Literature Review

Joel Mekler - Medicare Moments: Watch out for these latest scams New Castle News; by Joel Mekler; 6/3/24 ... Across the country, many unscrupulous hospice providers are recruiting and enrolling nonterminally ill patients for end-of-life care they do not need and then billing Medicare for services and items they may never receive. They trick beneficiaries into signing up for hospice by offering freebies, such as additional groceries, nurse visits, durable medical equipment, bus coupons, and more once they enroll. They also make false claims, such as saying “Medicare now covers cooking and cleaning services”. Or they tell beneficiaries they qualify due to age, saying “You’re now old enough to qualify for hospice!” Another tactic is giving money, with some recruiters telling beneficiaries, “You can earn $400/month if you agree to enroll in our program.” ... Tips [to consumers] to avoid hospice fraud:

NAHC, NHPCO to merge, Dombi to retire McKnights Home Care; by Adam Healy; 5/23/24 The National Association for Home Care & Hospice and the National Hospice and Palliative Care Organization are on track to begin merging by July. In a related development, NAHC’s president William Dombi disclosed that he intends to retire by the end of 2024. “Both boards have authorized an affiliation agreement; it’s fully drafted,” Ken Albert, chair of NAHC’s board of directors, told McKnight’s Home Care Daily Pulse in an interview. “We’re looking to transition July 1 of this year. The transition board has been selected. I’ll serve as chair of that transition board; [NHPCO board chair] Melinda Gruber will serve as vice chair. Board members have been identified, and then that next six months from July to December will kind of be the operational integration. We’re in the process of recruiting a new CEO right now, and then all the tech-side, the backend, office-end, that’s going on right now.” Albert added that neither Bill Dombi or Ben Marcantonio, NHPCO’s chief executive officer, would be eligible to lead the new organization.

Androscoggin Home Healthcare + Hospice rebrands to ‘Andwell Health Partners’ Home Health Care News; by Andrew Donlan; 5/21/24 The Maine-based Androscoggin Home Healthcare + Hospice is rebranding to “better reflect its evolutions and future,” and will be operating under the name Andwell Health Partners moving forward. ... Andwell – formerly Androscoggin – is a nonprofit operator that employs more than 500 workers across all 16 counties in Maine. The company ... has expanded past just home health care over the years to provide hospice, palliative, behavioral health and pediatric care services to patients. Its president and CEO, Ken Albert, has served on the board of the National Association for Home Care & Hospice (NAHC) ... including as chairperson of the board. ... The word Andwell is “an amalgamation of the organization’s history, mission and services,” the company said. Specifically, the “And” makes reference to Androscoggin, the “Well” emphasizes the focus on health and wellbeing and “Dwell” evokes its home-based care focus.

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. ... 

AHA, H-ISAC warn hospitals about Black Basta following Ascension cyberattack Healthcare IT News; by Andrea Fox; 5/13/24 Meanwhile, staff at the health system say they don't have paitent orders and can't page doctors. As it works to restore clinical systems, Ascension says it's working with law enforcement and sharing threat intelligence to help prevent similar attacks. The Health Information Sharing and Analysis Center issued a threat alert Friday about the Russia-backed ransomware group Black Basta, warning of its accelerated attempted attacks against the healthcare sector. Prompted by H-ISAC, the American Hospital Association also sent a cybersecurity advisory with technical mitigation recommendations to its members. ... 

Upskilling and retraining for talent innovation in the AI ​​era Tech Trends Post; 5/13/24 According to a report from the IBM Institute for Business Value, more than 60% of executives say generative AI will disrupt the way their organizations design customer and employee experiences. Employees must change to meet these demands. Many are turning to AI upskilling – the act of providing the workforce with the skills and training to use AI to do their jobs. ... A 2024 Gallup poll found that about 25% of workers worry that their jobs could become obsolete due to AI. ... [This article outlines the following:]

A Philadelphia pharmacy’s closure after 26 years highlights the industry’s growing challenges Times Daily; by Lizzy McClellan Ravitch, The Philadelphia Inquirerer; 5/11/24Last Monday, Friendly Pharmacy filled 318 prescriptions. For about 100 of them, insurance companies paid the pharmacy less than $3. In 22 instances that day, the reimbursement was less than the cost of the medication. ... [Managing pharmacist Brad] Tabaac plans to close his doors on May 31 after 26 years in business. ... Independent pharmacies like Friendly, as well as some chains, have been pinched by pricing and fees set by pharmacy benefit managers — the companies that handle prescription drug plans for health insurance. The three biggest pharmacy benefit managers are CVS Health, Optum Rx and Express Scripts. They control nearly 90% of the market, according to the National Community Pharmacists Association (NCPA), and some of their parent companies also own pharmacies.

