Literature Review

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.

NPHI supports lawsuit to ensure proper implementation of Hospice Special Focus Program National Partnership for Healthcare and Hospice Innovation, Washington, DC; Press Release; 1/16/25Today, a lawsuit was filed by the Texas Association for Home Care & Hospice; Indiana Association for Home & Hospice Care; Association for Home & Hospice Care of North Carolina; South Carolina Home Care & Hospice Association; and Houston Hospice. The lawsuit challenges CMS’s implementation of the hospice Special Focus Program (SFP) as unlawful and arbitrary. We acknowledge that Houston Hospice, an NPHI member, is one of the plaintiffs in this legal action, and we are committed to supporting them and others impacted by the SFP or the accompanying excel files. The hospice Special Focus Program (SFP), conceived and passed on a bipartisan basis as a part of the HOSPICE Act in 2021, was designed to address poor-quality hospice providers by offering them additional support and technical assistance to ensure compliance with the Medicare Hospice Conditions of Participation. NPHI is extremely disappointed that CMS has departed from that Congressional intent, transforming the hospice SFP into a burden for many well-meaning hospices, with an algorithm for identifying providers based on inaccurate data and including elements that are not referenced in the statutory language. ... NPHI fully supports the litigation filed today, which aims to direct CMS to comply with the spirit and intent of the statute and regulations. [Click on the title's link to continue reading.]

CMS Call for Nominations: 2025 CMS Health Equity Award U.S. Centers for Medicare and Medicaid Services; by CMS Health Equity; via CMS email 1/13/25Nominations for the 2025 CMS Health Equity Award are now open to organizations working to advance health equity, showing others how to reduce disparities in health care access, quality, and outcomes. Nominations are due February 18 at 11:59 pm PT.  ... Health equity is defined by CMS as the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, and other factors that affect access to care and health outcomes. 

CMS Gives Notice of 4.3% Pay Hike for Medicare Advantage Plans Hospice News; by Jim Parker; 1/13/25 The U.S. Centers for Medicare & Medicaid Services (CMS) plans to increase payments to Medicare Advantage plans for 4.3% in 2026, but implementation will depend on what happens with the new presidential administration. CMS has issued an advance notice of policy changes for Medicare Advantage and Part D that would install technical updates, including to the ways the agency calculates payments to health plans. ... Though Medicare Advantage does not cover hospice care, many providers depend on MA payments for other programs like palliative care, among others. The changes are intended to continue CMS’s three-year phase-in of updates to the MA risk adjustment model and growth-rate calculation related to medical education costs. However, it will be up to the incoming Trump administration to bring these changes to fruition — if they so choose. 

Hospice Coalition Questions and Answers: October 30, 2024Palmetto GBA; 12/12/2024Meeting Q&A and these attachments: Attachment A1: Hospice Appeals Report Q2; Attachment A2: Hospice Appeals Report Q3; Attachment B: Hospice CAP Updates.

MA Special Needs Beneficiaries more likely to receive lower quality hospice care Hospice News; by Jim Parker; 1/2/25 Medicare Advantage special needs plan (SNP) beneficiaries were more likely to use lower-quality hospices than those enrolled in fee-for-service Medicare. Researchers from the Perelman School of Medicine at University of Pennsylvania in Philadelphia examined Medicare enrollment and claims data for 4.2 million decedents and 2.2 million hospice enrollees from Jan 1, 2018 to Dec. 31, 2019. Among other findings, results indicated that MA SNP beneficiaries were more likely to receive care from hospices with lower Hospice Quality Reporting Program (HQRP) scores. “These results suggest that policymakers should consider incentivizing referrals to high-quality hospices and approaches to educating beneficiaries on identifying high-quality hospice care,” researchers wrote in the study, published in JAMA Network Open. Editor's note: Click here for the CMS.gov Special Needs Plans webpage.

Accountable Health Communities (AHC) Model: Third evaluation report (2018-2023)CMS press release; 12/27/24The Accountable Health Communities (AHC) Model tested whether connecting beneficiaries to community resources for their health-related social needs (HRSNs) improved health care utilization outcomes and reduced costs. [The five core HRNS's include housing instability, food insecurity, transportation problems, utility difficulties, and interpersonal violence.] Collectively, these findings provide evidence that navigation can transform the delivery of care in ways that address major HRSN barriers to health and promote health equity for underserved populations.

Inside the CMS plan to streamline quality measurement Modern Healthcare; by Bridget Early; 12/23/24 Quality measurement is burdensome and complicated. The government and the private sector are struggling to figure out a good fix. The Centers for Medicare and Medicaid Services uses quality data to inform its reimbursement rates, so it's a high-stakes matter for providers and health insurance companies. CMS has proposed an overarching framework meant to streamline the process: the Universal Foundation. ... The Universal Foundation consists of two dozen quality measures across several categories that track wellness and prevention, chronic conditions, behavioral health, and "person-centered" care. Those include measures of breast and colorectal cancer screenings, blood pressure, blood sugar levels, vaccinations, and hospital readmissions. ... CMS has incorporated this framework into recent regulations such as the Medicare Advantage final rule for 2024 and the Physician Fee Schedule final rule for 2025. 

U.S. health care spending reaches $4.9 trillion Hospice News; by Jim Parker; 12/20/24 The nation’s total health expenditures rose 7.5% to $4.9 trillion in 2023, a new analysis by the U.S. Centers for Medicare & Medicaid Services (CMS) found. This growth took place at a faster pace in 2023 than prior years. In 2022, health care spending rose at a rate of 4.6%. Total Medicare hospice spending accounted for $25.7 billion last year, according to a separate report from the Medicare Payment Advisory Commission (MedPAC). ... About 21% of U.S. health care spending in 2023 was via Medicare, with private insurance representing a 30% share. Medicaid accounted for 21%, and the remaining 10% were out-of-pocket costs. “Hospital care, physician and clinical services, and nursing care facilities and continuing care retirement communities, which collectively accounted for 33% of all out-of-pocket spending in 2023, were the main contributors to the faster growth in 2023,” CMS indicated.

Quality of hospices used by Medicare Advantage and traditional fee-for-service beneficiariesJAMA Network Open; Lindsay L. Y. White, PhD, MPH; Chuxuan Sun, MPA; Norma B. Coe, PhD; 12/24In this cross-sectional study including 4 215 648 decedents and 2 211 826 hospice enrollees, regular Medicare Advantage and fee-for-service beneficiaries enrolled in hospices of similar quality. However, beneficiaries in Medicare Advantage special needs plans were significantly more likely than fee-for-service beneficiaries to use hospices of inferior quality, with referral networks playing an important role in hospice quality choice. These results suggest that policymakers should consider incentivizing referrals to high-quality hospices and approaches to educating beneficiaries on identifying high-quality hospice care. 

Hospice utilization rebounds to pre-pandemic levels, but fraud casts a shadow Hospice News; by Jim Parker; 12/17/24 The nation’s hospice utilization rate among Medicare decedents has once again surpassed 50%, for the first time since the pandemic. However, fraud issues in the space create questions around the quality of care patients are receiving. Hospice utilization reached 51.7% in 2023, up more than two percentage points from the prior year, according to recent data from the Medicare Payment Advisory Commission (MedPAC). This is the highest rate since 2019. MedPAC observed increases in utilization across the board, even when stratified into subgroups by age, sex, race and rural or urban location. ... Despite these positive trends, an influx of new hospices continued in states considered hotbeds for Medicare fraud, including Arizona, California, Nevada and Texas. Many of these new additions came in areas where additional hospices were likely not necessary based on the needs of the patient population. Georgia also saw a large spate of new providers emerge in 2023.