Literature Review

Recommendations for palliative care program standards Center to Advance Palliative Care (CAPC); last updated 5/29/25CAPC has synthesized the NCP Guidelines into an operational summary for payers and policymakers to use in credentialing palliative care providers or informing minimum program requirements. These recommendations call for: an interdisciplinary team with 3 or more essential clinical disciplines: physician, advance practice provider, nurse, social worker, spiritual care professional and a child life specialist for programs serving children. One or more prescribers must have specialty certification in palliative care with others documenting some specialty training. PC services must include Comprehensive patient assessments, Pain and symptom management, Documented conversations about condition, treatment options, and goals of care, Psychological, social and spiritual support, Patient and family/caregiver education, and Coordination with behavior health and community health resources, and Development of a crisis intervention plan. The recommendations also specify 24/7 access to a prescribing clinician, clear discharge criteria, and routine evaluations of program quality.Guest Editor's Note, Ira Byock: These new recommendations from CAPC are timely and important. Building from the NCP Guidelines, CAPC is providing a framework for developing formal standards. That task is urgent given the pressures programs are under to reduce staffing, limit hours of service, and scope of services. I appreciate inclusion of crisis intervention planning, which should be a critical part of every palliative plan of care. The recommendations are strong, yet the statement’s wording is hesitant in tone. CAPC has the organizational stature to issue explicit minimum specifications for programs that purport to deliver palliative care. Health plans, payers, referring providers, and patients deserve assurance that such minimums are met or exceeded. CAPC has taken a significant step in the right direction.  

MedPAC Report: Medicare Advantage enrollees receive 11% fewer home health visits Home Health Care News; by Morgan Gonzales; 6/13/25 The Medicare Payment Advisory Commission’s (MedPAC) June report to Congress examined home health care use among Medicare Advantage (MA) and traditional Medicare patients and found that MA enrollees receive 11% fewer home health visits compared to Medicare fee-for-service. ... 

[Congressional Research Service] Medicare Coverage: Background and resources Congressional Research Service - In Focus; 6/13/25 This In Focus provides an overview of Medicare coverage of services and items, coverage determination processes, and core resources on these topics for beneficiaries, health care providers, and policymakers. ...

Chapter 6: Medicare’s measurement of rural provider quality MedPAC; 6/12/25 ... Because of low patient volumes in many rural health care settings, there are practical challenges in measuring some individual rural providers’ quality of care and in holding these providers accountable in quality reporting programs. ... The Commission acknowledged these difficulties when it established specific principles to guide expectations about quality in rural areas. These principles were developed with hospitals in mind but could be applied to other providers. ... [On page 4 of 40] Rural skilled nursing facilities and dialysis facilities had lower shares of providers with publicly reported quality results compared with their urban counterparts; in contrast, rural home health agencies and hospices had higher shares of providers with publicly reported quality results compared with their urban counterparts.Editor's Note: For ranking of hospices by quality scores, examine the National Hospice Locator, provided to the public by Hospice Analytics (a sponsor of this newsletter). 

Global adoption of value-based health care initiatives within health systems-A scoping reviewJAMA Health Forum; Ayooluwa O. Douglas, MD, MPH; Senthujan Senkaiahliyan, MHSc; Caroline A. Bulstra, DVM, MHSc, PhD; Carol Mita, MS; Che L. Reddy, MBChB, MPH; Rifat Atun, MBBS, MBA; 5/25The value-based health care (VBHC) framework was introduced in the US in 2006 to combat rising health care expenditures that failed to produce improvements in patient quality, safety, and outcomes over the past decades. The framework focuses on 6 elements: (1) organizing care around medical conditions, (2) measuring outcomes and costs for every patient, (3) aligning reimbursement with value through bundled payments, (4) integrating care systems regionally, (5) establishing national centers of excellence for complex care, and (6) using information technology systems to support these elements. This scoping review of 50 initiatives found that the implementation of VBHC globally is still in its early stages, with published scientific literature pointing to small-scale institutional-level implementation within individual departments and hospitals. Large-scale implementation designed to develop high-value health systems is limited.

A World War II hero is facing his final battle - with Medicare | PennLive letters PennLive Patriot News; by PenLive Letters to the Editor; 6/5/25 “Is this how one treats a 100-year-old World War II Army veteran?” I am such, having defended my country in the Philippines and then as one of the first GIs to step on Japan’s shores when it surrendered. Today, I am a widower, living alone under hospice care in the same small, comfortable home my wife and I cherished for so many years. My health condition has deteriorated dramatically, due to the ravages of ESRD, bladder cancer, anemia, high blood pressure, depression, and loss of balance. I am mostly bedridden, waiting for the inevitable. And yet, just now, I have received a Notice of Discharge from hospice because of an “extended prognosis,” literally meaning in lay terms that, “I’m living too long for hospice and Medicare purposes.” They argue that I’m now able enough medically to make it on my own without hospice care! ... I know I have only weeks, perhaps a month to live, but their rejoinder is simply, “Thank you for your service, but get out of our sight.”Editor's note: Click here for a similar related article and my editor's note, Dementia patient discharged from hospice over Medicare requirement. Here’s why it happened. (One of our "most read" Sunday posts.) These cases are too common. Basic communication, information, and coordinated care planning can mitigate much of the distress and pain. How does this dynamic play out with the patients and families you serve?

