Literature Review

National health expenditure projections, 2023–32: Payer trends diverge as pandemic-related policies fade Health Affairs - Research Article - Costs & Spending; by Jacqueline A. Fiore, Andrew J. Madison, John A. Poisal, Gigi A. Cuckler, Sheila D. Smith, Andrea M. Sisko, Sean P. Keehan, Kathryn E. Rennie, and Alyssa C. Gross; 6/12/24 Health care spending growth is expected to outpace that of the gross domestic product (GDP) during the coming decade, resulting in a health share of GDP that reaches 19.7 percent by 2032 (up from 17.3 percent in 2022). National health expenditures are projected to have grown 7.5 percent in 2023, when the COVID-19 public health emergency ended. This reflects broad increases in the use of health care, which is associated with an estimated 93.1 percent of the population being insured that year. ... Amonth eh major payers, Medicare has the highest projected ten-year average spending growth rath, mainly because of enrollment into the program. [Click on the title's link to examine this article's content and tables.]

How the Supreme Court’s Chevron Decision could help stop home health cuts Home Health Care News; by Andrew Donlan; 6/28/24 On Friday, the U.S. Supreme Court upended the Chevron doctrine precedent. For home health industry purposes, that means a potentially weakened Centers for Medicare & Medicaid Services (CMS) moving forward. The news comes just two days after the home health proposed payment rule was released, which included significant cuts for the third straight year. Broadly, moving away from the Chevron precedent – usually known as the Chevron doctrine – will mean less regulatory power for government agencies. Government agencies often take their own interpretations of certain laws and statutes, and then act upon those interpretations. ... The National Association for Home Care & Hospice (NAHC) already filed a lawsuit against the U.S. Department of Health & Human Services (HHS) and CMS over rate cuts in 2023. “In our own analysis, we believe that providers of home health have been underpaid as it relates to budget neutrality,” NAHC President William A. Dombi said when the lawsuit was filed. “At minimum, we would expect to see the rate cuts from 2023, that were permanent readjustments to the base rate, and the one proposed for 2024, along with the temporary adjustments … to go away. The end product of that is that we would have a stable system to deliver home health services to Medicare beneficiaries.”

[Updated] CMS proposes over 4% cut to Home Health Medicare payments in 2025 Home Health Care News; by Andrew Donlan; 6/26/24 The U.S. Centers for Medicare & Medicaid Services (CMS) published its FY 2025 home health proposed payment rule Wednesday. With it, the agency signaled that more significant cuts could be on the way for providers. To rebalance the Patient-Driven Groupings Model (PDGM) and make it budget neutral, at least according to its internal methodology, CMS is proposing a permanent prospective adjustment to the CY 2025 home health payment rate of -4.067%. For CY 2023 and CY 2024, CMS previously applied a 3.925% reduction and a 2.890% reduction, respectively.

The opportunity for palliative care in ACO Flex Palliative Care NEws; by Audrie Martin; 6/24/24 On Jan. 1, 2025, the Center for Medicare and Medicaid Services (CMS) Innovation Center will begin implementing a payment model for primary care known as the Accountable Care Organizations (ACOs) Primary Care Flex Model under the Medicare Shared Savings Program (MSSP). The ACO Flex Model is a voluntary initiative to improve funding and other resources to support primary care delivery within the MSSP. The model encourages the formation of new, physician-led ACOs, particularly those serving underserved communities and addressing health disparities. This program is not just a test but also seeks to empower participating ACOs and their primary care providers to employ more innovative, team-based, person-centered and proactive approaches to care. [Click on the title's link for more information.]

ASTHO and NAMD call on Congress to fully fund Medicaid and CHIP in U.S. territories ASTHO - Association of State and Territorial Health Officials; by Jane Esworthy and Stephanie Rhodes; 6/20/24 In a joint letter to Congress, the Association of State and Territorial Health Officials (ASTHO) and the National Association of Medicaid Directors (NAMD) urged Congress to fully fund Medicaid and Children's Health Insurance Programs (CHIP) in the U.S. territories. ASTHO and NAMD request that Congress lift the annual Section 1108(g) allotment cap for all territories and authorize a permanent 83% Federal Medical Assistance Percentage (FMAP) for Puerto Rico. ... “ASTHO recognizes the importance of permanent, sustainable, and equitable Medicaid financing for all U.S. territories,” says Joseph Kanter, MD, MPH, ASTHO CEO. ... “Unlike the states, the U.S. territories face an annual cap on their Medicaid funding,” says Kate McEvoy, Executive Director of NAMD. “This has impaired the territories’ capacity to provide needed health care to Medicaid-eligible U.S. citizens and nationals. It has also held the territories back from making the structural investments in care delivery and value-based payment reform, workforce, IT systems, and program integrity that are crucial to high performing and innovative Medicaid programs.”

