Literature Review

Viewpoint: Care fragmentation, care continuity, and care coordination—How they differ and why it mattersJAMA Intern Med., by Lisa M. Kern, MD, MPH; Julie P. W. Bynum, MD, MPH; Harold Alan Pincus, MD; 1/29/24Health care in the US is characterized by fragmentation, with many patients seeing multiple physicians. Indeed, 35% of Medicare beneficiaries saw 5 or more physicians in 2019.1 Having multiple physicians may be appropriate, but it may also lead to medical errors, unnecessary visits, avoidable hospitalizations, and suboptimal care if all of the physicians do not have complete information about the patient and each other’s care plans.

Medicare and Medicaid programs; Quarterly listing of program issuances-October through December 2023 Federal Register, "A Notice by the Centers for Medicare & Medicaid Services"; 1/30/24  This quarterly notice lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published in the 3-month period, relating to the Medicare and Medicaid programs and other programs administered by CMS. 

Changing payment dynamics are forcing home-based care providers to level up in value-based careHome Health Care News, by Patrick Filbin; 1/24/24When home-based care professionals were tasked with providing the “greatest challenge” facing them in the new year, 58% responded staffing. After that, 31% said changing payment dynamics, while 7% and 4% said consolidation or non-payment regulatory changes, respectively. Those findings come from a recent survey conducted by Home Health Care News and Homecare Homebase.

In-home care providers await updates on CMS Medicaid proposal, begin preparing for 80/20 ruleHome Health Care News, by Patrick Filbin; 1/23/24Drawing parallels between the intentions of the Centers for Medicare & Medicaid Services (CMS) and the narrative of a Charles Dickens novel is an uncommon venture. ...  “When the 80/20 rule came out, many of us saw this as a ‘Tale of Two Cities’ situation,” Dave Totaro, chief government affairs officer at Bayada Home Health Care, recently said during a Home Health Care News webinar. 

A study of how Americans die may improve their end of lifeMedical Xpress, by Rutgers University; 1/24/24A Rutgers Health analysis of millions of Medicare records has laid the groundwork for improving end-of-life care by demonstrating that nearly all older Americans follow one of nine trajectories in their last three years of life.

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.

January 2024 MedPAC and MACPAC Data Book: Beneficiaries Dually Eligible for Medicare and MedicaidMedPAC; 1/22/24View and download the Data Book

$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).

US Senate launches investigation of assisted living after lay media reports about safety, staffing, pricingMcKnight's Senior Living, by Kimberly Bonvissuto; 1/17/24The US Senate Special Committee on Aging is launching a review of the assisted living industry following recent articles in the Washington Post, which reported on the deaths of residents who wandered from communities, as well as the New York Times and KFF, which scrutinized an industry pricing structure that adds fees on top of basic charges to cover additional services, as well as rate increases and the for-profit status of most providers.

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.