Literature Review

National health expenditure projections, 2023–32: Payer trends diverge as pandemic-related policies fade Health Affairs - Research Article - Costs & Spending; by Jacqueline A. Fiore, Andrew J. Madison, John A. Poisal, Gigi A. Cuckler, Sheila D. Smith, Andrea M. Sisko, Sean P. Keehan, Kathryn E. Rennie, and Alyssa C. Gross; 6/12/24 Health care spending growth is expected to outpace that of the gross domestic product (GDP) during the coming decade, resulting in a health share of GDP that reaches 19.7 percent by 2032 (up from 17.3 percent in 2022). National health expenditures are projected to have grown 7.5 percent in 2023, when the COVID-19 public health emergency ended. This reflects broad increases in the use of health care, which is associated with an estimated 93.1 percent of the population being insured that year. ... Amonth eh major payers, Medicare has the highest projected ten-year average spending growth rath, mainly because of enrollment into the program. [Click on the title's link to examine this article's content and tables.]

2024 Home Health and Hospice Medicare Administrative Contractor Collaborative Summit: Oct. 2-4, 2024Press release; 7/2/24The Summit is a collaboration of three Medicare Administrative Contractors (MACs): National Government Services, Inc. (NGS); Palmetto GBA; and CGS Administrators; and it's a unique learning and networking opportunity for HH+H providers from every state and Medicare jurisdiction. [Occurring in Las Vegas, NV.]

NAHC re-files lawsuit against HHS, CMS over home health cuts Home Health Care News; by Joyce Famakinwa; 6/28/24 The National Association for Home Care & Hospice (NAHC) hasn’t given up on efforts to push back on Medicare home health payment calculations. NAHC has re-filled its lawsuit against the U.S. Department of Health and Human Services (HHS). The lawsuit focuses on the home health PDGM budget neutrality adjustment, which imposed both permanent and temporary calculations with a methodology that NAHC believes is noncompliant with the law. The original lawsuit was filed last summer, and in April the case was dismissed by a federal court in Washington D.C. The case was dismissed on the basis that NAHC did not fully exhaust administrative appeal remedies. ... There are a number of factors that made NAHC decide to re-file the lawsuit, according to [NAHC President, William A.] Dombi. “No. 1, it will be faster,” he said. “No. 2, we are highly likely to get the same judge, as there’s a related litigation standard in an assignment of cases,” he said. One of the biggest factors that heavily contributed to NAHC’s decision was the Supreme Court ruling, which upended the Chevron Doctrine.

AMA Advocacy 2024 efforts American Medical Association; by AMA; Updated June 2024, 6/27/24 There are far too many everyday practice challenges interfering with patient care. That’s why the American Medical Association is advocating to keep physicians at the head of the health care team, reform the Medicare physician payment system, relieve the burdens of overused prior authorizations and so much more. [Key advocacy efforts include:]

‘Lot of work to be done’: What home health leaders expect from payment rulemaking in 2024Home Health Care News; by Joyce Famakinwa; 6/24/24 In recent years, home health care has faced relentless cuts from the Centers for Medicare & Medicaid Services (CMS). It has plagued the industry, but providers and advocates alike are still hopeful a light at the end of the tunnel is ahead. ... Home Health Care News recently caught up with PQHH CEO Joanne Cunningham and David Totaro, the president and executive director of Hearts for Home Care. ... [Cunningham said,] "I anticipate that what we will see, given CMS’s posture and prior rulemaking cycles, is the continuation of the policy that will put in place permanent cuts to the Medicare home health program. We’re bracing ourselves for an additional sizable permanent cut. We don’t know exactly what CMS has planned for the temporary cuts, otherwise known as the clawback cuts. We will certainly see, at a minimum, CMS identify what their new projected value of the temporary cuts are. ...

ASTHO and NAMD call on Congress to fully fund Medicaid and CHIP in U.S. territories ASTHO - Association of State and Territorial Health Officials; by Jane Esworthy and Stephanie Rhodes; 6/20/24 In a joint letter to Congress, the Association of State and Territorial Health Officials (ASTHO) and the National Association of Medicaid Directors (NAMD) urged Congress to fully fund Medicaid and Children's Health Insurance Programs (CHIP) in the U.S. territories. ASTHO and NAMD request that Congress lift the annual Section 1108(g) allotment cap for all territories and authorize a permanent 83% Federal Medical Assistance Percentage (FMAP) for Puerto Rico. ... “ASTHO recognizes the importance of permanent, sustainable, and equitable Medicaid financing for all U.S. territories,” says Joseph Kanter, MD, MPH, ASTHO CEO. ... “Unlike the states, the U.S. territories face an annual cap on their Medicaid funding,” says Kate McEvoy, Executive Director of NAMD. “This has impaired the territories’ capacity to provide needed health care to Medicaid-eligible U.S. citizens and nationals. It has also held the territories back from making the structural investments in care delivery and value-based payment reform, workforce, IT systems, and program integrity that are crucial to high performing and innovative Medicaid programs.”

