Literature Review

Enhabit foresees smooth sailing on near-term hospice growth Hospice News; by Jim Parker; 9/5/24 Enhabit Inc. expects consistent hospice growth even as it contends with payer and reimbursement headwinds for its home health business. The home health and hospice provider recently terminated its home health contract with the Medicare Advantage payer UnitedHealthcare, a subsidiary of UnitedHealth Group, citing nine months of unsuccessful negotiations. In addition, Enhabit and the rest of the home health industry are facing a potential 1.7% rate cut from the U.S. Centers for Medicare & Medicaid Innovation’s proposed 2025 payment rule. Meanwhile, Enhabit’s hospice segment continues to grow sequentially.

Over 140 cars take part in 19th Lube-a-Thon for Hospice Portage.Life; by Center for Hospice Care; 9/10/24 Friday July 26 marked the 19th time Tom's Car Care Canter hosted its Lube-a-Thon for Hospice. From 7am until almost 6pm cars were lined up out to the street to get their oil changed for just a $45 donation to Center for Hospice Care. Even with the line, wait times weren't that long. The Tom's team was moving cars out on an average of five to six minutes each! Along with the oil change, patrons received a ticket for a free car wash (good until the end of October), a coupon for a free muffin or cookie and a cup of coffee or fountain drink as well as an event t-shirt. ... Thanks to all of the participants, sponsors and other donations, the 19th Lube-a-Thon for Hospice raised over $10,000 to help Center for Hospice Care improve the quality of living for those in our nine-county service area.

2024 NHPCO Facts and Figures Report now available National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 9/10/242022 Data Show First Increase in Hospice Utilization Rates Since COVIDThe National Alliance for Care at Home (the Alliance) published the 2024 edition of National Hospice and Palliative Care Organization (NHPCO) 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. Facts and Figures – the leading resource for hospice providers and others interested in understanding the work of the community – has been published annually for over two decades by NHPCO. ... The findings in this report reflect patients who received care in Calendar Year (CY) 2022, or Fiscal Year (FY) 2022, provided by hospices certified by the Centers for Medicare and Medicaid Services (CMS) and reimbursed under the Medicare Hospice Benefit. This year COVID-19 continued to impact patient care as COVID-19 waivers were still in place through May 2023. These waivers included increased telehealth services. With 49.1% of all Medicare decedents in 2022 choosing hospice care, utilization of hospice increased in 2022 for the first time since 2019. The increase hints at a normalization of the utilization rates back to pre-COVID data. Hospice utilization rates increased across all race and ethnicity groups, with the largest increase among Hispanic Medicare beneficiaries seeing. The total number of beneficiaries enrolled in hospice care in 2022 was 1.72 million. Due to the unique impact of COVID-19 on 2020 data, those data are not included in many of the charts this year.

Allowing patients to die: Louise Aronson and Bill AndereckGeriPal podcast; by Alex Smith, Eric Widera, Louise Aronson, Bill Andereck; 9/5/24In today’s podcast we set the stage with the story of Dax Cowart, who in 1973 was a 25 year old man horribly burned in a freak accident. Two thirds of his body was burned, most of his fingers were amputated, and he lost vision in both eyes. During his 14 month recovery Dax repeatedly demanded that he be allowed to die. The requests were ignored. After, he said he was both glad to be alive, and that the doctors should have respected his wish to be allowed to die. But that was 1973, you might say. We don’t have such issues today, do we? Louise Aronson’s recent perspective about her mother in the NEJM, titled, “Beyond Code Status” suggests no, we still struggle with this issue. And Bill Andereck is still haunted by the decision he made to have the police break down the door to rescue his patient who attempted suicide in the 1980s, as detailed in this essay in the Cambridge Quarterly of HealthCare Ethics.

More nonprofit hospices consolidating amid economic, regulatory pressures Hospice News; by Jim Parker; 9/12/24 As M&A in the for-profit space continues its two-year slump, nonprofits are consolidating in rising numbers. Recent years have seen an uptick in consolidation activity among nonprofits in the hospice space. Increasingly, nonprofits are pursuing acquisitions and affiliations, as well as forming regional collaboratives. In addition, some nonprofits have also been acquired by for-profit companies. Driving this trend are reimbursement and regulatory pressures, as well as a need to compete with larger, well-capitalized for-profit entities, according to Mark Kulik, senior managing director for the M&A advisory firm The Braff Group. [Click on the title's link to continue reading this significant article.] 

2024 NHPCO Facts and Figures Report now available National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 9/10/242022 Data Show First Increase in Hospice Utilization Rates Since COVID The National Alliance for Care at Home (the Alliance) published the 2024 edition of National Hospice and Palliative Care Organization (NHPCO) 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. Facts and Figures – the leading resource for hospice providers and others interested in understanding the work of the community – has been published annually for over two decades by NHPCO. ... The findings in this report reflect patients who received care in Calendar Year (CY) 2022, or Fiscal Year (FY) 2022, provided by hospices certified by the Centers for Medicare and Medicaid Services (CMS) and reimbursed under the Medicare Hospice Benefit. This year COVID-19 continued to impact patient care as COVID-19 waivers were still in place through May 2023. These waivers included increased telehealth services. With 49.1% of all Medicare decedents in 2022 choosing hospice care, utilization of hospice increased in 2022 for the first time since 2019. The increase hints at a normalization of the utilization rates back to pre-COVID data. Hospice utilization rates increased across all race and ethnicity groups, with the largest increase among Hispanic Medicare beneficiaries seeing. The total number of beneficiaries enrolled in hospice care in 2022 was 1.72 million. Due to the unique impact of COVID-19 on 2020 data, those data are not included in many of the charts this year.

