Literature Review

Hospice of Santa Cruz County enters regional partnership ahead of coming reimbursement model changes Modesto Bee, Scotts Valley, CA; by PK Hattis; 11/16/24 The health care landscape has changed a lot in the past 42 years, but for hospice care providers, some things have remained remarkably consistent. ... But that reimbursement process is about to be upended in only a few years and it has caused a handful of hospice providers, including a branch in Santa Cruz County, to form a regional partnership in hopes of ensuring the unique health care service endures for decades to come. Hospice of Santa Cruz County, founded in 1978 when the hospice movement was in its infancy, announced it has locked arms with four other nonprofit hospices and health care organizations to form Chapters Health West - a coalition that will allow the organizations to pool resources ahead of an era of reimbursement model upheaval. "We've been here for 47 years; we want to be here for another 47 years," Hospice of Santa Cruz County CEO Cathy Conway told the Sentinel in recent interview from her office in Scotts Valley. "What got us here for the last 47 won't get us to the next 47 because these changes are happening."

Inside the Justice Department’s Amedisys-Optum lawsuit Hospice News; by Jim Parker; 11/18/24 ... DOJ’s chief concern is that the combination of the two companies would dampen competition in the hospice and home health space. Should the transaction proceed, Optum would control 30% or more of the home health or hospice services in eight states, according to the Justice Department’s complaint. The deal would expand Optum’s home health and hospice footprint to five additional states, allowing the company to gain nearly 500 locations in 32 states. “UnitedHealth Group Incorporated and Amedisys, Inc. are two of the largest home health and hospice service providers in the country,” DOJ indicated in the complaint. “Today, competition between UnitedHealth and Amedisys benefits millions of Americans who need home health or hospice services. But the proposed merger between UnitedHealth and Amedisys would forever eliminate that competition.”

CMS ramps up efforts to root out ‘door knocker’ hospice schemes Hospice News; by Holly Vossel; 11/15/24 The U.S. Centers for Medicare & Medicaid Services (CMS) recently elaborated on its plans to expand public education campaigns designed to help protect hospice beneficiaries from fraudulent actors in the space. ... “One of the areas we’re working with right now is to enhance education — beneficiary education specifically,” Pryor said during a recent CMS webinar. “We have hospice beneficiaries who are unfortunately fraudulently signed up for the benefit in these kind of, what we call, ‘door knocker scams.’” The scams include bad actors reaching out to beneficiaries with offers of free goods and services, such as groceries, TVs, reclining chairs and furniture, Pryor explained. The fraudulent marketing tactics are posing significant complications for Medicare beneficiaries, he said.

Palliative care, ACO collaborations fuel ‘historical savings’ in MSSP Program Hospice News; by Holly Vossel; 11/11/24 Palliative care providers that form collaborative partnerships with Accountable Care Organizations (ACOs) may be lending to a landmark downward trend in health care spending in the value-based payment landscape. The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced that its Medicare Shared Savings Program (MSSP) yielded more than $2.1 billion net savings in 2023 — the largest amount in the program’s inception more than a decade ago, according to the agency. ACOs participating in MSSP earned an estimated $3.1 billion in shared savings payments during the program’s 2022 to 2023 performance year, the highest dollar amount thus far, CMS reported. [Click on the title's link to continue reading.]

Homecare owner allegedly withholds $86k in wages HomeCare, Indianapolis, IN; 11/11/24 The U.S. Department of Labor (DOL) has alleged that home health care company owner Hahn March violated federal wage laws and withheld $86,000 in wages by using improper pay practices at her two Indianapolis, Indiana, companies: Signal Health Group Inc. and SHG Employee Leasing Company. In 2018, federal investigators cited March for not paying overtime wages to employees at her then-owned company, Aging and Disabled Home Healthcare. ... The complaint was filed following an investigation by the DOL Wage and Hour Division, which discovered March and Nancy Stanley, the chief financial officer of both companies, used an artificial regular rate pay scheme to lower hourly pay rates and, in turn, shortchanged employees $86,427 in overtime wages. ... The DOL is seeking $172,854—including $86,427 in back wages and an equal amount in liquated damages—for 43 current and former employees. ... “Employees who work in home health care—one of our nation’s lowest-paying professions—provide necessary daily and hospice care that allow individuals to remain in their homes and aid them in navigating their basic needs, providing dignity and comfort to clients and their families,” said Aaron Loomis, Wage and Hour Division district director.

Long-term care market to grow by USD 394.8 billion from 2024-2028, as aging population drives demand with AI impact on market trends - Technavio Cision; by PR Newswire; 11/8/24 Report on how AI is redefining market landscape - The global long-term care (LTC) market size is estimated to grow by USD 394.8 billion from 2024-2028, according to Technavio. The market is estimated to grow at a CAGR of over 3.21% during the forecast period. Growing demand for long-term care from aging population is driving market growth, with a trend towards expansion and growth of several healthcare domain. However, lack of skilled nursing staff for long-term care  poses a challenge.Key market players include Abri Health Care Services LLC, Amedisys Inc., Brookdale Senior Living Inc., CareOne Management LLC, Diversicare Healthcare Services Inc., Extendicare Canada Inc, FCP Live In, Genesis Healthcare Inc., Honor Technology Inc., Illumifin Corp., Kindred Health Holdings LLC, Life Care Centers of America Inc., Revera Inc., SeniorLiving.org, Sonida Senior Living Inc., Sunrise Senior Living LLC, and Wickshire Senior Living.

