Literature Review

Hospice handoffs may lower odds of Medicare denials Medscape, by Lara Salahi; 4/29/24Clearer communication between primary care clinicians and hospice providers may decrease the number of denied Medicare approvals for end-of-life treatment, according to a small study presented on April 18 at the American College of Physicians Internal Medicine Meeting 2024. Tyler Haussler, MD, acting medical director at  Brookestone Home Health & Hospice in Carney, Nebraska, said he conducted the study. ... CMS requires a "face-to-face encounter" between a physician and hospice caregiver to communicate clinical findings and determine the patient's terminal status. Missing or incomplete documentation of a patient's medical condition remains one of the main reasons the agency denies hospice coverage. 

'Speak Up & Speak Out,' LeadingAge members head to the Hill on Lobby Day 2024 HomeCare; 4/18/24 Senator Mike Braun (R-IN) joined Katie Smith Sloan, president and CEO of LeadingAge, and hundreds of the association’s nonprofit and mission-driven members for the kick-off of annual Lobby Day activities. More than 225 LeadingAge members, who serve older adults and families nationwide in a range of care settings and community types, ... headed to Capitol Hill on Wednesday, April 17 ...  [Leading Age members] visited their elected officials in the House and Senate to discuss critical aging services issues to ensure older adults and families can access the care and services they need to age with dignity, including [but not limited to]: 

Summaries: FFY 2025 Hospice, Inpatient Rehabilitation Facility, Skilled-Nursing Facility Medicare Payment Rules California Hospital Association, 4/17/24 What’s happening: Summaries of the hospice wage index, inpatient rehabilitation facility (IRF) prospective payment system (PPS), and skilled-nursing facility (SNF) PPS proposed rules are now available.What else to know: Comments on the proposed rules are due by May 28. The members-only summaries, from Health Policy Alternatives, Inc., describe proposals for the post-acute care Medicare prospective payment systems for federal fiscal year 2025: 

CMMI’s proposed TEAM Model offers another risk-based opportunity for home health providers Home Helath Care News, by Andrew Donlan; 4/15/24Last week, the Centers for Medicare & Medicaid Services (CMS) Innovation Center announced a new proposed model that will undoubtedly affect home health providers, and also allow them the opportunity to get more involved in value-based care initiatives. The Transforming Episode Accountability Model (TEAM), which would eventually be mandatory if finalized, would have selected acute care hospitals put under full responsibility for the cost – and quality – of care from surgery up until the first 30 days after hospital discharge.

New DOJ rules for online healthcare content make sure seniors aren’t taken offline McKnights Senior Living, by Aaron Dorman; 4/11/24The Department of Justice took steps earlier this week to help make sure old adults have appropriate access to valuable web content they need for understanding important healthcare and coverage decisions. State and government agencies, such as the Centers for Medicare & Medicaid Services, must abide by new technical standards, according to a new DOJ rule signed Monday [4/1/24]. “Just as stairs can exclude people who use wheelchairs from accessing government buildings,” the official rule states, “inaccessible web content and mobile apps can exclude people with a range of disabilities from accessing government services.” The technical requirements of the rule are extensive — the updated document is almost 300 pages long — but the overall purpose is to instruct agencies on their obligations to account for possible disabilities.

AMA, AHIP, NAACOS outline value-based care best practices Modern Healthcare, by Nona Tepper; 4/10/24 Health insurers, physicians and accountable care organizations issued recommendations Wednesday outlining what they see as the best ways to boost value-based care initiatives. The report from the health insurance trade group AHIP, the American Medical Association and the National Association of ACOs focuses on total-cost-of-care contracts, ACOs that typically span three to five years and have demonstrated success improving quality and reducing costs, according to the organizations.

New study calls home health star ratings into question McKnights Home Care, by Adam Healy, 4/11/24A comparison of agency-reported functional measures and claims-based hospitalization measures raises doubts about the value of star ratings as a means of evaluating home health agency (HHA) quality. The study, published Wednesday in JAMA Network Open, analyzed differences between claims-based and agency-reported outcomes for nearly 23 million patient episodes before and after the introduction of the star ratings system to compare changes over time. 

