Literature Review

[Updated] Trump administration suspends hospice Special Focus Program Hospice News; by Jim Parker; 2/14/25 The Trump Administration has suspended implementation of the hospice Special Focus Program. Finalized in the 2024 home health payment rule, the program is designed to identify poor performing hospices, mandate quality improvement and in some cases impose additional penalties. However, stakeholders in the hospice space have contended that the agency’s methodology for selecting hospices for the program is deeply flawed. Notice of the suspension appeared [Friday, 2/14] on the U.S. Centers for Medicare & Medicaid Services (CMS) website.

Navigating palliative care models in ACO partnerships Hospice News; by Markisan Naso; 2/14/25 Partnerships between health care providers and Accountable Care Organizations (ACOs) can help to create effective, value-based palliative care models for patients, but navigating the development of those relationships requires communication and a true commitment to collaboration. ... “ACOs are looking for high-quality care that reduces avoidable crises, and specialty palliative care has been proven to do just that,” Allison Silvers, chief of health care transformation at the Center to Advance Palliative Care (CAPC), told Palliative Care News. ... 

Hospice leaders applaud CMS’s decision to reevaluate Special Focus Program, call for meaningful reforms National Alliance for Care at Home, Washington, DC and Alexandria, VA; Press Release; 2/14/25 Effective February 14, 2025, the Centers for Medicare & Medicaid Services (CMS) has ceased the implementation of the Hospice Special Focus Program (SFP) so that CMS may further evaluate the program. This decision is a positive move acknowledging that the current approach is not working as intended. The hospice community has long advocated for strong oversight and patient protections, but the SFP, as implemented, was deeply flawed, unlawful, and harmful to the very patients it was meant to protect. A multi-state coalition of hospices and hospice associations took legal action in January to challenge the program, citing its misrepresentation of hospice compliance records, misleading data, and jeopardized access to high-quality end-of-life care. The flawed algorithm behind the SFP failed to distinguish fraudulent providers from reputable ones, disproportionately penalized well-established hospices, and ignored repeated warnings from congressional leaders and industry stakeholders. ... Now that CMS is reassessing its approach, there is an opportunity to ensure that oversight efforts truly enhance patient protections without restricting access to trusted hospice providers. The National Alliance for Care at Home (the Alliance) and the National Partnership for Healthcare and Hospice Innovation (NPHI) remain committed to protecting access to high-quality hospice care and ensuring that regulatory oversight is fair, transparent, and aligned with congressional intent. ... [Click on the title's link to continue reading.] 

UnitedHealth Group withdraws motion to dismiss antitrust challenge Competition Policy International; by CPI; 2/8/25 UnitedHealth Group has withdrawn its motion to dismiss the Justice Department’s antitrust lawsuit challenging its proposed acquisition of Amedisys, a home care and hospice provider. According to the , the healthcare giant stated that new information provided by the government in late January rendered its initial motion moot. ... On January 29, the Justice Department responded to the motion by filing a list of 381 service areas where it alleged the acquisition would negatively impact competition. UnitedHealth Group, in its latest filing, acknowledged that this submission “finally identified” the locations in question, leading the company to withdraw its motion.

Flaws in the Medicare Advantage Star RatingsJAMA Health Forum; David J. Meyers, PhD, MPH; Amal N. Trivedi, MD; Andrew M. Ryan, PhD; 1/25The objective of the star ratings is to help beneficiaries select better plans, and to reward plans that deliver high-quality care. In June 2024, a US district court judge ruled that the Centers for Medicare and Medicaid Services (CMS) inappropriately calculated Medicare Advantage (MA) Star ratings due to not implementing a previously announced statistical adjustment. First, it is not clear if the star ratings are actually capturing a higher quality, as several measures in the star rating are reported by the plans themselves and plans often overstate their performance. Second, over 80% of contracts by enrollment are rated 4 stars or higher, which is the threshold needed to earn bonus payments, and a single star rating is assigned to each contract even when contracts may cover many different states and regions. Third, while bonus payments for star ratings are costly, plans eligible for enhanced bonuses have not shown greater improvement in measures related to clinical quality or administrative effectiveness. Taken together, the current star ratings are neither useful for all beneficiaries to make their plan decisions, nor do they appear to be capturing quality or catalyzing improvement. 

CMS Hospice Special Focus Program: What every hospice leader needs to knowCHAP; by Jennifer Kennedy, Kim Skehan; 1/22/25Join Jennifer Kennedy and Kim Skehan for an unfiltered conversation about the CMS Hospice Special Focus Program (SFP), launched on January 1, 2025. This transformative program is reshaping hospice care—and Jennifer and Kim are here to ensure you’re prepared to adapt and thrive. In this episode, they simplify the complexities of SFP, exploring how it works, who it impacts, and most importantly, how your hospice can stay ahead. Learn how to interpret the program’s data-driven selection process, evaluate your organization’s readiness, and build the strategies you need to mitigate risks while maintaining top-quality care.

Arizona couple pleads guilty to $1.2B health care fraud Office of Public Affairs - U.S. Department of Justice; Press Release; 1/31/25 An Arizona couple pleaded guilty for causing over $1.2 billion of false and fraudulent claims to be submitted to Medicare and other health insurance programs for expensive, medically unnecessary wound grafts that were applied to elderly and terminally ill patients. According to court documents, Alexandra Gehrke, 39, and her husband, Jeffrey King, 46, both of Phoenix, conspired with others to orchestrate the massive scheme. Gehrke ran two companies, Apex Medical LLC and Viking Medical Consultants LLC, that contracted with medically untrained “sales representatives” to locate elderly patients, including hospice patients, who had wounds at any stage and order amniotic wound grafts from a specific graft distributor. 