How hospices can leverage palliative care to ‘stay relevant’ in value-based care Hospice News; by Jim Parker; 11/6/24 U.S. health care is moving steadily towards value-based reimbursement, and having a robust palliative care program can help hospices ensure they are not left behind. The U.S. Centers for Medicare & Medicaid Services (CMS) is working to ensure that 100% of Medicare beneficiaries are aligned with a risk-based payment model by 2030. This can include Medicare Advantage (MA) and Accountable Care Organization (ACO) programs. With hospice reimbursement confined to the traditional Medicare benefit, a palliative care program is a likely entry point for those providers to access value-based reimbursement, Sue Lynn Schramm, a partner of the hospice and palliative care consulting company Confidis LLC, said in a presentation at the National Hospice and Palliative Care Organization Annual Leadership Conference. This may be even more the case now that the hospice component of the value-based insurance design model (VBID), often called the Medicare Advantage Hospice Carve-In, is ending on Dec. 31, Schramm said.

Longer hospice stays among dementia patients save Medicare dollars Hospice News; by Holly Vossel; 11/4/24 Hospice utilization has tripled among patients diagnosed with Alzheimer’s disease and related dementias (ADRD) during the past two decades. The trend has ignited concerns about these patients’ lengths of stay, as well as praise for hospices’ cost-savings potential. Massachusetts Institute of Technology (MIT) researchers analyzed Medicare fee-for-service claims spanning between 1999 and 2019, including data on hospice billing, patient enrollment, hospitalizations, health costs and chronic condition indicators. Roughly 14.7% of ADRD patients utilized hospices services in 2019, nearly triple the 4.4% of patients who received this care in 1999, according to the research, which was published in the National Bureau of Economic Research. The research compared billing claims among nonprofit and for-profit providers to explore spending associated with longer hospice stays among dementia patients. ...

20 Medicare FAQs: Do you know the answers? WealthUp; by Riley Adams, CPA; 10/29/24 Medicare is instrumental in ensuring that older adults, as well as individuals of all ages with certain medical conditions, have access to affordable health care. It’s also infuriatingly complex in some respects. According to the 2024 KFF Survey of Consumer Experiences, 37% of respondents said it was either “somewhat difficult” or “very difficult” to understand at least one of five aspects of their Medicare coverage. That’s at least better than employer-sponsored insurance (54%) or Medicaid (46%), but it’s still a high percentage that shows many Americans don’t know Medicare inside and out. ... I’ve compiled a list of some of the most frequently asked questions (FAQs) about Medicare, and (more importantly) answers to those questions. The better you understand this vital social program, the easier it should be to make educated decisions regarding it. [Click here and scroll down to "Common Medicare Questions."] 

LeadingAge: Diverting patients from SNF to home health does more harm than good McKnights Home Care; by Adam Healy; 10/28/24 Mounting evidence suggests that Medicare Advantage plans are directing beneficiaries to home health when they should receive skilled nursing facility care, which is negatively affecting providers’ care quality, according to LeadingAge. The Senate Committee Permanent Subcommittee on Investigations recently reported that MA plans may be diverting patients in need of SNF care to home health as a means of saving money. In an Oct. 25 letter, LeadingAge said this practice damages care quality and patient health outcomes, and asked the Medicare Payment Advisory Commission (MedPAC) to investigate the issue further. 

How today’s hospice fraud could warp tomorrow’s reimbursement outlook Hospice News; by Holly Vossel; 10/28/24 This is the second of a two-part Hospice News series that explores how fraud, waste and abuse in the hospice space could create headwinds for the industry at large. Fraudsters misspend millions of Medicare dollars annually, though the actual hospice-specific amounts are difficult to determine, regulators previously told Hospice News. Industry stakeholders have questioned whether the malfeasance will stymie the U.S. Centers for Medicare & Medicaid Services’ (CMS) ability to justify future reimbursement rate increases, which many hospice providers already consider insufficient to support the full range of their interdisciplinary services in today’s economic climate.

Medicare Part D paid millions for drugs for which payment was available under the Medicare Part A Skilled Nursing Facility Benefit HHS Office of Inspector General; Report Highlights; 10/27/24 What OIG Found: ... On the basis of our sample results, for 2018 through 2020, we estimated that up to the entire Part D total cost of $465.1 million was improperly paid for drugs for which payment was available under the Part A SNF benefit. Of that amount, we estimated that approximately $245.4 million was for drugs that the medical records showed were administered to Part D enrollees during their Part A SNF stays.What OIG Recommends: We made five recommendations, including that CMS work with its plan sponsors to adjust or delete PDEs, as necessary, and determine the impact to the Federal Government related to the Part D total costs of $953,370 for drugs associated with our sample items for which payment was available under the Part A SNF benefit; work with its plan sponsors to identify similar instances of noncompliance that occurred during our audit period and determine the impact to the Federal Government, which could have amounted up to an estimated $465.1 million in Part D total cost; and provide plan sponsors with timely and accurate information, such as dates of covered Part A SNF stays, to reduce instances of inappropriate Part D payment for drugs for which payment is available under the Part A SNF benefit. ... CMS concurred with all five recommendations.

Bill introduced to increase access to advanced wheelchairs HomeCare, Nashville, TN; 10/24/24 U.S. Senators Marsha Blackburn (R-Tenn) and Tammy Duckworth (D-Ill.) introduced the Choices for Increased Mobility Act (S 5154) to increase access to wheelchairs made with advanced materials by allowing Medicare beneficiaries to upgrade to lighter, more functional wheelchairs without bearing the entire upfront cost. These manual wheelchairs help prevent shoulder injuries, enhance maneuverability and reduce overall pain and fatigue for users. ... When the Medicare billing code for ultra-lightweight manual wheelchairs was established in 1993, materials like titanium and carbon fiber were not considered, as they were not yet in use for wheelchairs. As a result, ... providers have struggled to supply wheelchairs with these advanced materials at the fee schedule amounts set by Medicare.