Literature Review

8 health system CEOs on the turbulence defining 2025 Becker's Hospital Review; by Kelly Gooch and Kristin Kuchno; 4/16/25 From capacity constraints to reimbursement pressures, health system CEOs are navigating a changing healthcare landscape. One of the top concerns in 2025 is the potential for Medicaid funding cuts. A recent report estimates hospitals could face a $31.9 billion loss in revenue if federal proposals to scale back Medicaid expansion move forward. CEOs from across the country — including safety-net systems, academic medical centers and expanding regional providers — recently shared how they are preparing for continued uncertainty and what strategies they are prioritizing in response.

HHS restructuring and workforce reductions – key implications for the health care industry JD Supra; by Mintz.com; 4/15/25 ... As part of the department-wide restructuring plan, HHS is in the process of consolidating 28 different divisions into 15 divisions. As of April 4, 2025, it had also reduced the number of Regional Offices from ten to five. ... 

CMS clarifies physician referral authority, tightens attestation requirements in proposed hospice ruleInside Health Policy; by Jalen Brown; 4/11/25... The proposed rule would explicitly allow the physician member of the hospice interdisciplinary group (IDG) to recommend patients for hospice care, addressing a gap in current regulations over which physicians have that authority. While CMS already lets IDG physicians certify that a patient is terminally ill and eligible for hospice, the existing admission rules only name the hospice medical director or physician designee as authorized to recommend admission. CMS also wants to strengthen documentation requirements for hospice recertification, ... Starting at day 180 and every 60 days thereafter, Medicare requires a hospice physician or nurse practitioner (NP) to conduct a face-to-face visit with the patient before recertifying eligibility. After the visit, the clinician must provide a written attestation confirming that the visit occurred and was used to assess whether the patient still qualifies for hospice care. Under CMS' proposal, that attestation would also need to include the clinician's signature and the date signed, submitted as a clearly labeled section or addendum to the recertification form. 

Closing the gap in end-of life care coverage: The role of nonprofits in policy advocacy Forbes; by James Dismond; 4/14/25... As the demand for end-of-life care grows, so will the gap between the care that patients need and what they receive. ... Workforce shortages, restrictive regulations, outdated reimbursement models and misconceptions around hospice services are keeping millions of Americans from accessing quality hospice and palliative care services. ... These barriers disproportionately affect low-income families, rural communities and communities of color. ... Unlike for-profit entities, we can prioritize community needs over shareholders. We can prioritize patient well-being over profits—or, to say it more directly, we put people over profits. And I’ve seen firsthand how advocacy can drive progress. Nonprofits must engage in:

National Alliance for Care at Home responds to the FY 2026 Hospice Proposed Rule National Alliance for Care at Home, Alexandira, VA and Washington, DC; Press Release; 4/11/25 The National Alliance for Care at Home (the Alliance) issued the following statement [Fri 4/11] in response to the Centers for Medicare & Medicaid Services (CMS) Fiscal Year (FY) 2026 Hospice Wage Index proposed rule, which proposes payment and regulatory updates under the Medicare hospice benefit. The proposed 2.4% payment update fails to adequately address the mounting financial pressures facing hospices nationwide. With escalating operational costs driven by inflation, workforce shortages, and rising expenses for supplies and services, the proposed payment increase would threaten the ability of hospices to sustainably provide quality end-of-life care. “The proposed payment update for FY 2026 falls short of what is needed to sustain high-quality hospice care,” said Dr. Steve Landers, CEO of the Alliance. “Without meaningful adjustments, hospices across the country will face serious challenges—jeopardizing access to care for terminally ill patients and placing added strain on families already facing the unimaginable. ..."

