Literature Review

Mass layoffs hit workers at HHS; sweeping cuts extend to CDC, NIH, FDA: Recap USA Today; by Sarah D. Wire, Josh Meyer, Bart Jansen, Ken Alltucker, Cybele Mayes-Osterman, Eduardo Cuevas, Sudiksha Kochi, Adrianna Rodriguez and Terry Collins; 4/1/25Mass layoffs began Tuesday at the Centers for Disease Control and Prevention and at the Food and Drug Administration, the first steps in a plan to cut 10,000 jobs at the Department of Health and Human Services. The department responsible for overseeing protection for Americans' health, food and drug supplies and Medicare and Medicaid is also closing its internal agencies that are focused on older adults and people with disabilities. It's also getting rid of its offices tackling HIV and improving minority health. Staff had to present their badges at the building entrance and those who had been fired were given a ticket and told to return home. More than 100,000 federal workers have already lost their jobs in the last two months as part of President Donald Trump and billionaire Elon Musk's efforts to shrink staffing levels in federal departments and agencies. Tens of thousands more are expected as more agencies implement their reduction in force, or RIF, plans in the coming weeks.

[Palmetto] Home Health and Hospice Coalition Meeting Minutes: February 24, 2025Palmetto GBA press release; 3/27/25The February 24, 2025, Home Health and Hospice Coalition Meeting Minutes are now available. Please review this information and share it with your staff.

Kennedy slashing 10,000 jobs in health department overhaul USA Today, Washington, DC; by Joey Garrison; 3/27/25 Health and Human Secretary Robert F. Kennedy Jr. said Thursday he will cut about 10,000 full-time jobs from the Cabinet department in a dramatic reduction that includes closing half its regional offices as part of a wider Trump administration overhaul of the federal government. Combined with HHS employees who previously accepted buyouts and others who were already fired, the agency's workforce will be sliced by one-quarter from 82,000 full-time employees to 62,000 since President Donald Trump returned to the White House. The Department of Health and Human Services ‒ which oversees the Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services ‒ will consolidate the agency's 28 divisions into 15 new divisions in Kennedy's shakeup. ... Among the cuts in key divisions:

The Healing of America with T.R. Reid TCNtalks Podcast; podcast by Chris Comeaux with T.R. Reid; 3/26/25 In this episode of TCN Talks, host Chris Comeaux interviews NY Times bestselling author T. R. Reid.  They discuss T. R. Reid’s experiences and insights from researching healthcare systems around the world, particularly focusing on the need for universal coverage and the various models of healthcare delivery. ... This is a great listen as the U.S. spends more on healthcare, yet we are not even in the top 10 in the world.  It’s hard to make one aspect of healthcare successful, like Hospice and Palliative Care, if the broader ecosystem it resides in is flawed and unsustainable.  Join us; this is very timely.

[Austria] Influence of prior knowledge and experience on willingness to pay for home hospice services: a contingent valuation study International Journal of Health Economics and Management; Caroline Steigenberger, Andrea M Leiter, Uwe Siebert, Claudia Schusterschitz, Magdalena Flatscher-Thoeni; 3/25/25 Home hospice services contribute to dying in dignity by addressing medical and social needs at the end of life. ... We aim to quantify the benefits of home hospice services to society using society's monetary valuation and examine the influence of prior knowledge and experience on willingness to pay for home hospice services. A nationwide cross-sectional contingent valuation study was conducted in Austria. ... The two-part regression analysis showed a statistically significant positive impact on the probability of having a positive willingness to pay by prior knowledge of home hospice services, prior donations, and the wish of not dying alone. [Continue reading ...]Editor's note: Pair this research from Austria with today's USA post, "Medicare and 24-hour in-home hospice care: Is it covered?" Too often, we take for granted our Hospice Medicare payment system. Some choose to misuse it in ways that lead to fraud. This research reinforces openess to hospice services per "prior knowledge of home hospice services, prior donations, and the wish of not dying alone."

