Literature Review

Cost report prompts tweaks to ACO REACH model Modern Healthcare; by Bridget Early; 8/12/24 The Centers for Medicare and Medicaid Services is making changes to its largest accountable care organization experiment to ensure it’s actually saving money. In a notice published on its website Aug. 1, CMS outlines a slew of planned updates to the ACO Realizing Equity, Access and Community Health, or ACO REACH, model in 2025. Notably, the agency is changing how it establishes benchmarks for "high-needs population" ACOs to guard against overspending while addressing the so-called "ratcheting effect," under which ACOs that contain spending face higher hurdles to earning shared savings in future years because of their past successes. [Limited access due to paywall.]

NAHC President Dombi: There’s ‘good and bad’ to payers entering home health care Home Health Care News; by Joyce Famakinwa; 8/13/24 Before retiring at the end of year, National Association for Home Care & Hospice (NAHC) President William A. Dombi still has items to check off his to-do list. On the top of this list is the previously announced NAHC and National Hospice and Palliative Care Organization (NHPCO) merger. ... Ultimately, Dombi has seen home-based care evolve when he reflects back on his tenure at NAHC. ... [Dombi] sees the evolution of home-based care through large payers, such as Humana Inc. and UnitedHealth Group, investing in the space. “I think you can certainly look at it from a positive perspective, saying, these plans had options to invest in X, Y and Z in health care, and they chose home care and physicians,” he said. “Their forecast says it’s about community-based health care services.” However, he noted the downsides of payers investing heavily in the space, too. ...

Free CHAP Webinar: CMS Posts Final Hospice Rule - Quality changes and regulatory requirement Community Health Accreditation Partner (CHAP); taught by Dr. Jennifer Kennedy; posted 8/13/24, webinar will be 8/21/24, 1:00-2:00 pm EDTCMS posted the final rule for hospice providers which drives big changes into motion for 2025.  [Click here for the] Final FY 2025 Hospice Wage Index and Payment Rate Update/Quality Reporting Rule  (CMS-1810-F), posted on the Federal Register on August 7, 2024. This free webinar will be taught by Jennifer Kennedy, Vice President, Quality, Compliance and Standards, CHAP. She spent many years as a leader and nurse in diverse healthcare settings with the past 25 years in hospice and palliative care. Dr. Kennedy came to CHAP in 2021 with a vision of moving the organization’s quality forward as “the” accreditation partner of choice for the majority of community-based providers. She believes no matter what type of care a patient receives or how many times they receive care, every experience should be of the highest quality. Webinar Objectives:

CMS unveils services available to patients in the GUIDE Model, integrates palliative care principles Hospice News; by Jim Parker; 8/12/24 The U.S. Centers for Medicare & Medicaid Services (CMS) has outlined the range of services that will be available to patients aligned with the agency’s Guiding an Improved Dementia Experience (GUIDE) payment model. The payment model is designed to improve quality of life for dementia patients and their caregivers by addressing care coordination, behavioral health and functional needs. While the model does not use the term “palliative care,” it does incorporate principles and practices traditionally associated with those services, such as interdisciplinary care and caregiver support, among others. ... Nearly 400 health care organizations are developing Dementia Care Programs (DCPs) to potentially serve hundreds of thousands of Medicare beneficiaries nationwide, the CMS stated in a fact sheet. 

Making your Customer Experience [CX] investment strategy work CMSWire [not to be confused with CMS=Centers for Medicare & Medicaid Services]; by Jeb Dasteel, Amir Hartman, Brian P. O'Neill and Marc Madigan; 8/12/24 Uncover the key elements of a successful customer experience strategy, from capability planning to aligning with core business objectives. ... Investing in a customer experience strategy is fraught with complications and feelings. Most of us in the world of CX are here because we believe that thoughtful CX spending will make an impact on the performance of our company.Editor's Note: This article is written for a much larger scope than our hospice and palliative readership. However, it highlights the importance of tying "customers' experiences" to the company/organization's core goals and business objectives. The Centers for Medicare & Medicaid Services' CAHPS Hospice Compare Scores [not to be confused with this CMSWire source] reflect the hospice "customer experience," from the perspective of the bereaved caregiver. While the CMS Hospice Compare site sorts these public information scores alphabetically (per location and organization), our newsletter's sponsor Hospice Analytics' National Hospice Locator sorts this same data by the highest scores, for the purpose of helping the public "consumer" find the hospice that will provide them with the best "customer experience."