CMS budget puts complaint surveys over routine inspections as main nursing home oversight McKnights Long-Term Care; by Kimberly Marselas; 6/2/25 A proposed 2026 Trump administration budget request would shift nursing home survey priorities, further delaying the time between standard inspections at many facilities. The Centers for Medicare & Medicaid Services budget justification published late Friday calls for a $45 million increase in survey spending across multiple sectors next fiscal year. But it also prioritizes complaint surveys in a way that would reduce the availability of surveyors to conduct routine, annual inspections mandated by law. The document from the Department of Health and Human Services shows the percentage of nursing home standard surveys completed each year would fall from 74% in fiscal year 2024 to a projected 65% completion rate in fiscal year 2026. 

TCN/HPC Today: Storm clouds on the horizon for reimbursement - Top news stories, May 2025 Teleios Collaborative Network (TCN); podcast by Chris Comeaux with Cordt Kassner, 6/4/25 What happens when artificial intelligence meets end-of-life care?  How do we reconcile private equity's profit motives with hospice's mission-driven ethos?  These questions took center stage in this month's roundup of hospice news with host Chris Comeaux and guest Cordt Kassner. The May edition of TCNtalks' top news stories reveals a healthcare sector at a fascinating crossroads.  AI has emerged as both a tantalizing promise and a practical challenge for hospice providers.  ... In this episode of TCN Talks, hosts Chris Comeaux and Cord Kassner reflect on Memorial Day and discuss significant news stories from May, including the complexities of thanking veterans for their service, the role of artificial intelligence in hospice care, and the importance of honest conversations about racism in healthcare.Editor's note: This monthly podcast combines quantitative data and qualitative discussion from articles gleaned from the 400+ posts we provide each month. Do you seek to make sense of it all? Tune in and learn. We welcome your feedback via our newsletter's Contact page. 

2 West Covina women arrested for alleged $4.8 million hospice care fraud CBS News KCAL, Los Angeles, CA; by Julie Sharp; 6/3/25 The U.S. Department of Justice announced that two West Covina women were arrested Tuesday for an alleged scheme to defraud Medicare of $4.8 million with false hospice care claims. One of the women who was arrested is the owner and operator of two West Covina hospices, Golden Meadows Hospice Inc., and D'Alexandria Hospice Inc., which billed Medicare for hospice services for patients who were allegedly not terminally ill.  Between Sept. 2018 and Oct. 2022, owner and operator Normita Sierra, 71, and her alleged accomplice, Rowena Elegado, 55, collected more than $3.8 million from Medicare on false claims, the DOJ said.

A glossary of Medicare termsMedicalNewsToday; by Mandy French, medically reviewed by Oluwatoyin Kuloyo, Pharm.D., BCPS; 6/2/25 When a person first signs up for Medicare, they may come across many terms and abbreviations. Learning the definitions of these terms can help make it easier to understand and navigate Medicare. Medicare information can be confusing. This A to Z glossary can help individuals understand some common terms, acronyms, and abbreviations. ... Editor's note: A must-have resource to use and distribute, with multiple links to more depth information at Medicare.gov and MedicalNewsToday.

LeadingAge, Hospice Associations seek delay in HOPE implementation LeadingAge; Press Release; 5/28/25 LeadingAge, along with the National Alliance for Care at Home and the National Partnership for Healthcare and Hospice Innovation, on May 19 urged the Centers for Medicare and Medicaid Services (CMS) to delay implementation of the Hospice Outcomes and Patient Evaluation, or HOPE tool. In the letter to CMS Administrator Dr. Mehmet Oz the associations outline concerns with technology implementation in preparation for the HOPE tool. The letter specifically asks CMS to waive the HOPE timeliness submission requirement for two calendar quarters post implementation. The letter further requests that CMS delay the HOPE implementation date until at least six months after CMS education, training, and final validation specifications are available and the application for iQIES access has been opened for hospices. 

Door remains closed on CMS forums as new rules, requirements are phased in McKnights Long-Term Care News; by Kimberly Marselas; 5/28/25 Four months into the new presidential administration, skilled nursing leaders have had no opportunity to hear directly from Centers for Medicare & Medicaid Services staff during traditional Open Door Forums or National Stakeholder Calls. Open Door Forums have been held three-to-five times annually in a practice that started more than 20 years ago. The online meetings give providers, vendors and other stakeholders an opportunity to learn more about regulatory and logistical changes being pursued by CMS, as well as providing question-and-answer sessions with policy architects. In addition to skilled nursing forums, CMS has in the past also hosted similar events for home health, long-term care services and supports, rural health and other provider types. But CMS in January cancelled a skilled nursing forum and all others planned for February and has yet to add any new forums or stakeholder calls — which often feature the administrator discussing major policy or clinical updates — to its calendar.