Charting the path forward to Value-Based Care Forbes; by David Snow, Jr.; 3/25/25 The U.S. healthcare system is at a crossroads, embarking on a crucial transformation in how care is financed. For decades, we've operated under a fee-for-service (FFS) model, which incentivizes service volume with little accountability for efficacy or costs. According to the Commonwealth Fund, this model contributes to poor healthcare access, lower care quality and lack of care continuity and is a factor behind the staggering per-capita healthcare costs in the U.S., which are the highest in the world. ... In recent years, we've seen a shift away from the FFS model to progressive value-based care (VBC) models that link provider payments to patient outcomes, care quality and cost efficiency. This is a fundamental overhaul of healthcare economics, and although it may be challenging and disruptive, I believe it's essential. [Continue reading ...]

National Alliance’s Scott Levy: Hospices need ‘regulatory relief’ to protect ‘sacred benefit’ Hospice News; by Holly Vossel; 3/21/25 The hospice industry is undergoing a transformative period of rising demand and regulatory changes. Providers of all sizes and types are facing mounting operational challenges and financial strains with limited recourse to voice their collective concerns to legislators. This is according to Scott Levy, chief government affairs officer at National Alliance for Care at Home (the Alliance). Levy stepped into the role earlier this year after holding a similar position at Amedisys. He has been involved in government relations, public policy, advocacy and law for more than 20 years. Levy recently sat down with Hospice News to discuss the array of regulatory and legislative evolutions on the horizon in hospice care delivery.  .[Continue reading ...]

Hospice Medical Review Top Denial Reason Codes: Q4 2024 [Palmetto GBA]Palmetto GBA press release; 3/17/25We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing 81X bill types.  1 5CF36 Not Hospice Appropriate  2 56900 Auto Denial — Requested Records not Submitted  3 5CNER The Notice of Election Is Invalid Because It Doesn't Meet Statutory/Regulatory RequirementsSee the article for Top Ten.

Disparities in end-of-life symptom burden linked to complex interplay among wealth, health, and social supportJAMA Network Open; Peter A. Boling, MD; 3/25On average, US health care spending in the last year of life alone was $80,000, with 12% ($9,500) being out of pocket and mostly incurred before the final 6 months. This problem worsened in the past decade when the nonspecific diagnosis of failure to thrive was removed as a condition eligible for hospice care and more stringent definitions were applied for dementia, which became the next bubble as the hospice balloon was squeezed. Hospice care is a means of reducing symptom burden, but the Medicare payment model discourages prolonged enrollment during slowly progressing advanced chronic illness and effectively limits funding of social support during hospice care, which is particularly problematic for patients with cognitive and functional impairment and for their friends and families. Considering suffering as a medical condition warranting treatment rather than a social problem requiring support services might help with the evolution of a Medicare policy that might provide a more graduated approach to end-of-life care.

MedPAC recommends Congress tie physician pay to inflation for 2026 Healthcare Dive; by Susanna Vogel; 3/17/25 Dive Brief:

Medicare Payment Advisory Commission [MedPAC] releases report to Congress on Medicare Payment Policy 2025 report on Medicare payment policy Medicare Payment Advisory Commission, Washington, DC; News Release, contact Stephanie Cameron; 3/13/25Today [3/13/25], the Medicare Payment Advisory Commission (MedPAC) eleases its March 2025 Report to the Congress: Medicare Payment Policy. The report presents MedPAC’s recommendations for updating provider payment rates in fee-for-service (FFS) Medicare for 2026, providing additional resources to acute care hospitals and clinicians who furnish care to Medicare beneficiaries with low incomes, and eliminating certain Medicare coverage limits on stays in freestanding inpatient psychiatric facilities. The report reviews the status of ambulatory surgical centers (ASCs), the Medicare Advantage (MA) program (Medicare Part C), and the Part D prescription drug program (Medicare Part D). ... Fee-for-service payment rate update recommendations. ... MedPAC recommends ... payment reductions relative to current law for hospice providers, skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities.  [Click on the title's link to continue reading.]

2010 to 2019 saw early palliative care billing up for advanced cancer HealthDay News; by Elana Gotkine; 3/17/25 For patients with distant-stage cancers, there was an increase in early palliative care (PC) billing from 2010 to 2019, but the level remained low, according to a study published online March 7 in the Journal of Clinical Oncology. ... The researchers found that in 2010 to 2019, there was an increase in the percentage with early PC billing among 102,032 patients treated by 18,908 unique physicians, from 1.44 to 10.36 percent. The likelihood of early PC billing was increased in association with treating physician's early PC referrals in the previous year and organizations' employment of any HPM specialist (3.01 and 4.54 percentage points, respectively).