The iatrogenic consequences of medicalising grief: Resetting the research agenda Sociology of Health & Illness: by Sarah Gurley-Green, Lisa Cosgrove, Milutin Kostic, Lauren Koa, and Susan McPherson; published 11/28/25, distributed via Evermore 1/28/25When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, there was a firestorm of controversy about the elimination of the bereavement exclusion. Proponents of this change and of the proposed “complicated grief” designation believed that this change would help clinicians recognise major depression in the context of recent bereavement. Other researchers and clinicians have raised concerns about medicalising grief. In 2022 “prolonged grief disorder” (PGD) was officially included in the DSM-5-TR in the trauma- and stressor-related disorders section. ... As human rights activists have argued, bereavement support is an inalienable human right, one that is centered on the right to health and well-being, for “bereavement health is as intrinsic to our humanity as any other aspect of health and citizenship” (Macaskill 2022). That is why there are increasing calls for investing in bereavement as a public good and for “cultivat[ing] a bereavement-conscious workforce.” (Lichtenthal et al. 2024, e273). As Lichtenthal notes, it is not only clinicians but also institutions and systems that must “shift bereavement care from an afterthought to a public health priority.”Editor's note: "Iatrogenic" refers to unintentional consequences/condition from a medical intervention. In the hospice context, this means bereavement/grief from the hospice death. How many patients do you serve? The CMS Hospice Conditions of Participation identify "bereavement" and/or "grief" 155 times. What priority do you give to bereavement care before, at and after your patients' deaths?

AHHC joins other state hospice advocates in legal challenge to Special Focus Program The Association for Home and Hospice Care of North Carolina (AHHCNC); Press Release; 1/23/25The Association for Home and Hospice Care of North Carolina (AHHCNC) has joined a multi-state coalition of hospices and hospice associations in challenging the federal government's implementation of the Hospice Special Focus Program (SFP), deeming it unlawful and arbitrary. The challengers are seeking a preliminary injunction to halt the SFP, citing patient safety concerns, misrepresentation of compliance records, and jeopardized access to high-quality end-of-life care. Congress directed CMS to establish the SFP to enhance enforcement for noncompliance hospices, but the Final Rule includes unrelated measures, heavily relying on survey data and other information not related to hospices’ compliance with Medicare requirements. Tim Rogers, President and CEO of AHHCNC, states:  "The approach CMS uses disadvantages well-established hospices and ignores Congress’s intent." [Click on the title's link to continue reading.] 

Healthcare Industry Team 2024 Year in Review JD Supra; by Claire Bass, S. Derek Bauer, Kevin Bradberry, Ernessa Brawley, Sarah Browning, Charlotte Combre, Payal Cramer, Emily Crosby, Vimala Devassy, Shareef Farag, Amy Fouts, Winston Kirton, Caroline Landt, Charlene McGinty, Justin Murphy, Lynn Sessions, Gregory Tanner; 1/22/25As we begin a year that will once again be transformative for the industry, we are excited to present our comprehensive 2024 year-in-review, highlighting all that has happened and the trends that will shape 2025. [Downloadable PDF from BakerHostetler, bakerlaw.com. Large categories include the following:]

Trump freezes HHS communications: report Modern Healthcare Alert; by Bridget Early; 1/22/25 The Health and Human Services Department and its agencies are going silent for now, according to the Washington Post. On Tuesday, the day after President Donald Trump's inauguration, HHS received an order to halt all outbound communications, including health advisories, weekly reports, research, website updates and social media posts, the newspaper reported. The Washington Post reports that the pause has no definitive end date and that the decree does not specify whether exceptions will be made for disease outbreaks or other urgent situations. The directive applies to agencies such as the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, the National Institutes of Health and the Substance Abuse and Mental Health Services Administration.

Medicare spending, insurance claim denials top concerns: KFF poll Modern Healthcare; by Hayley Desilva; 1/17/25 A majority of individuals, regardless of their political leanings, say the federal government needs to spend more on healthcare programs, according to a KFF Health Tracking Poll released Friday. The survey of 1,310 people earlier this month highlights several areas in healthcare where the public would like to see things done differently. The results were published three days before a new administration is set to take over in Washington, D.C. 

Medicare to Veterans Affairs cost shifting—A challenging conundrumJAMA Health Forum; Kenneth W. Kizer, MD, MPH, DCM; Said Ibrahim, MD, MPH, MBA; 12/24In this issue, Burke et al highlight how costs previously paid by Medicare for VA-Medicare dual eligible enrollees are now being paid by the VA under the VCCP [Veterans Community Care Program]. Today, there is reason to be concerned whether VA health care will be adequately funded because of the rapidly rising VCCP expenditures (driven in part by Medicare to VA cost shifting) and the impact of caring for an additional 740,000 enrollees who have entered the system in the past 2 years. This has created a $12 billion medical care budget shortfall for FY 2024. The substantial budgetary tumult that has resulted from these dynamics is adversely impacting the front lines of care delivery at individual VA facilities, leading to delays in hiring caregivers and impeding access to VA care and timely care delivery, as well as greatly straining the traditional roles of VA staff and clinicians trying to manage the challenging cross-system referral processes. The intertwined issues of Medicare to VA cost shifting and the rising costs of the VCCP present a challenging policy and programmatic conundrum.