Dr. Oz outlines vision for CMS: 8 notesBecker's Hospital Review; by Jakob Emerson; 4/10/25CMS Administrator Mehmet Oz, MD, said April 10 that his vision for the agency includes a commitment to President Trump’s “Make America Healthy Again” agenda and modernizing Medicare, Medicaid and the ACA marketplace. Eight notes:

Proposed FY26 Hospice Wage Index and Payment RateCMS press release; 4/11/25On April 11, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that proposes updates to Medicare payment policies and rates for hospices under the Fiscal Year (FY) 2026 Hospice Wage Index and Payment Rate Updated Proposed Rule (CMS-1835-P). [Major provisions include:]

Trump administration continues to defend nursing home staffing mandate in court McKnights Long-Term Care News; by Kimberly Marselas; 4/7/25 The federal government continues to defend a national nursing home staffing mandate in court, despite several members of the new presidential administration having expressed major concerns about the rule finalized in 2024. Department of Justice attorneys on Thursday again outlined their justification for the rule, telling the Eighth Circuit Court of Appeals that the Centers for Medicare & Medicaid Services did not exceed its legal authority in dictating 24-hour registered nurse coverage and 3.48 hours a day of direct patient care from every US skilled nursing facility. 

New administration’s appointees confirmed to lead key health agencies Association for Clinical Oncology (ASCO); Press Release; 4/3/25 Several presidential appointees have been confirmed to lead key health agencies that the Association for Clinical Oncology (ASCO) will work with during the new administration. These include:

Impact of outpatient palliative care services on resource utilization and cost management in a capitated Medicare populationJournal of Palliative Medicine; Parag Bharadwaj, Gagandeep Gill, Nathan Dyjack, Lindsay Fahnestock, Lorie D'Amore, Shuinn Chang, Nancy Hanna, Tanya Dansky, Gwyn Merz, Annamarie Jones, David Kim, Manjit Randhawa; 3/25The integration of palliative care into the U.S. health care system has grown significantly, with outpatient palliative care services (OPCSs) playing an increasingly vital role in managing patients with serious illnesses. Results [of this study] demonstrate substantial growth in OPCS enrollment, with a 129% increase from 2019 to 2023. Per-member-per-month costs showed a sustained reduction, with a 23% decrease by 2023. In addition, there were consistent reductions in ED [emergency department] visits and IP [in-patient] admissions, indicating effective outpatient care management. Patients transitioning from OPCS to hospice exhibited longer hospice stays, further emphasizing the benefits of early palliative care interventions.

HHS restructures duals, PACE offices amid department overhaul Modern Healthcare; by Bridget Early; 4/3/25 The Health and Human Services Department is reorganizing a handful of key programs for dually eligible enrollees and older adults, including laying off numerous staffers. HHS is shuffling how it manages care coordination for people dually eligible for Medicare and Medicaid under the Medicare-Medicaid Coordination Office and the Program of All-Inclusive Care for the Elderly. PACE, which had been poised for growth, offers home and center-based care mostly to dual-eligible Medicare and Medicaid enrollees who qualify for skilled nursing but can still live in their communities. A spokesperson for HHS said the department has “planned productivity enhancements for the PACE management department.” HHS did not elaborate on what management changes for the PACE program might look like.

Federal legislation would mandate hospice education upon hospital discharge McKnights Home Care; by Adam Healy; 4/2/25 A bill under consideration in Congress would require hospitals to educate patients about hospice care options upon discharge. HR 2437, introduced Thursday by Rep. Erin Houchin (R-IN), would amend Medicare policy to mandate that hospitals “provide information on available hospice programs to certain individuals upon discharge,” according to the bill. Although hospitals are not necessarily required to provide patients with information on available hospice programs upon discharge, they are encouraged to do so. [Continue reading ...]

Walgreens settles Illinois Medicaid fraud lawsuit for $5M Modern Healthcare; by Katherine Davis; 3/25/25 Walgreens Boots Alliance will pay $5 million to settle allegations that it violated U.S. and Illinois false claims statutes by improperly billing Medicaid and Medicare. The settlement, disclosed in court filings [3/24], marks the end of the dispute, which began 11 years ago when two whistleblowers claimed Walgreens’ practices violated statutes. ... The settlement, disclosed in court filings yesterday, marks the end of the dispute, which began 11 years ago when two whistleblowers claimed Walgreens’ practices violated statutes. ... The settlement funds will be divided among the U.S. government, the state of Illinois and the whistleblowers, according to court filings. All parties also filed a joint stipulation of dismissal yesterday. Walgreens declined to comment. [Continue reading; access to the full article may be limited to subscription ...]