Literature Review

New ACO model paves way for innovative home-based primary care services: CMS McKnights Home Care, by Adam Healy; 3/20/24 The Centers for Medicare & Medicaid Services on Tuesday unveiled a new person-centered care payment model that expands how and where beneficiaries can receive primary care. “People whose primary care provider participates in the ACO PC Flex Model may get care in more convenient ways, like care based at home or through virtual means, extra help managing chronic diseases, and more preventive health services to keep them healthy,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Not only will people with Medicare receive more coordinated, seamless care that addresses their unique needs, but CMS is supporting primary care clinicians and giving them more flexibility to provide person-centered care.”

New report blasts nursing home citations, rate of abuse tagsMcKnights Long-Term Care News, by Josh Henreckson; 3/20/24An organization dedicated to helping seniors find care issued a report Tuesday raising alarm about the number of nursing home abuse citations in 2023, but senior care leaders say a more punitive approach to surveys is actually hurting residents and their facilities. The SeniorLiving.org report used last year’s Medicare data to highlight that nursing homes received nearly 95,000 health citations during that time frame. Of that number, nearly 7,700 — or approximately 8% — were citations for abuse, neglect or exploitation. 

Home-based care employment exceeding pre-pandemic levels Hospice News, by Jim Parker; 3/19/24 Employment in the home-based care sector rose above pre-pandemic levels in 2023, according to the Medicare Payment Advisory Commission (MedPAC). The U.S. Department of Commerce defines this sector to include hospices, home health agencies, private duty, pediatric agencies and other providers of care in the home. ... Nevertheless, workforce pressures and associated costs are overwhelmingly the industry’s most damaging headwind, including the associated wage hikes, enhanced benefits and bonus programs. The shortages also have reduced clinical capacity, which has contributed to drops in patient census and length of stay for many providers.

Personal care workers received most Medicaid fraud convictions in 2023: OIG McKnights Home Care, by Adam Healy; 3/15/24 More personal care workers were convicted for Medicaid fraud than any other provider type last year, according to a new report released Thursday by the Department of Health and Human Services Office of the Inspector General. OIG found that 279 personal care services (PCS) attendants were convicted of Medicaid fraud in 2023 — far more than the next four highest provider types combined. These convictions amounted to more than $10.5 million in criminal charges. 

For-profit nursing home owners rebut report that left few untarnished McKnights Long-Term Care, by Kimberly Marselas; 3/18/24 A brutal takedown of private nursing home ownership published last week included both pointed and widespread attacks on the role of for-profit companies in the sector, adding to stakeholders’ fears that negative characterizations will stymie much-needed future investment. ... However, what the article failed to highlight, providers and their representatives pointed out to McKnight’s Long-Term Care News Friday, are the investments many for-profits providers are pouring into quality and innovation efforts in a field with historically low margins — margins that they said dried up during the pandemic’s crisis days.Editor's Note: See the original article (posted above this summary) this article rebuts, "For-profit nursing homes are cutting corners on safety and draining resources with financial shenanigans - especially at midsize chains that dodge public scrutiny."

Dual eligibles, PACE expansion bill draws bipartisan support, industry endorsements McKnights Home Care, by Adam Healy; 3/18/24A bipartisan group of senators introduced legislation that would improve care coordination for dual-eligible beneficiaries and expand the Program of All-Inclusive Care for the Elderly to a larger share of people. The legislation’s primary function would be to require every state to develop a comprehensive, integrated health plan for dual-eligible beneficiaries, according to a summary. The bill also would require every state to allow PACE programs to be established, open up enrollment to any time in a given month, and extend PACE coverage to people under 55 years of age. 

Should the DOJ break up UnitedHealth Group? MedCity News, by Marissa Plescia; 3/17/24 The U.S. Department of Justice has reportedly recently launched an antitrust investigation of UnitedHealth Group, which begs the question of whether the healthcare giant should be broken up. Experts have varying opinions.

California Leads the State-Level Battle Against Hospice Fraud Hospice News, by Jim Parker; 3/13/24As hospice program integrity remains in the spotlight, California remains the only state to take action on curbing the problem. Beginning in 2021, numerous reports emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona. California’s Department of Justice (CDOJ) in 2021 issued a report detailing the state’s history of lax oversight.

A fond farewell: Musings on the end of the Medicare Advantage Hospice Carve-In Demonstration Husch Blackwell, podcast with Meg Pekarske and Chris Comeaux; 3/14/24It came as a surprise to our team when we learned that the Centers for Medicare & Medicaid Services (CMS) was ending the hospice component of Value-Based Insurance Design (VBID) on December 31, 2024. Upon learning this, Husch Blackwell’s Meg Pekarske contacted Chris Comeaux, the president and CEO of Teleios Collaborative Network, to see if he wanted to share his thoughts on this unexpected turn of events and what may be on the horizon. This is a forward-looking conversation where we explore how the lessons learned can galvanize new advocacy on the best ways to care for patients with advanced illnesses.

Nearly 53% of hospices undergo multiple audits simultaneouslyHospice News, by Jim Parker; 3/12/24Program integrity and an onslaught of audits are top of mind for many hospice providers in 2024. The nation’s four largest hospice industry organizations — LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO) and the National Partnership for Healthcare and Hospice Innovation (NPHI) — in late 2023 conducted a 133-respondent provider survey focused on regulation. ... About 52.9% reported having multiple audits, each of a different type, within six months of one another, and 31% said they were required to submit the same charts for each of these audits.

CMS Statement on continued action to respond to the cyberattack on change healthcareCMS.gov Press Release; 3/9/24 The Centers for Medicare & Medicaid Services (CMS) is continuing to monitor and assess the impact that the cyberattack on UnitedHealth Group’s subsidiary Change Healthcare has had on all provider and supplier types. Today, CMS is announcing that, in addition to considering applications for accelerated payments for Medicare Part A providers, we will also be considering applications for advance payments for Part B suppliers. 

Hospice provider experience underscores urgency of program integrity efforts: Findings reveal current audit process' shortcomings HomeCare News; 3/12/24 Following a series of meetings with the Centers for Medicare & Medicaid Services (CMS) and Members of Congress on efforts to improve and protect hospice program integrity, four national hospice organizations—LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO) and the National Partnership for Healthcare and Hospice Innovation (NPHI)—released findings of a hospice provider survey that the organizations say underscores the urgency and need for CMS and Congress to act.