Hospice pivotal to Enhabit’s growth strategy as a standalone company Hospice News; by Holly Vossel; 5/9/24Hospice will remain a core piece of Enhabit Inc.’s (NYSE: EHAB) strategic growth plans following its recent announcements to remain a standalone business. The company was mum about its strategic decision not to sell in Thursday’s earnings call, but executives elaborated on its home health and hospice focal points. 

What nurses really need is better staffing: The common strategies to raise nurse morale need an updatePenn LDI - Leonard Davis Institute of Health Economics; by Karen Lasater, PhD, RN, and Jane Muir, PhD, APRN; 5/10/24Pizza. Coloring books. Goody bags. They could be activities at a 5-year-old’s birthday party. But they’re not: These are many employers’ attempts to lift the morale of nurses on the frontlines of chronically understaffed organizations. What nurses really want are better working conditions so they can deliver the best care possible to their patients. As researchers at the University of Pennsylvania School of Nursing, we asked thousands of nurses why they are leaving their profession. Their answers are straightforward — short staffing is so rampant that the public’s health care is at risk. The playbook of corporate health care asks nurses to do much with little, but nurses aren’t willing to skimp on quality and safety. There isn’t a nursing shortage — it’s nurses’ refusal to be part of a system that puts profits before safety.

Van Duyne, Blumenauer, 38 lawmakers push CMS on hospice integrityVanDuyne.house.gov; Press Release; 5/8/24Today, Congresswoman Beth Van Duyne (R-TX) and Congressman Earl Blumenauer (D-OR) led a bipartisan group of 38 lawmakers demanding answers from Centers for Medicare & Medicaid Services (CMS) on the implementation of recent reforms aimed at combatting hospice fraud and abuse. “When electing to receive hospice care, individuals and their families must be confident the provider is committed to delivering individualized, compassionate care that optimizes quality of life; however, we continue to hear about instances of pervasive fraud and abuse,” the lawmakers wrote.  ... To better understand the steps CMS has taken to increase program integrity, the lawmakers continued the letter with detailed questions on the implementation of reforms. Read the full letter here.  ...“Thank you, Representatives Blumenauer and Van Duyne, for your leadership in holding CMS accountable and safeguarding hospice patients and families from fraudulent activities,” said Ben Marcantonio, Interim CEO of the National Hospice and Palliative Care Organization. “Preserving the integrity of the Medicare Hospice Benefit is paramount to ensure high-quality care for Americans with serious illness and end-of-life care needs.” 

Ordered to pay $1.536B in criminal fines and forfeiture for distributing misbranded opioid medication Office of Public Affairs, U.S. Department of Justice; Press Release; 5/3/24Endo Health Solutions Inc. (EHSI) was ordered to pay $1.086 billion in criminal fines and an additional $450 million in criminal forfeiture — the second-largest set of criminal financial penalties ever levied against a pharmaceutical company —for violations of the Federal Food, Drug and Cosmetic Act related to the distribution of the opioid medication Opana ER with INTAC (Opana ER). ...

Wide-ranging health care bill gets final approval from CT House CT Mirror - Connecticut's Nonprofit Journalism; by Jenna Carlesso; 5/6/24The House gave final passage Monday to a wide-ranging health care bill that would add protections for home care workers, boost preparedness for cyberattacks at medical facilities and establish new regulations for the state’s health information exchange, among other reforms. ... The sections on additional protections for home care workers were prompted by the murder of visiting nurse Joyce Grayson, who was killed in October while working at a halfway house in Willimantic. ... The bill requires home health aide agencies to collect certain client information upon intake and make it available to any employee assigned to the client. Information includes a history of violence against health care workers, domestic abuse, substance use, psychiatric history, any listing on a sex offender registry, the crime rate of the municipality the person lives in, and whether there are any weapons or safety hazards in the home. [Click on the title's link for more important information about this bill's safety measures.]