Literature Review

Study: Hospice care provides major Medicare savings Medical Xpress; by Peter Dizikes, Massachusetts Institute of Technology; 10/24/24 Hospice care aims to provide a health care alternative for people nearing the end of life, by sparing them unwanted medical procedures and focusing on the patient's comfort. A new study co-authored by MIT scholars shows hospice also has a clear fiscal benefit: It generates substantial savings for the U.S. Medicare system. ... In recent decades, hospice care has grown substantially. That growth has been accompanied by concerns that for-profit hospice organizations, in particular, might be overly aggressive in pursuing patients. There have also been instances of fraud by organizations in the field. Yet, the study shows that the overall dynamics of hospice are the intended ones: People are indeed receiving palliative-type care, based around comfort rather than elaborate medical procedures, at less cost.Editor's note: This study limited its data to for profit hospice agencies. That said, its results cannot be miscontrued to provide any type of comparison between for profits and non profits, in that data from non profits was (apparently) not examined.

New FTC regulations could create obstacles for hospice M&A Hospice News; by Jim Parker; 10/24/24 Changes to federal rules governing mergers and acquisitions could have sweeping effects on hospice and other health care transactions. The Federal Trade Commission (FTC) recently finalized a rule that will implement changes to required pre-merger notification forms. Pursuant to the Hart-Scott-Rodino Act, parties to certain transactions must submit these documents to the FTC and other regulatory agencies to help identify and address potential antitrust concerns. The law requires that transactions exceeding $120 million must submit the form, which agencies will use to conduct a 30-day premerger assessment, according to Luke Smith, member at the law firm Bass, Berry and Sims. The final rule will likely complicate the closing of some hospice acquisitions.

What hospices need to know about whistleblower lawsuits Hospice News; by Holly Vossel; 10/22/24 Hospices need to understand the range of risks involved in qui tam cases and how best to navigate whistleblower concerns amid an evolving regulatory landscape. Qui tam actions occur when a whistleblower, called a “relator” by the courts, files a False Claims Act suit on behalf of the government. The relator has the potential to receive a portion of any funds recovered by the government via the lawsuit, with amounts typically ranging from 15% to 25%. A federal judge recently found the qui tam clause unconstitutional, ruling that the relator’s role in sparking enforcement actions effectively makes them an executive branch officer appointed without due process.

[In case you missed it] The HOPE Assessment Tool: What you need to know [free webinar by CHAP]Community Health Accreditation Partner (CHAP); 10/21/24 On October 16, 2024, we hosted a webinar on the upcoming implementation of the HOPE Assessment Tool, which will catalyze hospice care starting in 2025. The webinar provided valuable insights into the tool’s implementation, content highlights, and its anticipated impact on hospice program operations. During the session, participants asked numerous important questions, many of which we’ve compiled into this FAQ for further clarification. Access the recorded session and handouts if you missed it or would like to review the presentation.

3 strategies for hospice GIP compliance Hospice News; by Jim Parker; 10/21/24 Utilization of the general inpatient level of care (GIP) is frequently the subject of audits by Medicare Administrative Contractors (MACs), and avoiding or responding to that scrutiny requires strict compliance to a complex web of rules. Audits are becoming more frequent in the hospice space, and GIP is an increasing focus, including ​for the most common types — Supplemental Medical Review Contractor (SMRC) and Targeted Probe and Educate (TPE). In a survey earlier this year, more than half of hospice providers reported having undergone multiple types of audits within a six-month period. ... In addition to these routine MAC audits, the U.S. Department of Health and Human Services Office of the Inspector General (GIP) has been performing a national audit of GIP utilization, as well as an additional investigation into management of the associated payment cap. The inpatient cap limits the number of days of inpatient care for which Medicare will pay to 20% of a hospice’s total Medicare patient care days, according to OIG. If GIP billing exceeds that metric, the hospice must refund those payments to Medicare.

BCBS reaches record antitrust settlement for $2.8B Becker's Payer Issues; by Jakob Emerson; 10/16/24  The Blue Cross Blue Shield Association, along with the 33 independent BCBS companies, have agreed to pay $2.8 billion to settle antitrust claims from healthcare providers, marking the largest settlement of its kind in the healthcare industry. In addition to the cash settlement, the plaintiffs stated in an Oct. 14 filing in Alabama federal court that BCBS plans must implement significant operational changes across 16 categories. These changes include how BCBS processes claims, communicates, contracts with, and makes payments to providers. The new operational requirements are expected to alleviate administrative burdens and inefficiencies experienced by providers, according to the plaintiffs' counsel. The settlement applies to providers who treated BCBS members between July 2008 and October 2024. The tentative agreement still requires approval from U.S. District Judge R. David Proctor. The BCBS Association denies the allegations made in the lawsuit.

CMS grants temporary relief for home health, hospice agencies affected by hurricane McKnights Home Care; by Adam Healy; 10/15/24 The Centers for Medicare & Medicaid Services has issued several temporary flexibilities intended to help hospices and home health agencies affected by Hurricane Helene continue to provide care amid the emergency. During the emergency period, home health providers may take advantage of extended deadlines for quality reporting and patient assessment requirements, according to CMS. The agency communicated last week that it would permit delayed Outcome and Assessment Information Set submissions, and it also extended the five-day completion requirement for patients’ comprehensive assessments to 30 days. These patients assessments may also be conducted remotely or by record view — a departure from the typical in-person requirement — during the temporary emergency period. CMS said that this change will allow patients to be cared for in the environment of their choice, reduce impacts on acute care and long-term care facilities, and maximize clinicians’ ability to care for patients with the greatest acuity.

