Literature Review

HIMSSCast: Improving patient safety and employee retention with best incident reporting practicesHealthcare IT News; by Andrea Fox; 7/26/24 By modernizing systems and improving leadership and culture to embrace reporting, healthcare organizations can better address the top 10 patient safety concerns for 2024, says Heidi Raines, founder and CEO of Performance Health Partners. Ultimately improving the quality of care healthcare systems deliver and preventing harm requires a degree of self-reflection. Along with digital transformation, putting an easy-to-use incident reporting system in place can help healthcare organizations address today's chief patient safety concerns, including medication errors, care delays, workplace violence and preventing patient falls, said Raines.

Medicare physician pay has plummeted since 2001. Find out why. American Medical Association - AMA; by Tanya Albert Henry; 7/17/24 Medicare physician payment—often called Medicare reimbursement—must be tied to an inflation index called the Medicare Economic Index (MEI). As part of its campaign to fix the unsustainable Medicare pay system, the AMA has outlined in a quick, easily navigable fashion why this payment fix needs to happen now. ... The AMA’s two-page explainer on the Medicare Economic Index (PDF) outlines how it incorporates these two categories reflecting the resources used in medical practices:

These are the most common jobs in each state in the US USA Today; by Sara Chernikoff; 7/22/24 The most common job in the U.S. is a three-way tie, according to data from the Bureau of Labor Statistics. Home health care and personal aides, retail workers and fast food counter workers ranked at the top of the list with 3.6 million workers in each occupation. ... The desire for home health and personal care aides is on the rise as the share of the elderly U.S. population grows exponentially. This occupation is the fastest growing among most states, news outlet Stacker, reported. ... Home health care aides typically assist people living with disabilities or with chronic illness. Personal care aides are often hired to care for people in hospice care, according to BLS. Advanced degrees are not required for most home health aides, rather those employed by home health or hospice agencies may need to complete formal training or pass a standardized test.Editor's Note: Federal requirements for nursing aides in hospice care are defined in the CMS Hospice of Conditions Participation §418.76 and for home health in the CMS Home Health Conditions of Participation §484.80. Additionally, extensive state laws exist, with differences between states.

How well does Medicare cover end-of-life care? It depends on what type Medical Xpress; by Mark Harden, CU Anschutz Medical Campus; 7/19/24 Not all versions of Medicare are created equal—and when it comes to end-of-life care, some versions may serve a patient's needs better than others. That's the focus of newly published research by Lauren Hersch Nicholas, Ph.D., MPP, a University of Colorado Department of Medicine and CU Cancer Center health economist, and her colleagues. The researchers analyzed the experiences of more than a million people receiving Medicare-funded services in the last six months of their lives. ... Their paper was published July 19 in JAMA Health Forum. What Nicholas and her colleagues found is that the kind of Medicare a patient is enrolled in can make a difference in whether that patient gets certain treatments, and whether the patient dies in a hospital or in hospice care.

Does Medicare pay for dementia care? Here’s what coverage you can expect for treatments and therapies Aol - Fortune; by Margie Zable Fisher; 7/18/24 Age-related memory loss is common, but more serious memory problems may be a sign of dementia, which is not a normal part of aging. ... Dementia patients have a variety of medical issues. “In addition to symptoms related to dementia, the overwhelming majority of dementia patients have one or more chronic health conditions,” says Matthew Baumgart, Vice President of Health Policy, at the Alzheimer's Association. Medicare (and Medicare Advantage) provide some coverage for dementia, beginning with the diagnosis, says Baumgart. [Click on the title's link for practical, user-friendly information about what Medicare provides arose the trajectory of dementia's progression. CMS's new GUIDE pilot program is described.]

C-TAC: CMS’ ‘Palliative’ Definition in 2025 Proposed Hospice Rule ‘Misaligned, Problematic’ Hospice News; by Holly Vossel; 7/12/24 Efforts to establish potential payment mechanisms for high-acuity palliative services within the Medicare Hospice Benefit will require greater clarity from regulators, according to the Coalition to Transform Advanced Care (C-TAC). The U.S. Centers for Medicare & Medicaid Services’ (CMS) 2025 proposed hospice payment rule contained a request for information (RFI) on the potential implementation of reimbursement pathways for “high intensity palliative care services,” such as chemotherapy, blood transfusion and dialysis. CMS in its proposed rule indicated that, “Hospice care changes the focus of a patient’s illness to comfort care (palliative care) for pain relief and symptom management from a curative type of care.” C-TAC’s recommendations are as follows: [Click on the title's link to read more.]

