Literature Review

2023’s Most Impactful Hospice Regulatory MovesHospice NewsDecember 12, 2023Program integrity issues that have heated up in the hospice space during the past five years reached a boiling point in 2023. Hospice providers have seen an array of increased regulatory oversight in 2023. That momentum has been fueled by two main concerns among regulators—risks of patient safety and evidence of malfeasance in the space. Hospice News sat down with providers, advocacy groups, legal experts and other stakeholders to uncover the most significant hospice regulatory trends from this year and their anticipated impacts heading into 2024 and beyond. ...Editor's Note: Quoted in the article, Jason Wallace, partner in health care, Barnes & Thornburg LLP; Ben Marcantonio, COO and interim CEO, NHPCO; Carrie Uebel, senior vice president and chief ethics and compliance officer, Compassus

Forced to work in a vacuum, MedPAC recommends another Medicare cutMcKnight’s Long Term Care NewsDecember 11, 2023A Congressional advisory group appears ready to recommend a 3% Medicare pay cut for nursing homes in 2025. In what has become an annual tradition, members of the Medicare Payment Advisory Commission voiced ongoing concerns Friday about the use of Medicare Fee for Service reimbursement to effectively subsidize Medicaid rates and Medicare Advantage payments. With official data indicating that patients still have plenty of access to care, panel staff recommended MedPAC tell Congress that it should pursue a cut to Chair Michael Chernew, PhD, a healthcare policy professor at Harvard, said the 3% cut could be steeper given the reported margins. But the commission—tasked only with considering Medicare policy—remains cognizant of the pressures faced by providers accepting Medicaid and being increasingly low balled by managed care plans.

Shifting focus to MA will alter ‘life as we know it’ for home care providers, experts sayMcKnight’s Home Care DailyDecember 7, 2023Medicare Advantage is disrupting the traditional home care landscape, experts from the Research Institute for Home Care said in a webinar hosted Wednesday afternoon by the National Association for Home Care & Hospice. As MA continues to dominate Medicare and cover those beneficiaries receiving home health, certain trends—such as access issues or shifting utilization rates for services within traditional Medicare—have become more pronounced. “Medicare Advantage is growing, and that’s going to result in a decreased volume in home health claims among traditional Medicare beneficiaries,” Elizabeth Hamlett, senior research associate for evaluation and health economics at KNG Health, said during the webinar about the recently released 2023 RIHC [Research Industry for Home Care] Chartbook. Home health users in general also may become more reflective of the characteristics of MA beneficiaries—which essentially means sicker and poorer, she said. ... However, MA and fee-for-service beneficiaries showed greater variation in their reported access to home health services. “What we’re seeing here is potentially an access problem for Medicare Advantage users,” Hamlett said.

The Medicare Gold Rush Is Slowing DownWall Street JournalDecember 6, 2023The popularity of private Medicare plans has been a huge driver of profits for insurance companies in recent years. There are signs the gold rush isn’t quite what it once was. ... The most immediate red flag came from the industry leader, UnitedHealth. During an investor day last week, it predicted its Medicare Advantage enrollment would grow by 450,000 to 550,000 seniors in 2024. That translates to around 5% growth next year, a significant slowdown from the 11% it grew so far this year, according to TD Cowen analyst Gary Taylor. As UnitedHealth executives were presenting in New York, The Wall Street Journal reported that the second-largest Medicare plan provider, Humana, was in merger talks with Cigna. While Cigna’s interest in Humana surely attests to insurers’ continued desire to expand into the Medicare market, some investors took it as a sign that Humana isn’t so sure about the strength of the business going forward.