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All posts tagged with “Regulatory News | Medicare.”
Making your Customer Experience [CX] investment strategy work
08/13/24 at 02:00 AMMaking 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."
Value-Based Insurance Design Model: Hospice Benefit Component
08/12/24 at 03:00 AMValue-Based Insurance Design Model: Hospice Benefit ComponentCMS email; 8/9/24Calendar Year (CY) 2024 Technical and Operational Guidance on the Conclusion of the Hospice Benefit Component. The guidance covers CMS’s requirements and expectations for the remainder of the Hospice Benefit Component’s operations through Calendar Year (CY) 2024 along with requirements and expectations for operations on and after January 1, 2025. This document covers the following topics:
Closing the gap in value-based care: Lessons from provider-led ACO experience
08/09/24 at 03:00 AMClosing 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.
Enhabit walks away from UnitedHealthcare after ‘9 months of unsuccessful negotiations’
08/09/24 at 03:00 AMEnhabit walks away from UnitedHealthcare after ‘9 months of unsuccessful negotiations’Home Health Care News; by Joyce Famakinwa;8/7/24Staying on course with its payer innovation strategy, Enhabit Inc. (NYSE: EHAB) has decided to walk away from certain Medicare Advantage (MA) payers – and namely UnitedHealth Group’s (NYSE: UNH) UnitedHealthcare. That decision, and the recent home health proposed payment rule, were top of mind for Enhabit leaders on Tuesday.
CMS 2025 Hospice Final Rule: Additional responses
08/07/24 at 03:05 AMCMS 2025 Hospice Final Rule: Additional Responses
Hospice advocate Judi Lund Person ... featured on Close Up Radio
08/07/24 at 02:00 AMHospice advocate Judi Lund Person ... featured on Close Up Radio Western Slope Now, Ashburn, VA; by EIN Presswire; 7/26/24 (article) and 7/29/24 (recording)... Talking about where you’d like to be, who you’d like to be, and what you’d like to do is essential to entering this life-stage with confidence and grace. As the former Vice President of Regulatory and Compliance at the National Hospice and Palliative Care Organization (NHPCO) and a longtime advocate for hospice services under Medicare, Judi Lund Person has been working hard for more than 40 years to protect the definition of hospice care and to provide resources and guides for hospice providers to meet the Medicare requirements and provide high quality hospice care. ... Her passion for supporting patients and families during and after death began as a child. “When I was 12, my dad had a heart attack at night and passed when he was only 42. With two younger sisters, ages eight and ten, I was stunned that no one seemed to know what to do with us concerning our grief as children. We were left to try and figure it out on our own. I always thought that wasn’t quite right. Deep down, that experience was a driver for my career. I always knew families deserved more support during the grieving process,” shares Ms. Person. Editor's Note: Click here for the session's description. Click here for the recording.
Healthcare providers wary CMS dementia pilot will not cover costs
08/06/24 at 03:05 AMHealthcare 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.
Home health sees spending, utilization decline as hospice equivalents grow, MedPAC reports
08/06/24 at 03:00 AMHome health sees spending, utilization decline as hospice equivalents grow, MedPAC reportsMcKnight's Home Care; by Adam Healy; 7/19/24Though hospice spending and utilization appear to be on the rise, Medicare spending on home health has fallen amid declining utilization in recent years, according to a new report by the Medicare Payment Advisory Commission. In 2022, the year of the most recent available data, Medicare home health spending shrank to $16.4 billion. That compares to $17 billion the year prior, the report found. Meanwhile, the number of home health users declined by 6.3% from 2021, and the overall share of Medicare beneficiaries that use home health shrank by 3% from the year prior. The total number of in-person home health visits decreased by 9.6% year-over-year in 2022... Meanwhile, the hospice industry has experienced both reimbursement and utilization gains in recent years, MedPAC reported. Medicare hospice payments rose 2.7% year-over-year in 2022, while the number of beneficiaries using hospice services ticked up by 0.4%. These patients are also receiving more care; the total number of hospice days provided to beneficiaries increased by 2% in 2022.
Hospice Coalition Questions and Answers: June 20, 2024
08/05/24 at 03:00 AMHospice 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.
Help improve the PEPPER Program
08/02/24 at 03:00 AMHelp improve the PEPPER ProgramPEPPER email; 7/30/24There is a temporary pause in distributing Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) as the Centers for Medicare & Medicaid Services (CMS) work to improve and update the program and reporting system. This pause will remain in effect through the fall of 2024. We recognize the importance of these reports to your practice. Therefore, during this time, CMS will be working diligently to enhance the quality and accessibility of the reports. In fulfilling this commitment, CMS seeks responses to a series of questions listed in the Request for Information (RFI). These questions will provide CMS with information that may be used to reevaluate PEPPERs and improve the effectiveness and accessibility of the program. The RFI (PDF) is available here. Responses are due on or before 08/19/2024 and must be provided via online submission at the following address: CBRPEPPERInquiries@cms.hhs.gov.
CMS 2025 Hospice Final Rule: Content and Initial Responses
08/01/24 at 02:00 AM[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.
HHS unveils major revamp to shift health data, AI strategy and policy under ONC
07/31/24 at 03:00 AMHHS unveils major revamp to shift health data, AI strategy and policy under ONC Fierce Healthcare; by Emma Beavins; 7/25/24 The Office of the National Coordinator for Health Information Technology (ONC) has been renamed and restructured, the Department of Health and Human Services (HHS) announced [July 25]. The restructuring will affect technology, cybersecurity, data and artificial intelligence strategy and policy functions. The agency will be renamed the Office of the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC). Head of ONC, Micky Tripathi, will hold the new title of assistant secretary for technology policy in addition to his title of national coordinator for health IT. ... Under ASTP, there will be an Office of Policy, an Office of Technology, an Office of Standards, Certification and Analysis and an Office of the Chief Operating Officer.
