plans, after an earlier challenge was dismissed on technical grounds. Humana, in the lawsuit in Fort Worth, Texas, federal court, says the lower ratings could cause it to lose customers and potentially billions of dollars in bonus payments from the government, which would have been used to reduce premiums and increase benefits for its members. U.S. District Judge Reed O'Connor in Fort Worth dismissed those claims last week, finding Humana had failed to exhaust all of its out-of-court options to challenge the ratings. In the new lawsuit, Humana says it has in recent months exhausted an administrative appeals process, giving the insurer standing to sue.