Literature Review

Hospice providers must be better regulatedScientific American, 2/1/24 (also ran last week)Too many hospice providers in the U.S. are run by private equity and for-profit corporations. A lack of regulation allows them to provide abysmal end-of-life care.

CMS Strategic Plan [last modified 1/23/24]CMS.gov; 1/23/24[Includes CMS Strategic Pillars; CMS Accomplishments for 2022; 2023 CMS Strategic Framework; Cross-Cutting Initiatives; more]

$15 billion win for physicians on prior authorizationAMA, by Kevin B. O'Reilly; 1/18/24Under the leadership of Administrator Chiquita Brooks-LaSure, the Centers for Medicare & Medicaid Services (CMS) has released a final rule making important reforms to prior authorization to cut patient care delays and electronically streamline the process for physicians. Together, the changes will save physician practices an estimated $15 billion over 10 years, according to the U.S. Department of Health and Human Services (HHS).

US Senate launches investigation of assisted living after lay media reports about safety, staffing, pricingMcKnight's Senior Living, by Kimberly Bonvissuto; 1/17/24The US Senate Special Committee on Aging is launching a review of the assisted living industry following recent articles in the Washington Post, which reported on the deaths of residents who wandered from communities, as well as the New York Times and KFF, which scrutinized an industry pricing structure that adds fees on top of basic charges to cover additional services, as well as rate increases and the for-profit status of most providers.

MedPAC approves hospital, physician pay bump; Doubles down on post-acute cutsInsideHealth Policy, by Bridget Early; 1/12/24Congress’ Medicare pay advisors recommended pay raises in 2025 for hospitals and physicians along with extra so-called Medicare safety-net pay and voted Thursday ... to recommend a second year’s worth of post-acute pay cuts as it approved proposals that would lower base pay rates for skilled nursing facilities, home health agencies and inpatient rehabilitation facilities. 

CMS terminates 2 Centene Medicare Advantage plansModern Healthcare, by Nona Tepper; 1/8/24A pair of Centene Medicare Advantage plans must suspend enrollment and marketing because of poor star ratings, the Centers for Medicare and Medicaid Services notified the company.

Will we close the Medicare Advantage primary care gap in 2024?MedCity News, by Jim Bonnette; 1/8/24... Across all healthcare industry stakeholders, there is a pressing need to address this growing concern: MA members without primary care physicians (PCPs). This cohort, called the MA Primary Care Gap, may present the highest risk to health plans as MA becomes their fastest-growing segment . ... Furthermore, the MA Primary Care Gap is widening due to industry shortages of primary care providers and the rise of healthcare deserts in both rural areas and under-served urban areas. The absence of primary care physicians is particularly troublesome for Medicare Advantage patients with multiple chronic diseases and complex healthcare needs.

The Wall Street Journal: Exclusive: Cigna nears deal to offload Medicare businessThe Wall Street Journal, by Laura Cooper, Anna Wilde Mathews and Lauren Thomas; 1/3/24Cigna is in advanced talks to sell its Medicare business in an about-face for the health-insurance giant, which had been expanding its footprint in the fast-growing sector. Cigna, which has been running an auction for the business, known as Medicare Advantage, is now in exclusive talks to sell it to Health Care Service Corp. for between $3 billion and $4 billion, according to people familiar with the matter. Editor's Note: Access to the full article requires a subscription to The Wall Street Journal

12 healthcare trends and issues we are following for 2024 Becker's Hospital Review, by Scott Becker and Molly Gamble; 1/2/24The year begins with a number of challenges that have only intensified for U.S. healthcare providers. Below are a dozen trends and issues that commanded our attention throughout 2023 and hold our curiosity in the year ahead. These patterns and shifts directly or indirectly influence how healthcare providers fare in 2024, and ultimately affect how Americans access, afford and receive care.

Evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design Model Test: First three years of implementation (2020–2022)CMS Report; 12/29/23Year Two Evaluation Report - Key Takeaways: The Medicare Advantage (MA) Value-Based Insurance Design (VBID) model test enables MA insurers to offer one or more innovative benefit design options in eligible MA plans. The model aims to encourage the use of high-value care and promote healthy behavior, with goals of enhancing care quality, improving beneficiary health, and reducing spending. Most VBID benefits can be targeted based on beneficiaries’ chronic conditions or socioeconomic status (SES). A separate Hospice Benefit component is also included in the model. 

The Top 10 Home Health Care News Stories Of 2023Home Health Care NewsDecember 20, 2023In the first year that truly felt “post-COVID,” home-based care providers did not see a shortage of challenges. Instead, in 2023, home health providers saw another year defined by payment struggles, with both the Centers for Medicare & Medicaid Services and Medicare Advantage plans.  ... Reflect back on this year in home-based care by revisiting 10 of HHCN’s most widely read stories.

Largest nursing home in St. Louis closes suddenly, forcing out 170 residentsAssociated PressDecember 18, 2023St. Louis, MO—The largest skilled nursing facility in St. Louis has closed suddenly, forcing about 170 residents to be bused to other care centers. Many left with nothing but the clothes they were wearing. The abrupt shutdown of Northview Village Nursing Home on Friday came after workers learned they might not be paid and walked out, confusing residents and their relatives. Many family members gathered through the day Saturday outside the facility on the city’s north side. Some didn’t immediately know where their loved ones were taken.