Medicare Program: FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements
07/31/24 at 02:00 AMMedicare 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.
Despite past storms’ lessons, LTC residents again left powerless
07/30/24 at 03:00 AMDespite past storms’ lessons, LTC residents again left powerless: How a long-term care facility prepares for and handles power outages is one of the first questions potential residents should ask KFF Health News - Rethinking65; by Sandy West; 7/29/24 ... Even after multiple incidents of extreme weather — including a 2021 Texas winter storm that caused widespread blackouts and prompted a U.S. Senate investigation — not much has changed for those living in long-term care facilities when natural disasters strike in Texas or elsewhere. ... [While] nursing homes face such federal oversight, lower-care-level facilities that provide some medical care — known as assisted living — are regulated at the state level, so the rules for emergency preparedness vary widely. ... Editor's Note: While this article is written for the public, its content applies to all hospices that (1) provide hospice facility care, and/or (2) partner with senior care facilities: nursing homes, long-term care, assisted living, senior living communities, and PACE. This can be an important QAPI analysis and gap improvement.
How Medicare Advantage, traditional Medicare differ on end-of-life care
07/30/24 at 03:00 AMHow 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.
New proposed federal legislation takes aim at concerns regarding perceived “looting” of health care systems by private equity investors
07/30/24 at 03:00 AMNew proposed federal legislation takes aim at concerns regarding perceived “looting” of health care systems by private equity investors JDSupra - Epstein Becker Green; by Melissa Jampol, Enrique Miranda, Kathleen Premo; 7/26/24On June 11, 2024, U.S. Senators Ed Markey and Elizabeth Warren from Massachusetts, introduced proposed legislation titled The Corporate Crimes Against Health Care Act (“CCAHCA”), aimed at addressing a perceived “looting” of health care systems by for profit private equity investors. According to Sen. Warren, the bill was introduced to “root out corporate greed and private equity abuse in the health care system,” “prevent exploitative private equity practices,” and to specifically ensure that actions such as “looting” do not happen again by addressing trigger events and targeting real estate investment trusts. ... Finally, the CCAHCA would require health care entities, including, but not limited to: ... a hospice program, a home health agency, ... to publicly report to the Secretary of Health and Human Services on an annual basis: (i) transactions entered into ... [Click on the title's link to continue reading.]
HIMSSCast: Improving patient safety and employee retention with best incident reporting practices
07/29/24 at 03:00 AMHIMSSCast: 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.
Youngstown hospice nurses help alert feds on alleged insurance fraud; company pays settlement
07/29/24 at 03:00 AMYoungstown 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.”
Medicare-Covered Services Near the End of Life in Medicare Advantage vs Traditional Medicare
07/27/24 at 03:00 AMMedicare-Covered Services Near the End of Life in Medicare Advantage vs Traditional MedicareJAMA Health Forum; by Lauren Hersch Nicholas, Stacy M Fischer, Alicia I Arbaje, Marcelo Coca Perraillon, Christine D Jones, Daniel Polsky; 7/24Financial incentives in Medicare Advantage (MA), the managed care alternative to traditional Medicare (TM), were designed to reduce overutilization. For patients near the end of life (EOL), MA incentives may reduce potentially burdensome care and encourage hospice but could also restrict access to costly but necessary services. MA enrollment was associated with lower rates of potentially burdensome and facility-based care near the EOL. Greater use of home-based care may improve quality of care but may also leave patients without adequate assistance after hospitalization.
Medicare physician pay has plummeted since 2001. Find out why.
07/25/24 at 03:00 AMMedicare 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:
Why home health providers should expect to see a ‘less draconian’ final payment rule
07/25/24 at 03:00 AMWhy home health providers should expect to see a ‘less draconian’ final payment rule Home Health Care News; by Joyce Famakinwa; 7/22/24 As home health providers continue to digest the proposed payment rule for 2025, National Association for Home Care & Hospice (NAHC) President William A. Dombi believes that the industry will ultimately see a comparatively toned down final rule. “We believe we will not end up with this proposed rule as a final rule,” he said during the opening presentation at NAHC’s Financial Management Conference in Las Vegas on Sunday. “We will end up with something less draconian. The cuts will be reduced because, No. 1, that’s what they’ve done for the last several years, and, No. 2, it’s an election year.” Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies.
These are the most common jobs in each state in the US
07/24/24 at 02:00 AMThese 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
07/23/24 at 03:00 AMHow 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.
Exhausted by prior auth, many patients abandon care: AMA survey
07/23/24 at 03:00 AMExhausted by prior auth, many patients abandon care: AMA survey AMA News Wire - American Medical Association; by Tanya Albert Henry; 7/18/24 Among America’s physicians, more than nine in 10 surveyed say that prior authorization has a negative impact on patient clinical outcomes. Most telling is that 78% of physicians reported that prior authorization often or sometimes results in their patients abandoning a recommended course of treatment, according to the results of the AMA’s annual nationwide prior authorization survey (PDF) of 1,000 practicing physicians. In addition to patients forgoing care, physicians also see the burdensome insurance company practice known as prior authorization leading to care delays and serious adverse events. [Click on the title's link for more specific stats.]
‘Bad apples in a barrel’: How fraudsters in home health care impact the entire space
07/23/24 at 02:00 AM‘Bad apples in a barrel’: How fraudsters in home health care impact the entire space Home Health Care News; by Joyce Famakinwa; 7/19/24 The home health industry has its very own boogeyman--the bad actor. However, there's a difference between providers that had made errors in claims ... [Subscription required to continue reading]