Literature Review

Court Orders VitalCaring to place 43% of profits into trust for Encompass Health Hospice News; by Jim Parker; 12/3/24 A federal judge in Delaware has ordered home health and hospice provider VitalCaring Group and its private equity backers to share future profits with Encompass Health (NYSE: EHC). The case has a long circuitous history that dates back to 2022 when Encompass Health spinned off its home health and hospice business as a standalone company, now known as Enhabit Inc. (NYSE: EHAB) brand. At the time, VitalCaring CEO April Anthony was CEO of the Encompass home-based case segment. “Encompass is entitled to one recovery,” a court opinion indicated. “That recovery takes the form of an equitable payment stream of VitalCaring’s future profits to be administered via a constructive trust, certain mitigation damages, and attorneys’ fee.” The court ordered that 43% of VitalCaring’s future profits be placed in trust to benefit Encompass. The remaining 57% would go to VitalCaring’s private equity backers, the Vistria Group and Nautic Partners.

Hospice Oversight: 2024’s most impactful regulatory action Hospice News; by Jim Parker; 11/27/24 The past year has seen a slew of regulatory developments aimed at improving quality and combatting fraud in the hospice industry. The drive by regulators and members of Congress to strengthen oversight is fueled by two main factors. The first was two July 2019 reports on hospice quality from the Office of the Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS). These spurred passage of the Helping Our Senior Population in Comfort Environments (HOSPICE) Act, which mandated the establishment of a hospice Special Focus Program (SFP), among other actions. The second driving force was the emergence of fraudulent actors in the space in relatively large numbers, particularly concentrated in California, Nevada, Arizona and Texas. [Click on the title's link to continue reading this important information.]

Keeping referral partners happy after dropping contracts with Medicare Advantage plans Home Health News; by Audire Martin; 11/25/24 Home health providers may walk away from specific health plans due to financial feasibility, administrative burdens, or misalignment with their patient care values and priorities. However, this decision can create short-term challenges with referral partners and health systems, as they may have patients enrolled in those plans. “If a health plan consistently under-reimburses for services or requires excessive administrative hurdles, it may compromise the ability to deliver quality care efficiently,” Preston Lucas, chief financial officer at Interim HealthCare Great Lakes, told Home Health Care News. “Additionally, if the plan’s policies restrict access to necessary treatments or fail to support the level of care required for patients, it becomes difficult to sustain the partnership.” ... Maintaining open lines of communication and emphasizing the shared goal of providing high-quality care helps mitigate the short-term consequences of leaving a health system, according to Lucas.

National Alliance for Care at Home lays out 2024, 2025 priorities HomeCare, Washington, DC; 11/21/24 As 2024 starts to wind down and a new administration and Congress begins to take over in Washington, home health advocates are focused on two primary priorities: reversing planned reimbursement cuts for home health and reforming plans that target underperforming hospices. As Americans gather for Thanksgiving, “these are major family issues and also major national public policy issues of the highest level of strategic importance for our country,” said Dr. Steve Landers, CEO of the National Alliance for Care at Home, the organization formed by the recent merger of the National Association for Homecare and Hopsice and the National Hospice and Palliative Care Organization. “We’re not done with 2024 yet,” Landers said Thursday, Nov. 21. “We’ve got a lot that we want to accomplish right now, this year—and we’re looking to the future.” The number one priority, he said, is for Congress to intervene and stop home health payment cuts as outlined in a final rule from the Centers for Medicare and Medicaid Services (CMS). He said that the cuts would impact patient outcomes, reduce visits and hurt providers—and that they were implemented based on a Congressional mandate saying CMS should support home health.

Hospital at home saves lives and money: CMS report American Medical Association; by Jennifer Lubell; 11/22/24 A federal report to Congress on the Acute Hospital Care at Home initiative shows that at-home acute care produces lower mortality rates and post-discharge spending than traditional inpatient care while also yielding positive feedback from patients and caregivers. The Centers for Medicare & Medicaid Services (CMS) launched the home-care initiative in response to the COVID-19 public health emergency, granting waivers to individual hospitals to provide Medicare patients with inpatient-level home care. With 358 approved hospitals across 137 health systems in 39 states since its start in November 2020, this innovation in care delivery has become an important feature of the Medicare program. ... Importantly, these programs demonstrate clinically, and often more cost-effective care. “Numerous studies have demonstrated that many types of care that are currently delivered in an office or facility could be provided at home, with clinically appropriate, high quality, and cost-effective outcomes,” wrote the authors of the AMA report. About 15–20% of emergency and urgent care services and up to 35% of hospice services are capable of being administered at home. As home care continues to evolve, this service could provide up to 25% of post-acute and long-term care in the home. 

Empassion achieves $34 million in savings in novel Medicare program serving high needs patients Globe Newswire, New York City; 11/21/24 Empassion Health, Inc., the nation’s largest managed care provider of high-quality end-of-life care for adults living with serious illness so that they can have more good days, today reported near-record results for four Medicare Accountable Care Organizations (ACOs) serving Original Medicare lives in 35 states.  Specifically, Empassion achieved total gross savings of $34.1m in the High Needs Population Track of ACO REACH for Performance Year 2023 while managing a record number of lives – nearly 9,000 across 35 states – in total cost-of care arrangements.  This includes a 50-percent reduction of unnecessary hospital stays.  Empassion also earned the highest quality scores for provider communication and care coordination.  “While we are enormously proud of the $34 million in Medicare savings, more important is that Empassion provided high-quality end-of-life care for adults living with serious illness so that they had more good days,” said Robin Heffernan, the CEO of Empassion. “These outcomes are specific to Empassion and its unique model. ..." 

Pontiac hospital to lay off most of its staff as feds pull Medicare reimbursement Modern Healthcare; by Dustin Walsh; 11/19/24 Pontiac General Hospital plans to lay off most of its staff as CMS is cutting the troubled hospital from Medicare funding. The Pontiac, Michigan-based hospital is laying off 186 employees, including 94 mental health technicians, on Nov. 29. Another 62 employees, including 13 nurses, will be laid off Dec. 6 and Dec. 20, according to a WARN notice.

Hospices leaders: ‘Vigilant’ compliance pivotal in MAC auditing climate Hospice News; by Holly Vossel; 11/18/24 e auditing environment has heated up in the hospice industry, with inconsistencies reportedly proliferating among the various types of regulatory enforcement activity — particularly those performed by Medicare Administrative Contractors (MACs). The issue has some hospice providers delving deeper into a range of compliance strategies. Differences exist in the scope of data being reviewed by MAC auditors, as well as the audit appeals approval and denial processes, said Ashley Arnold, senior vice president of quality at St. Croix Hospice. The Minnesota-headquartered hospice provides care across 85 locations in 10 Midwestern states and has an average daily census of roughly 5,200 patients.  

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.