Literature Review

CMS Health Equity Data Book U.S. Centers for Medicare and Medicaid Services - Office of Minority Health; by CMS Office of Minority Health; published December 2024, email notifications 1/15/25 One of the six pillars of the Centers for Medicare & Medicaid Services (CMS) 2023 Strategic Plan is to, “Advance health equity by addressing the health disparities that underlie our health system.” The CMS Office of Minority Health (OMH) aims to advance health equity by providing broader access to data about the state of health equity across CMS’ programs. This Data Book presents summary information on disparities within CMS programs as demonstrated by data related to prevalence. ... This Data Book is intended for use as a readily-available information source on health disparities within the Medicare, Medicaid, and the Health Insurance Marketplace populations. This Data Book is organized into five key sections – CMS at a Glance, Demographics, Chronic Conditions, Behavioral Health, and Social Determinants of Health – so that Data Book users can jump to the section most relevant to their data needs. Within each section, data are presented by each population type.

The Alliance on CMS Hospice Special Focus Program Implementation: “Doubling down on a dangerous decision, eager to work with incoming administration to fix” National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 1/16/25 The National Alliance for Care at Home (the Alliance) issued the following statement in response to the news of hospice providers filing litigation against the Centers for Medicare & Medicaid Services (CMS) over their flawed implementation of the Hospice Special Focus Program (SFP). The Alliance and the broader hospice community, who have been engaged on this program since its inception, have repeatedly shared concerns directly with CMS staff at all levels. They warned that this approach would inflict unnecessary harm to patient care, cause confusion to families when selecting a hospice provider to care for their loved ones at the end of life, and will cause some providers to sustain irreparable damage. These concerns have been echoed by lawmakers, providers, and the leading national hospice trade organizations. “With CMS doubling down on a dangerous course of action by proceeding with the Hospice SFP in its current state—and offering no due process or administrative recourse to address or mitigate its flaws—some hospice providers will suffer irreparable harm and have no choice but to seek justice through the courts on behalf of their patients and mission,” said Dr. Steve Landers, CEO of the Alliance. [Click on the title's link to continue reading.]

Special Bulletin – CA Wildfires Public Health EmergencyCommunity Health Accreditation Partner (CHAP); Special Bulletin; 1/14/2025 HHS Declares Public Health Emergency for California to Aid Health Care Response to Wildfires. The declaration follows President Biden’s major disaster declaration and gives the Centers for Medicare & Medicaid Services’ (CMS) health care providers and suppliers greater flexibility in meeting the emergency health needs of Medicare and Medicaid beneficiaries. HHS has waived sanctions and penalties for violations of certain provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule against hospitals in the emergency area. [Click on the title's link to continue reading]

The most-read Health Affairs Forefront articles of 2024 Health Affairs; by Health Affairs; 1/8/25... [We] offer a look back at the most-read Health Affairs Forefront articles of 2024. Each year’s list has its own character. This year’s list is heavy on work by authors at the Centers for Medicare and Medicaid Services—in particular, articles from our Forefront Featured Topic “Accountable Care For Population Health,” which claimed the first three spots on the “top ten” roster.

Winter snow storm slams into over a dozen states in the East, Midwest USA Today; by Julia Gomez; 1/6/25 The Central Plains and Midwest are getting slammed by a winter storm , according to officials, and it's leaving over a dozen inches of snow in some places. Here's a look at what the storm is leaving behind. Over 60 million people in the Central Plains, Midwest and along the East Coast are being bombarded by heavy snowfall because of the "disruptive" winter storm moving through the area, according to the National Weather Service. Some areas could see snowfall anywhere between 8 to 14 inches. The storm is also expected to impact travel in Kansas City, St. Louis, Indianapolis and Cincinnati and bring the cities to a standstill.Editor's note: Are you ready for emergencies in your service areas? Click here for the CMS.gov Emergency Preparedness Rule. Click here for Wisconsin's CMS Emergency Preparedness Rule Toolkit: Hospices.

Hospital CEOs: What to expect from CMS next yearBecker's Hospital CFO Report; by Laura Dyrda; 12/13/24Healthcare providers will face more reimbursement challenges next year, S&P Global predicts, especially as demographic shifts increase the number of Medicare beneficiaries in many markets. Factors likely to pressure providers next year include:

CMS scraps value-based Medicare Advantage model [VBID]Modern Healthcare; by Bridget Early; 12/20/24Citing overspending, the Centers for Medicare and Medicaid Services is calling an early end to an initiative that aimed to provide better, more efficient care to Medicare Advantage enrollees. The Value-Based Insurance Design model, or VBID, will sunset at the end of 2025, CMS announced, just 20 months after the agency extended it until 2030. The latest data show “substantial and unmitigable costs” totaling $4.5 billion in 2021 and 2022, an amount "unprecedented in CMS innovation center models," CMS said in a news release Monday.