National Health Statistics Reports: Overview of Post-acute and Long-term Care Providers  and Services Users in the United States, 2020 CDC U.S. Centers for Disease Control and Prevention; by Jessica P. Lendon, Ph.D., Christine Caffrey, Ph.D., Amanuel Melekin, Ph.D., Priyanka Singh, M.P.H., Zhaohui Lu, M.S., and Manisha Sengupta, Ph.D; dated 8/27/24, released 9/7/24 Objective: This report presents national results from the National Post-acute and Long-term Care Study to describe providers and services users in seven major settings of paid, regulated post-acute and long-term care services in the United States. Methods - Data Sources: Data include about 11,400 home health agencies, 5,200 hospices, 1,200 inpatient rehabilitation facilities, 350 long-term care hospitals, and 15,300 nursing homes. Results:

Modeling nursing home harms from COVID-19 staff furlough policiesJAMA Open Network; by Sarah M Bartsch, Colleen Weatherwax, Bruce Leff, Michael R Wasserman, Raveena D Singh, Kavya Velmurugan, Danielle C John, Kevin L Chin, Kelly J O'Shea, Gabrielle M Gussin, Marie F Martinez, Jessie L Heneghan, Sheryl A Scannell, Tej D Shah, Susan S Huang, Bruce Y Lee; 8/24What is the tradeoff between COVID-19–related harms and non–COVID-19–related harms when allowing nursing home staff with mild COVID-19 to work while masked? The findings of this study suggest that allowing nursing home staff who were mildly ill with COVID-19 to work while masked was associated with less harm from alleviated missed tasks, outweighing increasing harm from COVID-19 transmission.

Trends in post-acute care use in Medicare Advantage versus Traditional Medicare: A retrospective cohort analysisJournal of the American Medical Directors Association; by Robert E Burke, Indrakshi Roy, Franya Hutchins, Song Zhong, Syama Patel, Liam Rose, Amit Kumar, Rachel M Werner; 8/24We sought to describe national trends in hospitalization and post-acute care utilization rates in skilled nursing facilities (SNFs) and home health (HH) for both Medicare Advantage (MA) and Traditional Medicare (TM) beneficiaries, reaching up to the COVID-19 pandemic (2015-2019). We found hospitalizations, SNF stays, and HH stays were all decreasing over time in both populations. Although similar proportions of MA and TM beneficiaries received SNF or HH care, MA beneficiaries received fewer days. The largest difference we found was in the number of post-acute care providers used in TM and MA, with MA using far fewer; however, quality ratings were similar among post-acute care providers used in each program.

OhioHealth and Compassus finalize partnership for home health and hospice PR Newswire, Columbus, OH and Brentwood, TN; by Compassus / OhioHealth; 9/4/24 Compassus, a leading national provider of integrated home-based care services, and OhioHealth, a nationally recognized, not-for-profit, charitable healthcare outreach of the United Methodist Church, are pleased to announce the finalization of their partnership for home health and hospice services to be called OhioHealth at Home in partnership with Compassus. Under this partnership, Compassus has acquired ownership interest in three hospice locations and four home health locations that were formerly led by OhioHealth. Compassus will manage the operations of these agencies, leveraging its extensive experience in home-based care, while OhioHealth will continue to play a key role in delivering high-quality care in Ohio. OhioHealth's Athens hospice services and the Kobacker House in Columbus, Ohio, are excluded from the partnership. Editor's note: This finalizes the announcement we posted on 6/12/24: Compassus announces new partnership for home care and hospice.

“Rehabbed to Death” in oncology: Where do we go from here?JCO Oncology Practice; by Daniel E. Lage, Craig D. Blinderman, Corita R. Grudzen; 9/3/24You can go to rehab to see if you get stronger for chemo. These are words that every clinician caring for hospitalized patients with cancer has heard or said countless times. And yet, especially when it comes to older adults with advanced solid tumors, less than a third of these patients will ever receive systemic therapy again. Furthermore, their symptom profile is more similar to those discharged to hospice than to those discharged home, and they face debilitating functional decline and early mortality—leading some to coin the term “rehabbed to death” to describe this phenomenon. We suggest a few keys area of focus: (1) reframing hospital discharge conversations, including incorporating practices of disclosing prognoses using validated tools or other algorithms; (2) empowering team-based care and inclusion of palliative care clinicians in the SNF setting; and (3) identifying patients failing to make functional progress early. [Also see accompanying article: Respect for the patient-oncologist relationship may limit serious illness communication by acute and postacute care clinicians after discharge to a skilled nursing facility by Sarguni Singh, Ashley Dafoe, John Cagle, Elizabeth R. Kessler, Hillary D. Lum, Brooke Dorsey Holliman, Stacy Fischer.]

Hospice leaders: Culture the key to sustaining the workforceHospice News; by Jim Parker; 8/30/24In a time of workforce shortages, hospices are seeking the “secret sauce” that will help keep employees on board and bring new people into their fold. To find the right mix, hospice providers that have achieved national recognition for employer best practices point to a particular secret ingredient — a supportive culture with open lines of communication, a career path with room to grow and competitive compensation. For the California-based YoloCares, culture is critical, according to the nonprofit’s CEO Craig Dresang.Notable mentions: YoloCares, Vitas, Jennifer Blades of Haven Hospice.