Literature Review

Navigating new requirements in the 2025 proposed Hospice Rule Hospice News, by Jim Parker; 3/5/24 If the U.S. Centers for Medicare and Medicaid Services’ (CMS) proposed 2025 hospice rule is finalized as written, hospices may encounter some hurdles implementing some of the new requirements. MS late last month issued its proposed hospice rule for 2025. The proposal called for a 2.6% increase in hospice per diem base rates, a number that many stakeholders say is insufficient in today’s economic climate.

Incorporating bereavement into the continuum of careMedpage Today, by Charles Bankhead; 4/4/24... Despite being integral to high-quality, family-centered healthcare, bereavement support often is poorly resourced, even described as the "poor cousin of palliative care." ... To develop a framework for compassionate communities requires shifting bereavement care from "an afterthought to a public health priority," wrote Wendy G. Lichtenthal, PhD, of the University of Miami Sylvester Comprehensive Cancer Center, and co-authors in Lancet Public Health. ... In an ideal setting, bereavement care begins with pre-death grief education, continues through the dying process and end of life, and transitions into community-based support and psychosocial services, as needed. .. The [continuum of care] model comprises five essential "pillars":

Proposed hospice rule offers key quality improvement changes, experts offer McKnights Home Care, by Adam Healy; 4/4/24While the recently proposed 2025 hospice payment update included a payment adjustment that stakeholders have perceived as inadequate, it also introduced valuable new tools to address hospice quality and more, according to industry regulatory experts. One of the proposed rule’s most enticing features is the Hospice Outcomes and Patient Evaluation (HOPE) tool, which next year will replace the current Hospice Item Set (HIS) measurement system used by the Centers for Medicare & Medicaid Services to track hospice quality.

CMS provides first look at shorter, Risk-Based Survey process McKnights Long-Term Care News, by Kimberly Marselas; 4/4/24 The Centers for Medicare & Medicaid Services on Wednesday revealed initial information about a potential “Risk-Based Survey” option that could be available to some of the nation’s best performing nursing homes. ... CMS said in an update to its nursing home provider enrollment page Wednesday that it is working with states to test this process over the next several months. ... CMS said the proposed risk-based survey, or RBS, approach would allow “consistently higher-quality facilities” to receive a more focused survey, while still ensuring compliance with health and safety standards. 

What home health providers need to know about the Medicare TPE Audit ProcessHome Health Care News, by Joyce Famakinwa;  4/2/24... TPE is a medical review program that began for the home health and hospice settings in December 2017. The goal of the program is to weed out improper payments by zeroing-in on providers with high claims denial rates or unusual billing practices. ... TPE has three pillars. Target refers to errors or mistakes that are identified through data in comparison to providers or peers. Probe is the examination of 20 to 40 claims. ... Education means helping providers reduce claim denials and appeals through one-on-one individualized education.

Glendale, California men sentenced for role in $9M hospice fraud scheme – owner of San Gabriel Hospice and Palliative Care Inc. and Broadway Hospice Inc.Sierra Sun Times; 3/31/24The owner of two California-based hospice companies, along with his biller and consultant, were sentenced last Thursday for their respective roles in a scheme that resulted in stealing over $9 million from Medicare in false and fraudulent claims for hospice services. ... According to court documents, ...  [Gayk] Akhsharumov concealed his ownership and control over the hospice entities from Medicare, inserted nominee owners, paid kickbacks to patient recruiters, and profited from the scheme. In April 2020, after San Gabriel had ceased operations, Akhsharumov used the company to fraudulently obtain COVID-19 relief funds.

14 Joint Commission patient safety goals for post-acute facilities Becker's Hospital Review, by Mariah Taylor; 3/21/24 The Joint Commission released a breakdown of patient safety goals for post-acute care facilities in 2024. The organization published an easy-to-read resource outlining goals for nine sectors of healthcare, including nursing facilities, surgery, hospitals and behavioral care. For post-acute facilities, the goals mostly revolved around identifying patients correctly, using medicines safely, and preventing infections and falls. Here are the patient safety goals for post-acute facilities: ...