Compliance landmines in the hospice regulatory landscape Hospice News; by Holly Vossel; 6/14/24 Hospice providers are navigating a minefield in today’s regulatory environment to avoid getting caught up in the mix of fraudulent activity in the space. The current state of hospice regulations has providers walking compliance tightropes, according to Patrick Harrison, senior director of regulatory and compliance at the National Hospice and Palliative Care Organization (NHPCO). Fraud, waste and abuse exist in several different industries and health care is no exception. But the majority of hospices are striving to provide quality end-of-life experiences to terminally ill patients and their families, Harrison said at the Hospice News Elevate conference in Washington D.C. 

Red River Valley expands services for dual-eligible populationsHospice News; by Holly Vossel; 6/11/24North Dakota-based Hospice of the Red River Valley is focused on expanding its home- and community-based services among dual-eligible Medicare and Medicaid populations in need of greater support. Serious and terminally ill patients in lower socioeconomic and underserved regions face several competing challenges in accessing health care, according to Tracee Capron, executive director at Hospice of the Red River Valley. Developing a sustainable care delivery model that better addresses unmet needs among patients and their families requires significant investment, Capron said. 

Hawaiʻi is the first state to provide palliative care coverage EIN Presswire; by Governor JOsh Green, MD; 4/4/24 Governor Josh Green, M.D., and the Department of Human Services (DHS) Med-QUEST Division are pleased to announce that the Centers for Medicare and Medicaid Services (CMS) approved a new State Plan Amendment (SPA) to cover community palliative care services through Medicaid, making Hawaiʻi the first state in the nation to do so.  ... “After several years of hard work and collaboration with many community members and experts in the field, I am proud to announce that Med-QUEST is the first Medicaid program in the country to get this benefit approved,” said Governor Green. “This will greatly improve the quality of life and health outcomes for thousands of people who face serious medical conditions in our state. Hawaiʻi continues to lead the nation in innovations in health and health care.”  

Hospice CAHPS scores updated 5/22/24CMS CAHPS® website; multiple updates posted 5/22/24 CMS has posted numerous CAHPS® Hospice Survey updates. Click on the title's link to access the CMS site. Click on "Care Compare Reporting Updates" or the following 5/22/24 updates:

America’s biggest Medicaid insurer just pledged to help build nearly $1 billion of affordable housing: ‘We know 80% of what drives health is nonmedical’ Fortune Well; by Marco Quiroz-Gutierrez; 5/20/24The nation’s largest Medicaid insurer is pledging to help build nearly $1 billion worth of affordable housing in eight states as it moves to address one of the biggest determinants of health. ... “We know 80% of what drives health is nonmedical. Eighty percent,” Dr. Michelle Gourdine, senior vice president at CVS Health, said earlier in the conference. “We could have the best doctors in the universe and it would only fix 20% of the problem.”  

Hospice remains underserved by Medicare Advantage, data showsBioMedWire; 5/13/24 While the Medicare Advantage space grows bigger, it is difficult for regulators and the medical industry to decide how best to integrate hospice into MA programs. This is a major concern because hospice care is the only segment of the healthcare sector that isn’t catered for in Medicare Advantage (MA). ... Almost 50% of all individuals (1.7 million) on MA programs that succumbed to their terminal illnesses in 2022 were recipients of hospice services. ... 

Planning ahead: How Medicare services at home differ from at-home Medicaid The Mercury; by Janet Colliton; 5/10/24 When asked how they would like to receive long-term care services many consumers, probably most, indicate they would like to receive them at home. Expectations for extensive help at home with government support often exceed what is available and this, considering shortages in available health care workers and limited funding is likely to continue. However, knowing the differences between what is offered under Medicare versus Medicaid is extremely helpful. ... [Click on the title's link for practical, user-friendly descriptions of Medicare versus Medicaid at home, for short term rehab, hospice, and more.] 

Fraudulent hospice providers may be moving between states Hospice News; by Jim Parker; 5/7/24Fraudulent hospices continue to proliferate, and some may be moving between states to escape regulators. Beginning in 2021, numerous reports emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona. Thus far, California is the only state to take action on the issue, including a moratorium on hospice licensing. The U.S. Centers for Medicare & Medicaid Services has also taken steps to bolster program integrity.