Closing the gap in value-based care: Lessons from provider-led ACO experienceHealth Affairs; by Clive Fields, Gary M. Jacobs; 8/6/24Achieving the Centers for Medicare and Medicaid Services’ (CMS’s) goal to bring every Medicare patient into a value-based care (VBC) arrangement by 2030 requires bold action. With six years left to achieve that goal (as of January 2024), only half of current Medicare beneficiaries are aligned with an accountable care organization (ACO) providing care within a VBC arrangement. This gap is large, but accelerated participation and reaching the 2030 goal remain possible. To close the gap, policy makers must apply the lessons learned from the real-world experience of models developed by the Center for Medicare and Medicaid Innovation (the Innovation Center), the Medicare Shared Savings Program (MSSP), and other CMS demonstrations. ACOs participating in the MSSP and alternative payment models developed by the Innovation Center have proven that they can deliver high-quality care, improve the patient experience, and generate savings for Medicare. The Congressional Budget Office has found that physician-led ACOs and ACOs with a larger proportion of primary care providers, as opposed to specialists or clinicians in non-primary care settings, generate greater savings.

CMS 2025 Hospice Final Rule: Additional Responses

Healthcare providers wary CMS dementia pilot will not cover costsModern Healthcare; by Diane Eastabrook;7/23/24Hospitals, primary care practices and other healthcare providers are split over whether Medicare will pay them enough to cover dementia patients at home as part of a new pilot. Nearly 100 providers began enrolling patients July 1 in the Centers for Medicare and Medicaid Services’ Guiding an Improved Dementia Experience model, known as GUIDE. Another 300 others will begin enrolling patients in the program on July 1, 2025. Some participants that previously provided comprehensive wrap-around services for dementia patients at home said getting a monthly care management payment for each fee-for-service beneficiary will cover costs they had been absorbing. But others aren’t sure the reimbursement will be enough to scale up programs or cover the cost of care for these complex patients.

Hospice Coalition Questions and Answers: June 20, 2024Palmetto GBA; 7/15/2024Meeting Q&A and these attachments: Attachment A: Hospice Appeals Report 2024; Attachment B: Hospice CAP Updates.

[CMS Fact Sheet] Fiscal Year (FY) 2025 Hospice Payment Rate Update Final Rule (CMS-1810-F) CMS Fact Sheet - Final Rule (CMS-1810-F); 7/30/24 On July 30, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1810-F) updating Medicare hospice payment rates and the aggregate cap amount, for fiscal year (FY) 2025, in accordance with existing statutory and regulatory requirements. This rule also finalizes the proposal to adopt the most recent Office of Management and Budget (OMB) statistical area delineations, which impacts the hospice wage index and clarifies current policy related to the hospice “election statement” and the “notice of election” (NOE), as well as adds clarifying language regarding hospice admission and certification of terminal illness. The final rule summarizes public comments received related to the request for information regarding implementing a separate payment mechanism to account for high-intensity palliative care services. Editor's Note: Click here for the full Final Rule. 

Medicare Program: FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program RequirementsFederal Register; 7/30/24Highlights include finalization of a 2.9% increase in payment rate and Hospice Cap of $34,465.34 for FY 2025.

How Medicare Advantage, traditional Medicare differ on end-of-life care Becker's Payer Issues; by Rylee Wilson; 7/24/24 Medicare Advantage enrollees were less likely to receive burdensome treatments or transfers in the last months of life compared to their peers in traditional Medicare, a study published July 19 in JAMA Health Forum found. MA beneficiaries were less likely to die in a hospital than their counterparts in traditional Medicare, the study found. MA enrollees were more likely to receive home-based care at the end-of-life. This home-based care can improve quality but can also leave patients without adequate assistance after a hospitalization, the study's authors wrote. Though Medicare Advantage beneficiaries were less likely to be hospitalized during the last months of life than their counterparts in traditional Medicare, once hospitalized, MA enrollees were more likely to die in the hospital and less likely to be discharged to rehabilitative or skilled nursing facilities. 

Youngstown hospice nurses help alert feds on alleged insurance fraud; company pays settlementMahoning Matters; by Erina Anwar; 7/26/24 ... The U.S. Department of Justice announced on July 17 that federal prosecutors had settled with Gentiva, formerly known as Kindred at Home, after more than 20 whistleblowers — including two hospice nurses from Youngstown, Ohio — alerted the government for alleged fraud. The [Youngstown] nurses, Jason Medved and Anthony Donnadio, will receive a portion of the payout for reporting the fraud at a Youngstown hospice via a lawsuit they filed in 2023 under the federal False Claims Act (FCA). “As registered nurses, Jason and Anthony owed a duty to their hospice patients first and foremost,” Janel Quinn, a principal of The Employment Law Group said. “They were advocates for ethical medicine, even when it wasn’t easy. This settlement is a fitting recognition of their professionalism and their bravery.”