Literature Review

Home health providers, CMS raise red flags over delayed access Modern Healthcare; by Diane Eastabrook; 10/11/24 Delayed home health access for Medicare beneficiaries is increasingly raising alarms from the Centers for Medicare and Medicaid Services and the home health industry as providers place blame on staff shortages and the program's reimbursement rates. More than a third of Medicare fee-for-service beneficiaries referred to home health following hospitalizations did not receive services within seven days of discharge, according to an analysis of 2023 Medicare claims from healthcare analytics company CareJourney. The report echoes a similar study published by the Commonwealth Fund in July, as well as concerns CMS raised about access in its proposed 2025 home health pay rule. ... Years of low Medicare reimbursements are taking a toll on the home health companies trade groups represent, said William Dombi, president emeritus of the National Association of Home Care and Hospice, which is part of the National Alliance for Care at Home, and Cunningham.

Two Los Angeles-area residents arrested on indictment alleging scheme to fraudulently obtain and launder Medicare proceedsUnited States Attorney's Office - Central District of California; Press Release; 10/9/24 A Los Angeles woman and a San Fernando Valley man were arrested today on a 24-count federal grand jury indictment alleging a scheme to defraud Medicare out of more than $54 million via hospice and diagnostic testing services that were never provided and then laundered their illicit proceeds, including by buying millions of dollars’ worth of gold bars and coins. Sophia Shaklian, 36, of the Larchmont area of Los Angeles, and Alex Alexsanian, 47, of Burbank, were arrested early this morning. They are scheduled to be arraigned this afternoon in United States District Court in downtown Los Angeles. ... According to the indictment that a federal grand jury returned on October 2, Shaklian, often using aliases, managed and submitted claims for seven health care providers enrolled with Medicare and located in Los Angeles County. These businesses included a hospice company she owned – the Pasadena-based Chateau d’Lumina Hospice and Palliative Care – and several diagnostic testing companies: Saint Gorge Radiology in Sylmar; Hope Diagnostics in North Hollywood; Direct Imaging & Diagnostics and Lab One – both located in Hollywood; and Labtech and Lifescan Diagnostics in Claremont.

The best bets for palliative care reimbursement post-VBID Hospice News; by Jim Parker; 10/8/24 The hospice component of the value-based insurance design model (VBID) will sunset at the end of this year, but opportunities for payment through Medicare Advantage and other models remain. The hospice component is part of the larger VBID program, which will continue through 2030. The component was designed to test coverage of hospice through Medicare Advantage. It also contained elements intended to expand access to palliative care, for which reimbursement in general is scarce. Hospice News spoke with Dr. Bob Parker, chief clinical officer and chief compliance officer for the Texas-based hospice provider Kindful Health, about the opportunities in place for palliative care providers. [Click on the title's link for this interview.]

Hosparus Health ranked fourth in nation for overall quality The News-Enterprise; 10/5/24 Hosparus Health has been ranked fourth in the nation for Overall Quality among the 50 largest hospices, according to a study published in the American Journal of Hospice & Palliative Medicine. This ranking was determined based on key metrics: Consumer Assessment of Healthcare Providers and Systems caregiver survey scores, employee satisfaction ratings from Glassdoor and sentiment scores from Google reviews. David W. Cook, president and CEO of Hosparus Health, expressed his pride in the organization’s staff. “Your care, your compassion, it’s those on the front line of our care,” Cook said. “It’s thrilling to see the recognition of what you do here celebrated nationally.” Since 1978, Hosparus Health has been at the forefront of hospice and palliative care services, caring for thousands of patients across Kentucky and Indiana, the release said. Today, the nonprofit organization, which has offices in Elizabethtown, continues to provide expert care and holistic support to more than 14,000 patients and families annually, ensuring that each individual receives compassionate, high-quality care during life’s most challenging times.

The road ahead: 2 pressures framing the future of hospice care Hospice News; by Jim Parker; 10/1/24 The workforce shortage and value-based care will shape the future of hospice, according to some providers. The health care reimbursement environment is moving towards significant change. The U.S. Centers for Medicare & Medicaid Services (CMS) has signaled its intention to align every Medicare beneficiary with a value-based payment system by 2030. To keep pace, hospice providers must start preparing now, according to Phil Ward, president and CEO of Community Hospice of Northeast Florida. We’re implementing quality movement projects now. So that when these changes come we’re not taken by surprise,” Ward said at the National Hospice and Palliative Care Organization (NHPCO) Annual Leadership Conference. ... The second major force that could mold the industry’s future is the staffing shortage, Leigh Anderson, medical director for Our Hospice of Indiana, said during the NHPCO conference. This includes issues like turnover, nurse-to-patient ratios and health care worker burnout, she said.

BREAKING NEWS 10/1/2024, 12:30pm - Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements; Correction Federal Register - The Daily Journal of the United States Government; Centers for Medicare & Medicaid Services  (CMS), Department of Health and Human Services (HHS); 10/1/24 This document corrects technical and typographical errors in the final rule that appeared in the August 6, 2024 Federal Register titled “Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements”.I. Background: In FR Doc. 2024-16910 of August 6, 2024 (89 FR 64202), there were a number of technical and typographical errors that are identified and corrected in this correcting document. The provisions in this correction document are effective as if they had been included in the final rule that appeared in the August 6, 2024 Federal Register . Accordingly, the corrections are effective October 1, 2024.II. Summary of Errors: ...Given these errors, we are republishing the FY 2025 Hospice Wage Index file accordingly on the CMS website at: https://www.cms.gov/​medicare/​payment/​fee-for-service-providers/​hospice/​hospice-wage-index effective October 1, 2024.

