Literature Review

Hospice providers must be better regulatedScientific American, 2/1/24 (also ran last week)Too many hospice providers in the U.S. are run by private equity and for-profit corporations. A lack of regulation allows them to provide abysmal end-of-life care.

Number of Georgians dropped from Medicaid nears 500,000 The Atlanta-Journal Constitution, by Ariel Hart; 1/22/24Georgia has dropped at least 488,000 from Medicaid, the government health insurance for the poor, as part of a federally mandated project to ensure those covered by the program qualify to remain on it.

$15 billion win for physicians on prior authorizationAMA, by Kevin B. O'Reilly; 1/18/24Under the leadership of Administrator Chiquita Brooks-LaSure, the Centers for Medicare & Medicaid Services (CMS) has released a final rule making important reforms to prior authorization to cut patient care delays and electronically streamline the process for physicians. Together, the changes will save physician practices an estimated $15 billion over 10 years, according to the U.S. Department of Health and Human Services (HHS).

Congressional advisors grapple with Medicare Advantage data that reveals plenty on excess, but not much on accessMcKnight's Long-Term Care News, by Kimberly Marselas; 1/16/24Medicare Advantage risk scores continue to rise, inflating payments to the private plans that far exceed their actual costs, staff for a Congressional advisory commission warned members Friday. The Centers for Medicare & Medicaid Services uses risk scores, based on patient demographics and their needs, to establish payments to plans during each bid season. 

CMS.gov: Diversity, Equity and InclusionCMS.gov, by Chiquita Brook-LaSure; ongoing key referenceAt CMS, we believe that at the core of our organization are the employees that carry out the Agency’s vision: Advancing health equity, expanding coverage, and improving health outcomes. Editor's Note: This definitive resource equips your organization with CMS's definitions; resources; Diversity, Equity, and Inclusion Strategic Plan; and more.

Racial and ethnic differences in hospice use among Medicaid-only and dual-eligible decedentsJAMA Health Forum, by Julie Robison, Noreen Shugrue, Ellis Dillon, Deborah Migneault, Doreek Charles, Dorothy Wakefield, Bradley Richards; 12/23Hospice care enhances quality of life for people with terminal illness and is most beneficial with longer length of stay (LOS). Most hospice research focuses on the Medicare-insured population. Little is known about hospice use for the racially and ethnically diverse, low-income Medicaid population.

12 healthcare trends and issues we are following for 2024 Becker's Hospital Review, by Scott Becker and Molly Gamble; 1/2/24The year begins with a number of challenges that have only intensified for U.S. healthcare providers. Below are a dozen trends and issues that commanded our attention throughout 2023 and hold our curiosity in the year ahead. These patterns and shifts directly or indirectly influence how healthcare providers fare in 2024, and ultimately affect how Americans access, afford and receive care.

Unlicensed Saratoga County nursing home operator to pay $650,000Times Union (Albany, NY)December 21, 2023Ballston Spa, NY—The unlicensed operator of a now shuttered Saratoga County nursing home is set to repay Medicaid $656,000 after an investigation by the state attorney general’s office and U.S. attorney for the Northern District of New York found years’ worth of fraud and resident neglect at the facility. 

Think tank raises fraud, waste allegations within New York’s home care industryMcKnight’s Home Care DailyDecember 20, 2023On Tuesday, New York’s state assembly heard proposals regarding expansion of the healthcare workforce. But critics cautioned against overreach as the labor force is already “bigger and better paid than ever.” 

‘Tougher Every Day’—Nursing Home Operators, CCRCs Weigh in on Future of Skilled NursingSkilled Nursing NewsDecember 14, 2023Operating a skilled nursing facility today is considered a “tough business” with regulations and reimbursement woes making the space “tougher every day.” Other operators say they regularly budget a loss for skilled nursing services, and if it weren’t for other lines of business, skilled nursing would be unsustainable. 

2023 NHPCO Facts and Figures Report Now AvailableNews ReleaseDecember 13, 2023Alexandria, VA—The National Hospice and Palliative Care Organization has published its 2023 edition of Facts and Figures, an annual report on key data points related to the delivery of hospice care, including information on patient characteristics, location and level of care, Medicare hospice spending, and hospice providers. NHPCO Facts and Figures is the leading resource for hospice providers and others interested in understanding the work of the community. Editor's Note: Click here to access NHPCO's Report

MedPAC draws fire with draft recommendations for massive home health cut, hospice rate freezeMcKnight’s Home Care DailyDecember 12, 2023The Medicare Payment Advisory Commission offered initial recommendations for Congress to cut home health reimbursement by 7% and pause hospice payment updates in 2025. “The 2022 [home health] margins remain above 20%, higher than the long-run average of 16.8% since 2001,” Evan Christman, senior analyst at MedPAC, said during last Friday’s public meeting, according to a transcript. “Overall, these margins indicate that Medicare fee-for-service continues to pay well in excess of cost.” Part of the reason home health agencies reportedly saw margins of 22.2%, on average, according to Christman, is a decline in the number of visits per 30-day period. Since the implementation of the Patient-Driven Groupings Model in 2020, these visits have declined more than 15%; between 2021 and 2022, visits per 30 days declined 3.5%. Home health advocates were quick to dispute MedPAC’s claims. “There are many shortfalls in MedPAC’s home health margins report—starting with the fact that MedPAC’s analysis only captures a declining fraction of the Medicare home health population, ignoring that overall margins are low,” Joanne Cunningham, chief executive officer of the Partnership for Quality Home Healthcare, said in a statement. ... The Partnership and National Association for Home Care & Hospice cited poor methodology and data in the recent home health final rule, which contained a Medicare cut related to PDGM. MedPAC also recommended that Congress eliminate any payment updates for hospice providers in 2025.