Compliance landmines in the hospice regulatory landscape Hospice News; by Holly Vossel; 6/14/24 Hospice providers are navigating a minefield in today’s regulatory environment to avoid getting caught up in the mix of fraudulent activity in the space. The current state of hospice regulations has providers walking compliance tightropes, according to Patrick Harrison, senior director of regulatory and compliance at the National Hospice and Palliative Care Organization (NHPCO). Fraud, waste and abuse exist in several different industries and health care is no exception. But the majority of hospices are striving to provide quality end-of-life experiences to terminally ill patients and their families, Harrison said at the Hospice News Elevate conference in Washington D.C. 

Chicago laboratory owner charged with defrauding Medicare in $60 million COVID-19 test kit scheme JD Supra; by Randall Brater, M.H. Joshua Chiu, Michael Dearington, Rebecca Foreman, Nadia Patel, D. Jacques Smith, Hillary Stemple; 6/17/24 The Chicago-based owner of two laboratories, Zoom Labs Inc. and Western Labs Co., has been charged with health care fraud and money laundering in connection with more than $60 million in Medicare claims for over-the-counter (OTC) COVID-19 test kits, including tests delivered to thousands of deceased beneficiaries. Federal prosecutors began investigating Medicare claims from Syed S. Ahmed’s two laboratories after noticing a “massive spike” in the laboratories’ claims in 2023, which coincided with Ahmed assuming control of Zoom [Labs]. ... Ahmed is charged with health care fraud under 18 U.S.C. § 1347 and money laundering under 18 U.S.C. §§ 1956 and 1957. 

CMS recalculates Medicare Advantage star ratings Becker's Payer Issues; by Rylee Wilson; 6/13/24CMS has recalculated Medicare Advantage plans' star ratings after insurers challenging the agency's methodology were handed court victories. In a memo sent to MA plans on June 13, the agency said it would recalculate plans' star ratings for 2024 without eliminating extreme outliers.  

Rep. Earl Blumenauer plans landmark hospice reform billHospice News; by Jim Parker; 6/13/24Rep. Earl Blumenauer (D-Oregon) is drafting a landmark bill that, if enacted, would represent the most significant reforms to date for hospice payment and oversight. Blumenauer announced the bill, the Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act, on Thursday at the Hospice News Elevate conference in Washington D.C. Though the bill language is still in development, key provisions will likely include a new payment mechanism for high-acuity palliative services, changes to the per-diem payment process and actions to improve quality and combat fraud.

Red River Valley expands services for dual-eligible populationsHospice News; by Holly Vossel; 6/11/24North Dakota-based Hospice of the Red River Valley is focused on expanding its home- and community-based services among dual-eligible Medicare and Medicaid populations in need of greater support. Serious and terminally ill patients in lower socioeconomic and underserved regions face several competing challenges in accessing health care, according to Tracee Capron, executive director at Hospice of the Red River Valley. Developing a sustainable care delivery model that better addresses unmet needs among patients and their families requires significant investment, Capron said. 

Five arrested over 'sham hospices' alleged to bilk Medicare for over $15 million Los Angeles Times; by Emily Alpert Reyes; 6/8/24 Angeles over an alleged scheme to bilk the Medicare program of more than $15 million. The U.S. Department of Justice said three of the San Fernando Valley residents who were arrested — Petros Fichidzhyan, also known as Peter; Juan Carlos Esparza; and Karpis Srapyan, also known as Tony Levy — were accused of running "sham hospice companies" and turning in fraudulent claims to Medicare for hospice services. ... As part of the alleged scheme, the three defendants misappropriated the identifying information of doctors to claim those physicians had deemed hospice services necessary for patients, federal prosecutors said. They also allegedly used the names and Social Security numbers of Russian and Ukrainian citizens who had left the U.S. to open bank accounts and sign leases, indicating that the "impersonated identities" were the owners of the hospice companies that they in fact controlled, according to the federal indictment. 

Why private equity hospice investors need to re-focus on patients Hospice News; by Jim Parker; 6/7/24 As private equity investors seek out hospice and other health care transactions, they should retrain their sights on potential benefits for patients in addition to financial metrics. Driving this is a changing regulatory environment as scrutiny heats up for both hospices and the private equity firms themselves. Tightened regulation in the hospice space has led to longer, more stringent diligence processes when it comes to buying and selling provider companies. This means that potential buyers are looking hard at compliance and quality metrics before completing a deal, along with the seller’s financials.