New hospice physician requirements sow claims submission confusionMcKnights Home Care, by Adam Healy; 4/8/24As hospice providers prepare for new physician certification rules going into effect next month, many are still seeking clarification from the Centers for Medicare & Medicaid Services on how the new rules will affect claims processes, experts said in a recent webinar. “The new requirement is effective May 1, 2024,” Katie Wehri, director of regulatory affairs for the National Association for Home Care & Hospice, said during the webinar Thursday. “We know that is right around the corner, and we have some concerns about that date, frankly, because of some of the inconsistent instructions that we have seen from CMS.”

Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements Federal Register; A Proposed Rule by the Centers for Medicare & Medicaid Services on 4/4/24This document has a comment period that ends in 53 days, 5/28/24.This proposed rule would update the hospice wage index, payment rates, and aggregate cap amount for Fiscal Year (FY) 2025. This rule proposes changes to the Hospice Quality Reporting Program. This rule also proposes to adopt the most recent Office of Management and Budget statistical area delineations, which would change the hospice wage index. This rule proposes to clarify current policy related to the “election statement” and the “notice of election”, as well as to add clarifying language regarding hospice certification. Finally, this rulemaking solicits comments regarding potential implementation of a separate payment mechanism to account for high intensity palliative care services.

CMS: Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F)CMS, Medicare Part D, Policy; 4/4/24On April 4, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the Medicare Advantage Program, Medicare Prescription Drug Benefit Program (Medicare Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications. Additionally, this final rule addresses several key provisions that remain from the CY 2024 Medicare Advantage and Part D proposed rule, CMS-4201-P, published on December 14, 2022. ... This fact sheet discusses the major provisions of the 2025 final rule which can be downloaded here: https://www.federalregister.gov/public-inspection/2024-07105/medicare-program-medicare-advantage-and-the-medicare-prescription-drug-benefit-program-for-contract

It’s past time for an upgrade to the Medicare Hospice BenefitHealth Affairs, by Cara L. Wallace and Stephanie P. Wladkowski; 4/5/24When most people think about hospice care, they imagine someone such as the late Rosalynn Carter, who enrolled onto hospice and died within a few days. Jimmy Carter’s long hospice stay, now more than a year, has shown a different model for hospice—one that supports its mission to help people live well, with dignity and quality of life, for whatever time remains. However, current policy restrictions to enroll and remain on hospice make it difficult for many hospice recipients to receive hospice care for “whatever time remains,” as 17.2 percent of Medicare hospice patients are discharged alive. Editor's Note: Many hospices used Jimmy Carter's one-year anniversary as a marketing tool that hospice is not really for the "dying." Many--if not most--of these articles were not transparent in identifying any type of recertification, decertification, or revocation processes. Yes, while it may be past time for CMS to upgrade the Hospice Benefit, it's also past time for hospice marketing to be more transparent with the public.

Elevating quality, outcomes, and patient experience through Value-Based Care: CMS Innovation Center’s Quality PathwayNEJM Catalyst; by Susannah M. Bernheim, MD, MHS; Noemi Rudolph, MPH; Jacob K. Quinton, MD, MPH; Julia Driessen, PhD; Purva Rawal, PhD; and Elizabeth Fowler, PhD, JD; 4/3/24The U.S. Center for Medicare and Medicaid Innovation is launching a new Quality Pathway to elevate patient-centered quality goals in the design and evaluation of alternative payment models. The Quality Pathway will align model design around quality goals; elevate outcomes and experience measures, particularly patient-reported outcomes; and ensure that evaluations have the ability to assess the impact of models on primary quality goals. These determinations will help the Innovation Center make critical decisions about which models to scale or expand in the pursuit of improving the quality of care for people with Medicare and Medicaid.

CMS finalizes 2025 Medicare Advantage rates Becker's Payer Issues, by Rylee Wilson; 4/1/24 CMS finalized a slight decrease in Medicare Advantage benchmark payments for 2025. The agency published its final rate notice for 2025 April 1. The final rule was largely similar to CMS' proposed payment rates issued in January. The agency will cut benchmark payments by 0.16% from 2024 to 2025. CMS estimated plans will see 3.7% higher revenue overall in 2025. MA risk score trend of 3.86% — the average increase in risk adjustment payments year over year — will offset risk model revisions that will lead to a 2.45% decline in revenue and a projected decline in star rating bonuses, according to the agency.