Literature Review

Local Coverage Determination (LCD) Update: Home Health and HospiceCMS / Palmetto GBA email; 1/10/24The Hospice: The Adult Failure to Thrive Syndrome L34558 LCD was revised. Please review this update and share it with your staff.

Will we close the Medicare Advantage primary care gap in 2024?MedCity News, by Jim Bonnette; 1/8/24... Across all healthcare industry stakeholders, there is a pressing need to address this growing concern: MA members without primary care physicians (PCPs). This cohort, called the MA Primary Care Gap, may present the highest risk to health plans as MA becomes their fastest-growing segment . ... Furthermore, the MA Primary Care Gap is widening due to industry shortages of primary care providers and the rise of healthcare deserts in both rural areas and under-served urban areas. The absence of primary care physicians is particularly troublesome for Medicare Advantage patients with multiple chronic diseases and complex healthcare needs.

The Wall Street Journal: Exclusive: Cigna nears deal to offload Medicare businessThe Wall Street Journal, by Laura Cooper, Anna Wilde Mathews and Lauren Thomas; 1/3/24Cigna is in advanced talks to sell its Medicare business in an about-face for the health-insurance giant, which had been expanding its footprint in the fast-growing sector. Cigna, which has been running an auction for the business, known as Medicare Advantage, is now in exclusive talks to sell it to Health Care Service Corp. for between $3 billion and $4 billion, according to people familiar with the matter. Editor's Note: Access to the full article requires a subscription to The Wall Street Journal

12 healthcare trends and issues we are following for 2024 Becker's Hospital Review, by Scott Becker and Molly Gamble; 1/2/24The year begins with a number of challenges that have only intensified for U.S. healthcare providers. Below are a dozen trends and issues that commanded our attention throughout 2023 and hold our curiosity in the year ahead. These patterns and shifts directly or indirectly influence how healthcare providers fare in 2024, and ultimately affect how Americans access, afford and receive care.

Evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design Model Test: First three years of implementation (2020–2022)CMS Report; 12/29/23Year Two Evaluation Report - Key Takeaways: The Medicare Advantage (MA) Value-Based Insurance Design (VBID) model test enables MA insurers to offer one or more innovative benefit design options in eligible MA plans. The model aims to encourage the use of high-value care and promote healthy behavior, with goals of enhancing care quality, improving beneficiary health, and reducing spending. Most VBID benefits can be targeted based on beneficiaries’ chronic conditions or socioeconomic status (SES). A separate Hospice Benefit component is also included in the model. 

The Top 10 Home Health Care News Stories Of 2023Home Health Care NewsDecember 20, 2023In the first year that truly felt “post-COVID,” home-based care providers did not see a shortage of challenges. Instead, in 2023, home health providers saw another year defined by payment struggles, with both the Centers for Medicare & Medicaid Services and Medicare Advantage plans.  ... Reflect back on this year in home-based care by revisiting 10 of HHCN’s most widely read stories.

Largest nursing home in St. Louis closes suddenly, forcing out 170 residentsAssociated PressDecember 18, 2023St. Louis, MO—The largest skilled nursing facility in St. Louis has closed suddenly, forcing about 170 residents to be bused to other care centers. Many left with nothing but the clothes they were wearing. The abrupt shutdown of Northview Village Nursing Home on Friday came after workers learned they might not be paid and walked out, confusing residents and their relatives. Many family members gathered through the day Saturday outside the facility on the city’s north side. Some didn’t immediately know where their loved ones were taken. 

Washington Post Reports Highlight Assisted Living Resident Elopements and Staffing Problems, Industry Pushes BackSenior Housing NewsDecember 17, 2023A new Washington Post investigation has detailed dozens of incidents where senior living residents have wandered away and died as well as “bare-bones” staffing levels at communities across the country. In one article published over the weekend, the Post examined thousands of cases since 2018 where senior living residents wandered away from their communities, resulting in nearly 100 deaths in that time. ... The articles underscore the challenges senior living operators will surely have in the coming years, in terms of both staffing and managing communities and maintaining positive perceptions among the public. 

‘Tougher Every Day’—Nursing Home Operators, CCRCs Weigh in on Future of Skilled NursingSkilled Nursing NewsDecember 14, 2023Operating a skilled nursing facility today is considered a “tough business” with regulations and reimbursement woes making the space “tougher every day.” Other operators say they regularly budget a loss for skilled nursing services, and if it weren’t for other lines of business, skilled nursing would be unsustainable. 

NAHC President Bill Dombi—History Repeating Itself on Hospice Program IntegrityHospice NewsDecember 14, 2023Issues of fraud in the hospice industry echo events that previously affected the home health space, and providers can learn from that prior experience. This is according to Bill Dombi, president of the National Association for Home Care and Hospice, who spoke Thursday in a Relias webinar. ... “What I’m seeing is history repeating itself. Back in the 1990s, the microscope ended up focusing on the Medicare Home Health Program. 

Home Health Spending Begins To Climb Again Post-PandemicHome Health Care NewsDecember 13, 2023After stalling in 2021, spending on home health care returned to a more normalized growth rate in 2022, according to a new analysis from the Office of the Actuary at the Centers for Medicare & Medicaid Services. Specifically, national health expenditures on home health care increased by 6% to $132.9 billion in 2022. 

Medicare Advantage market got more competitive in 2022—AMA.Modern HealthcareDecember 12, 2023The majority of the nation’s health insurance markets remain highly concentrated, but one segment of the industry in particular continues to grow more competitive—Medicare Advantage. The Medicare Advantage market has decreased in concentration since 2017 and continued to do so in 2022, according to the American Medical Association’s annual report Tuesday on health insurers.