New CMS Medicaid, CHIP Guidance could help clarify pediatric palliative care payment Hospice News; by Holly Vossel; 10/15/24 The Centers for Medicare & Medicaid Services (CMS) recently released new guidelines intended to better support state-based pediatric reimbursement systems and help improve equitable health access among youth populations. The new guidance includes best practices for state Medicaid programs and the Children’s Health Insurance Program (CHIP) to implement and comply with early and periodic screening, diagnostic and treatment (EPSDT) coverage requirements. One of the most significant challenges confronting children living with serious illness and their families is the heterogeneity of policies and programs across the country, said Allison Silvers, chief health care transformation officer at the Center to Advance Palliative Care (CAPC). ...

Care utilization for neurodegenerative diseases compared to patients with cancer Physician's Weekly; 10/14/24 Neurodegenerative diseases are a leading cause of death, yet healthcare utilization and costs during the end-of-life (EoL) period are poorly understood.  Researchers conducted a retrospective study to describe and compare resource utilization among U.S. Medicare decedents with neurodegenerative diseases and cancer. ... The results showed 1,126,799 Medicare beneficiaries, of which 357,926 had a qualifying diagnosis. Individuals with neurodegenerative diseases were older and more frequently received Medicaid assistance than those with brain or pancreatic cancer. ... The study concluded that individuals with neurodegenerative diseases were more likely to visit ED and less likely to utilize inpatient and hospice services at the EoL compared to those with brain or pancreatic cancer. 

Humana, UnitedHealthcare, Aetna fall in new MA star ratings Modern Healthcare; by Nona Tepper; 10/10/24 The Centers for Medicare and Medicaid Services sought to make it more challenging for Medicare Advantage insurers to win top quality scores and the payment bonuses that go along with them. It's working. On Thursday, CMS released the latest Medicare Advantage star ratings, and the contrast to just a few years ago is stark. In 2022, 74 Medicare Advantage with prescription drug coverage contracts garnered five-out-of-five stars. For the 2025 plan year, only seven did.

Why recent outages are a wake-up call for healthcare and regulators Forbes; by Chris Bowen; 10/11/24 When the CrowdStrike outage first started to show itself in the early hours of that hazy July morning, it was hard to believe that this wasn’t a hack or cyberattack. I was driving in my car that morning and looked up to see a digital billboard glitch into the "blue screen of death" before my eyes. Flights were grounded, travel was delayed, and nearly every Windows machine in the world was unusable. It was total mayhem. Clearly, this was an outage of major proportions, as millions of Windows systems worldwide essentially cratered. Caused by a faulty misconfiguration, we saw firsthand how the very digital advancements that have helped transform and modernize our world also expose us to more vulnerabilities than ever. ... In healthcare, this event laid bare the vulnerabilities we cannot overlook—the gaps that directly threaten patient care and safety. It’s a clear reminder of our industry’s utmost responsibility to patient privacy and well-being. ...

CMS memo hints at what hospices can expect under Special Focus ProgramMcKnight's Home Care; by Adam Healy; 10/8/24Hospices subjected to Special Focus Program (SFP) scrutiny will undergo frequent surveys, and noncompliant providers may face termination from the Medicare program, according to the Centers for Medicare & Medicaid Services. Under the SFP, hospices will receive surveys no less than every six months, and follow-ups may be needed, CMS said in a memo to state hospice survey agencies. Hospices that are found to have condition-level deficiencies will be required to complete appropriate enforcement remedies, which include suspension of payment, civil money penalties, directed plans of correction, directed in-service training or termination, according to CMS’ state operations manual. Hospices that have completed two SFP surveys within 18 months, have zero uncorrected condition-level deficiencies and zero pending immediate jeopardy or condition-level complaints may graduate from the SFP, CMS said. However, any hospice that does not comply with all of CMS’ requirements within the necessary timeframes may be considered for termination.

Temporary regulatory relief for South Carolina health care providers responding to Hurricane Helene Baker Donelson; Alissa D. Fleming; 10/4/24 South Carolina Governor Henry McMaster declared a State of Emergency on September 25, 2024, to prepare for Hurricane Helene. On September 29, 2024, the Federal Emergency Management Agency (FEMA) issued a Federal Major Disaster Declaration (FEMA-4829-DR) for South Carolina. On September 30, 2024, the United States Department of Health and Human Services (HHS) declared a public health emergency in South Carolina, and the Centers for Medicare and Medicaid Services (CMS) issued several blanket waivers to provide greater compliance flexibility and continuity of care while responding to Helene in the geographic area covered by the President's declaration. These waivers [detailed in the article] provide health care facilities with flexibility in service delivery, staffing, and patient care, aimed at alleviating the strain caused by Helene. Further, HHS, the South Carolina Department of Health and Human Services (SCDHHS), and other regulatory bodies have announced relief efforts, all aimed at reducing administrative burdens so providers can continue to care for and treat those in need. ...7. Hospices Assessment Timeframe Extension: CMS is extending the timeframe for updating comprehensive hospice patient assessments from 15 to 21 days, though initial and ad-hoc assessments must still be completed based on patient needs. ...Editor's note: Click on the title's link to continue reading. Other CMS waivers are defined for 1. General ... for Health Care Facilities; 2. Critical Access Hospictals; 3. Hospital and Long Term Care Facilities; 4. Skilled Nursing Facilities; 5. Home Health Agencies; 6. DME, Prosthetics, Orthotics, and Supplies; 7. Hospice (above); 8. Practioner Licensure and Enrollment ... HIPAA; Disaster Relief