Hospice sues Medicare over alleged recouped overpayment errors Bloomberg Law; by Ganny Belloni; 12/23/24 A hospice sued the Biden administration over allegations an agency unlawfully attempted to recoup millions in purported overpayments through inaccurate sampling and extrapolation methods. The complaint, filed in the US District Court for the Western District of Missouri, claims that a Centers for Medicare & Medicaid Services contractor had extrapolated the amount the Medicare program incorrectly paid to a handful of beneficiaries under the agency’s hospice benefit to the full “universe” of claims made to Kansas City-based Crossroads Hospice from Nov. 1, 2008, through Oct. 31, 2010.

CMS names first Hospice Special Focus Program Cohort, delays list of future candidates Hospice News; by Jim Parker; 12/23/24 Finalized in the 2024 home health payment rule, the program is designed to identify poor performing hospices, mandate quality improvement and in some cases impose additional penalties. However, stakeholders in the hospice space have contended that the agency’s methodology for selecting hospices for the program is deeply flawed. For this reason, they have argued that the list of operators should not be made public. Though CMS published the list, it delayed the release of a second that would point to future candidates for the program. “CMS has also generated a list of future SFP candidates. We are not publishing the candidate list at this time, but we are sharing the underlying data used to create both lists to allow for external review, thereby ensuring transparency in the process by which low-performing hospices are identified,” the agency indicated on its website. “We will continue to work with providers, patients and their families, and industry, to improve hospice care across the nation.” Stakeholders applauded the delay, including the National Alliance for Care at Home. [Click on the title's link to continue reading.]

Convicted trio jailed for elder abuse Inland News Today, Riverside, CA; 12/18/24 A 7-year prison sentence has been meted out for the neglect and abuse of six severely disabled residents at an unlicensed Riverside care facility. Ronnel Tiburcio was convicted of six counts of elder abuse likely to produce great bodily harm. Earlier, co-defendants Joel Ombao and registered nurse Nimfa Molina were handed jail sentences. Ombao owned several hospice companies, including the unlicensed Secure Hands board and care facility where the victims were housed. Ombao, his assistant Tiburcio, and registered nurse Molina, were responsible for operating the facility and caring for the residents. When investigators first checked out the care facility, residents were being housed in squalor. Many of them were emaciated and dehydrated.

States ranked by nurse communication Becker's Hospital Review; by Mackenzie Bean; updated 12/13/24 Hospitals in Louisiana, Minnesota, North Dakota, Nebraska and South Dakota have the highest nurse communication scores, while hospitals in the District of Columbia have the lowest, CMS data shows. CMS collects and publicly reports data on nurse communication as part of its HCAHPS survey data. The nurse communication measure assesses the percentage of patients who reported that their nurses "always" communicated well. The data was collected in 2023 and published in CMS' Provider Data Catalog Oct. 30. Nationwide, 80% of patients reported nurses always communicated well, up one percentage point from the year prior, according to CMS data. [Click on the title's link for this ranked list.]

Hospice utilization rebounds to pre-pandemic levels, but fraud casts a shadow Hospice News; by Jim Parker; 12/17/24 The nation’s hospice utilization rate among Medicare decedents has once again surpassed 50%, for the first time since the pandemic. However, fraud issues in the space create questions around the quality of care patients are receiving. Hospice utilization reached 51.7% in 2023, up more than two percentage points from the prior year, according to recent data from the Medicare Payment Advisory Commission (MedPAC). This is the highest rate since 2019. MedPAC observed increases in utilization across the board, even when stratified into subgroups by age, sex, race and rural or urban location. ... Despite these positive trends, an influx of new hospices continued in states considered hotbeds for Medicare fraud, including Arizona, California, Nevada and Texas. Many of these new additions came in areas where additional hospices were likely not necessary based on the needs of the patient population. Georgia also saw a large spate of new providers emerge in 2023.

MedPAC advises cutting home health payments by 7 percent, freezing hospice payments in ’26 McKnights Home Care; by Liza Berger; 12/16/24 The Medicare Payment Advisory Commission (MedPAC) on Friday issued draft recommendations that entail cutting payments to home health agencies by 7% and freezing hospice payments in 2026. The body, which advises Congress on Medicare payment issues, issued the same recommendations last year. Providers, once again, were not pleased. “The recent recommendations by MedPAC regarding Medicare home health and hospice policy are misguided and deeply troubling,” Steve Landers, MD, CEO of the National Alliance for Care at Home, said in a statement to McKnight’s Home Care Daily Pulse. “Medicare hospice spending has not kept up with labor inflation in the past five years and the typical length of stay and proportion of beneficiaries accessing hospice has stagnated. With respect to home health, the recommendation for drastic cuts is based on a flawed analysis of agency margins that fails to account for all payers and the true financial health of the home health system.”