Chevron deference derailed The Rowan Report; by Kristin Rowan; 7/12/24 ... Chevron Deference in Home Health: Since the advent of the PDGM model, CMS has calculated payment rates based on its interpretation of budget neutrality. The National Association for Home Care and Hospice [NAHC] has disputed the validity of both the interpretation of budget neutrality and the formulas used to calculate it. Last year’s 2024 CMS Proposed Rule cut payment rates even further with a 2.890% Budget Neutrality permanent payment rate adjustment and a temporary rate adjustment to account for alleged overpayments from 2020-2022. The lawsuit filed against CMS in response to the 2024 Final Rule was dismissed. NAHC began pursuing an administrative review with CMS. [Click on the title's link to continue reading the discourse between CMS and NAHC, specific to home health.]

Senior living providers embrace role in CMS dementia care pilot program McKnights Senior Living; by Kimberly Bonvissuto; 7/11/24 Senior living providers named participants in the federal government’s new dementia care pilot program said they are excited to be part of a new effort to support people living with dementia and their family caregivers. The Center for Medicare and Medicaid Innovation, CMMI, announced the Guiding an Improved Dementia Experience, or GUIDE, model last summer. The Centers for Medicare & Medicaid Services launched the eight-year GUIDE model on July 1 and published the program participant list on Monday [7/8]. Eligible model participants are Medicare Part B-enrolled providers eligible to bill for Medicare services and that provide, or will provide, ongoing care to people living with dementia. Eligible organizations include accountable care organizations, home health and hospice agencies, Programs of All-Inclusive Care for the Elderly, and physician practices. Additional long-term care providers and other healthcare providers, however, can participate as partner organizations by contract with another Medicare provider/supplier to meet the program care delivery requirements. Assisted living residents who are Medicare beneficiaries may be part of the model. Editor's Note: Adding to our previously published posts about the new CMS GUIDE Program (7/10/24 and 7/11/24) and its use by hospice organizations, this article describes its use by senior living care providers. 

CMS: GUIDE Model Participants and Infographic CMS.gov and various press releases; retrieved from the internet 7/10/24 The Guiding an Improved Dementia Experience (GUIDE) Model is a voluntary nationwide model test that aims to support people with dementia and their unpaid caregivers. The model began on July 1, 2024, and will run for eight years. Editor's Note: Multiple press releases are populating across the internet. We share this list of links to information, participants, and sample press releases from well-known participants. 

3 pillars of effective hospice sales Hospice News; by Jim Parker; 7/8/24Hospices seeking to grow should consider building a culture of compliance driven by data, effective system design and accountability, including for its sales force. Compliance and sales should walk hand-in-hand, according to a recent report from the Transcend Strategy Group. This can help prevent sales staff from running afoul of regulations inadvertently as well as support sustainable growth, according to Tony Kudner, chief strategy officer for Transcend. ... “[Without] understanding of what the rules of the road are, you’re going to run into trouble,” he said. “Though no one-size-fits-all approach exists, providers can adapt three overarching strategies to support this kind of culture.”

Long-term care providers among 193 criminally charged, $2.75 billion in fraud recoveries so far in 2024McKnight's Senior Living; by Kathleen Steele Gaivin; 7/1/24The Justice Department has recovered more than $2.75 billion in false claims against healthcare providers and charged 193 defendants so far this year in criminal cases through its 2024 National Health Care Fraud Enforcement Action, and many of the cases involve nursing homes, home health or hospice agencies, and assisted living providers, according to a Thursday report from the department’s criminal division.

Survey: Adults dropped from Medicaid after pandemic faced healthcare access, affordability issues CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota; by Mary Van Beusekom, MS; 7/2/24 A survey of low-income adults in four southern US states shows that nearly half of those disenrolled from Medicaid after COVID-19 pandemic protections ended had no insurance in late 2023, leading to struggles to afford healthcare and prescription drugs and threatening to broaden a gap that had narrowed during expanded governmental benefits. The data were derived from 89,130 adult residents of Arkansas, Kentucky, Louisiana, and Texas participating in the National Health Interview Survey in 2019, 2021, and 2022. In 2023, states rechecked Medicaid eligibility after COVID-19 governmental protections expired, disenrolling millions. The average participant age was 48.0 years, and 51.6% were women. Researchers from Beth Israel Medical Center and Harvard Medical School published the results late last week in JAMA Health Forum.

Medicare Program: End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, etc. Federal Register; Proposed Rule by the Centers for Medicare & Medicaid Services; 7/5/24