[UPDATED] CMS 2025 proposed rule signals changes to quality measurement, omits program integrity actionsHospice News, by Jim Parker; 3/29/24In a proposed rule released [Thursday], the U.S. Centers for Medicare & Medicaid Services (CMS) proposed a 2.6% increase in hospice per diems for 2025. The agency also proposed two new quality measures and 2025 implementation of the Hospice Outcome and Patient Evaluation (HOPE) assessment tool to replace the Hospice Item Set.However, stakeholders in the hospice space contend that the increase is insufficient in light of continued inflation, interest rates, staffing shortages and wage hikes.

Medicare, Medicaid made $100B in improper payments in 2023 Becker's Hospital Review - Legal & Regulatory Issues, by Andrew Cass; 3/27/24 The federal government reported an estimated $235.8 billion in improper payments in fiscal year 2023, with more than $100 billion coming from Medicare and Medicaid, according to a March 26 report from the U.S. Government Accountability Office. The $235.8 billion in improper payments reported by 14 agencies across 71 programs is a decrease from the $247 billion reported in 2022, but the figure remains higher than pre-pandemic levels, according to the report. 

Fall prevention for the elderly: 13 strategies to keep them safe U.S. News & World Report, by Claire Wolters, ed. by Christine Comizion, MPH; 3/26/24Falls are the leading cause of injury in adults 65 and older – with reports showing about 14 million adults fall each year, according to the Centers for Disease Control and Prevention. ... According to the CDC, falls are also the leading cause of injury-related death in the 65-and-older population – and the fall death rate is growing.Here's what to know about what increases risk for falls in older adults, and get familiar with fall prevention tips and safety measures that can help reduce the risk.Editor's Note: This U.S. News article primes the pump. Preventing falls matters especially for vulnerable hospice patients as their disease progresses, and as they and/or family want the person to be as mobile as possible. What do your Incident Reports tell you about falls? What falls-specific education do you provide for your interdisciplinary teams? On-call staff? Family caregivers? Volunteers? What QAPI programs have addressed falls? 

Nearly half of health systems are considering dropping Medicare Advantage plans Becker's Hospital CFO Report, by Andrew Cass; 3/22/24 ... "HFMA Health System CFO Pain Points Study 2024" is based on a survey of 135 health system CFOs conducted in January.  According to the report, 16% of health systems are planning to stop accepting one or more Medicare Advantage plans in the next two years. Another 45% said they are considering the same but have not made a final decision. 

Improving the Quality Of Quality Metrics Health Affairs; by Aditya Narayan, Bob Kocher, and Nirav R. Shah; 3/19/24... The landscape of health care quality measures is dynamic, reflecting efforts to enhance patient care, safety, and outcomes. These measures are developed and reimbursed by a variety of stakeholders, including government agencies such as the Centers for Medicare and Medicaid Services (CMS), health care organizations, and independent bodies such as the National Quality Forum and the Agency for Healthcare Research and Quality (AHRQ). The development process involves rigorous research, stakeholder engagement, and consensus-building to ensure measures are evidence-based, applicable across different health care settings, and meaningful to patient care.Editor's Note: Read and share this informative, big-picture article about the evolution of healthcare's quality metrics, its tools, and best practices. 

New legislation proposes national expansion of integrated care modelsHealth Affairs, by Laura M. Keohane; 3/20, 24 This article is the latest in the Health Affairs Forefront major series, Medicare and Medicaid Integration. The series features analysis, proposals, and commentary that will inform policies on the state and federal levels to advance integrated care for those dually eligible for Medicare and Medicaid.  ... On March 14, a bipartisan group of senators—members of the Senate Duals Working Group—released legislation (The DUALS Act: Delivering Unified Access to Lifesaving Services Act of 2024) that commits to ambitious goals for aligning Medicare and Medicaid coverage ... Would the integration measures proposed in this bill be more successful [than previous programs] in achieving these goals? This Forefront article highlights the key components of the legislation and assesses its ability to advance better outcomes for dual-eligible beneficiaries.