Literature Review

Older adults spending excess time in ED, putting hospitals at risk of failing to meet new guideline, analysis finds McKnights Long-Term Care News; by Donna Shryer; 7/1/25 A new national analysis of hospital data shows that older adults in the United States increasingly are spending more time in emergency departments (EDs) than federal guidelines recommend — delays that can be harmful to aging patients. The findings come as hospitals prepare to comply with new Medicare rules aimed at improving emergency care for older adults. ... Among patients who were admitted to the hospital, more than one-third (36%) waited more than three hours after the decision was made to admit them, a delay known as boarding. These benchmarks — eight hours in the ED and three hours to admission — are part of the new Age-Friendly Hospital Measure introduced by the Centers for Medicare & Medicaid Services (CMS). As of January 2025, hospitals are required to confirm they have procedures in place to meet these time goals.

United Palliative & Hospice Care accused of $87M hospice scam Hospice News; by Jim Parker; 7/2/25 Three women associated with Houston-based United Hospice & Palliative Care (UPHC) have been charged with Medicaid and Medicare fraud after allegedly bilking more than $87 million in federal health care funds. The trio includes UPHC owner Dera Ogudo, an UPHC employee Victoria Martinez and a psychiatric hospital employee, Evelyn Shaw, ABC-13 Houston reported. The prosecutor’s indictment also includes an unnamed physician who allegedly received kickbacks for referrals to UPHC. “Ogudo and her co-conspirators preyed on the vulnerable residents of those group homes by enrolling them in hospice services with UPHC when they were not terminally ill,” the indictment indicated.

Nearly 50 charged in Southern District of Texas as part of national health care fraud takedown United States Attorney's Office - Southern District of Texas, Houston, TX; 6/30/25 A total of 22 cases are being announced as part of local efforts targeting health care fraud and include various schemes alleging unlawful distribution of controlled substances, some of which were diverted onto the black market, hospice fraud, kickbacks and other Medicare/Medicaid fraud schemes involving medically unnecessary genetic tests, durable medical equipment and more.  The charges filed in Southern District of Texas (SDTX) federal court are part of the Department of Justice’s 2025 national health care fraud takedown. ... One of the largest cases include three individuals for their alleged roles in a $110 million hospice fraud and kickback scheme. The charges allege Dera Ogudo, 39, and Victoria Martinez, 35, both of Richmond, operated hospice company United Palliative & Hospice Company (UPHC) that misled vulnerable elderly adults about what services were being billed to their Medicare and Medicaid plans.

Provider payment incentives: Evidence from the U.S. hospice industry ScienceDirect - Journal of Public Public Economics; by Norma B. Coe and David A. Rosenkranz; online ahead of print for August 2025 (retrieved from the internet 7/1/25) Highlights

Wisconsin author discusses her mother’s aging, dying in the American health care system: The long-term care system failed both her and her mother, she writes Wisconsin Public Radio; by Colleen Leahy; 6/27/25At age 99, Judy Karofsky’s mother was kicked out of her Wisconsin hospice facility. Within 48 hours of that decision, Karofsky became her mother’s default nurse. “I had to find a wheelchair for her. I had to keep track of her meds. I had to buy all the bandages and supplies that she would [need],” Karofsky told WPR’s “Wisconsin Today.” Karofsky is the author of “Diselderly Conduct: The Flawed Business of Assisted Living and Hospice.” In it, she chronicles nightmare scenarios as her mother aged and died in the American healthcare system: making her way through independent living, six different assisted living facilities, memory care, skilled nursing and hospice.  

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.