Alliance sees Hospice CARE Act as opportunity to advance hospice benefit discussionNHCPO / National Alliance for Care at Home; Press Release; 9/26/24 The National Alliance for Care at Home (the Alliance), a new national organization formed by the integration of the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) recognizes the introduction of the Hospice Care Accountability, Reform, and Enforcement (CARE) Act, by Congressman Earl Blumenauer (OR-3).  The Alliance shares Rep. Blumenauer’s desire to update the Medicare hospice benefit to address the evolving needs of our country’s aging population while ensuring the sustainability and integrity of the hospice program. As a long-standing champion of hospice care, Rep. Blumenauer has consistently demonstrated a commitment to ensuring that hospice services remain accessible, compassionate, and of the highest quality for patients and their families. The Alliance appreciates Rep. Blumenauer’s commitment to involving a diverse group of stakeholders in developing this legislation and will continue to work closely with congressional leaders on the finer points of the proposed bill to ensure that the final legislation supports the needs of patients, families, and providers alike. 

Blumenauer proposes overhaul to Hospice Benefit: If enacted, the legislation would be the single most significant update to the hospice benefit and payment structure since its inception in 1982.U.S. Congressman Earl Blumenauer, Washington, DC; Press Release; 9/26/24Today, Congressman Earl Blumenauer (D-OR), a senior member of the Ways and Means Committee, introduced the Hospice Care Accountability, Reform and Enforcement Act (Hospice CARE Act) to modernize Medicare’s hospice benefit, which has remained largely unchanged since its inception in 1982. The proposal comes as egregious reportsof fraud and abuse within the benefit persist, despite action from Centers for Medicare & Medicaid Services (CMS). The legislation is the product of years of collaboration between stakeholders, lawmakers, and industry leaders. It builds on Blumenauer’s decades-long commitment to ensure the federal government supports families at a time of great stress and vulnerability: the end of life. 

‘Think like a reviewer’: How hospices can use communication, documentation to boost quality McKnights Home Care; by Adam Healy; 9/24/24 Regulators are tightening their scrutiny of the hospice industry, so providers must prioritize the documentation and communication practices that help them obtain higher quality scores. That’s according to hospice industry experts who spoke during an educational session at the National Hospice and Palliative Care Organization’s annual meeting in Denver. “They’re looking closely at the hospice industry,” Angela Huff, senior managing consultant at Forvis Mazars, said last week during the conference. “They have increasing concerns about fraud, waste and abuse in this space. … Don’t think this is going to stop.” ... A key part of hospice quality assurance is communication, Gallarneau said. Providers should support open, friendly channels of communication. This helps staff and clients feel comfortable raising concerns, making quality issues easier to tackle quickly and effectively. Also, prioritizing accuracy in documentation will help providers stay ready for any surveys or audits, Gallarneau noted. Hospices should ensure patient consent and election of benefit forms are properly filled out, signed and dated, and staff should all be trained to do so accordingly. 

Cigna to cut Medicare Advantage plans in several statesModern Healthcare; by Lauren Berryman; 9/19/24Cigna Group's health insurance unit is scaling back Medicare Advantage offerings in eight states next year, according to a notice to third-party marketers published by the insurance brokerage Pinnacle Financial Services. Members in 36 health plans will be affected by Cigna Healthcare’s cuts and service area reductions in Colorado, Florida, Illinois, Missouri, North Carolina, Tennessee, Texas and Utah. Most people will have another Cigna Medicare Advantage plan available in their counties. The company's Medicare Advantage business is fully exiting at least three counties: two in Missouri and one in North Carolina, the notice said.

New red flags emerge in hospice UPIC auditing Hospice News; by Holly Vossel; 9/20/24 Unified Program Integrity Contractor (UPIC) auditors are taking a sharper look at nursing home room-and-board for hospice patients. Hospices have increasingly faced more regulatory scrutiny in recent years amid rising program integrity concerns, including ramped up UPIC audits, among various others. These audits are designed to instill oversight measures aimed at safeguarding against bad actors in the hospice industry. Regulators have been zeroing in around hospices’ data when it comes to patient interviews and Medicaid skilled nursing room-and-board payments, among other aspects of care delivery. These data could give UPIC auditors clues as to potential malfeasance. However, auditors’ data extrapolation methodology is flawed and poses risks for quality hospice providers, according to Bryan Nowicki, partner at the law firm Husch Blackwell.

How palliative care-ACO partnerships could reduce health disparities Hospice News; by Holly Vossel; 9/18/24 Palliative care providers engaging in Accountable Care Organization (ACO) relationships have the potential to make significant strides in bridging inequitable gaps of access. Groups of physicians, hospitals and other health care providers voluntarily join forces in ACOs, which are designed to offer high-quality, coordinated care to Medicare patients. Collaborating or contracting with ACO networks can help palliative care providers better understand and address the leading barriers among underserved populations as they move across the continuum, said Empath Health CEO Jonathan Fleece. The ACO reimbursement landscape includes incentives and quality measures designed to improve outcomes based on population needs. Providing palliative care through ACO relationships can result in greater potential to address patients’ full scope of medical, non-medical and psychosocial needs further upstream in their illness trajectories, Fleece stated, speaking at the recent Hospice News Palliative Care Virtual Summit.