Literature Review

3 strategies for hospice GIP compliance Hospice News; by Jim Parker; 10/21/24 Utilization of the general inpatient level of care (GIP) is frequently the subject of audits by Medicare Administrative Contractors (MACs), and avoiding or responding to that scrutiny requires strict compliance to a complex web of rules. Audits are becoming more frequent in the hospice space, and GIP is an increasing focus, including ​for the most common types — Supplemental Medical Review Contractor (SMRC) and Targeted Probe and Educate (TPE). In a survey earlier this year, more than half of hospice providers reported having undergone multiple types of audits within a six-month period. ... In addition to these routine MAC audits, the U.S. Department of Health and Human Services Office of the Inspector General (GIP) has been performing a national audit of GIP utilization, as well as an additional investigation into management of the associated payment cap. The inpatient cap limits the number of days of inpatient care for which Medicare will pay to 20% of a hospice’s total Medicare patient care days, according to OIG. If GIP billing exceeds that metric, the hospice must refund those payments to Medicare.

Music therapist helps patients navigate end-of-life journey on Long Island CBS New York / YouTube; by Jenna DeAngelis; 10/15/24 Music therapy helps with emotional and physical health, and now the healing power of music is being brought to hospice patients on Long Island.

What the heck is a PBM, and why does it matter? Forbes; by Web Golinkin; 10/14/24... [Pharmacy Benefit Managers] PBM BasicsUnless you are a healthcare industry insider—and even if you are— it’s difficult to understand exactly how PBMs work. While they are essentially invisible to the average health plan member, PBMs have a tremendous impact on which medications are covered, the prices paid for these medications, and how patients access them. Here’s a summary of key PBM functions: Formulary Management. ... Negotiating Discounts and Rebates. ... Pharmacy Network Management. ... Claims Processing. ... Clinical Management. ... How PBMs Influence Drug Costs: Rebate System. ... High Deductible Health Plans. ... Prior Authorization and Step Therapy. ... Spread Pricing. ... What Are the Alternatives? ...

Compassus CEO Mike Asselta: Hospice, home health JVs crucial to growth Hospice News; by Holly Vossel; 10/9/24 Home-based care provider Compassus has been on a growth trajectory for several years running – placing hospice and home health at the center of its strategic vision. Compassus provides home health, home infusion, palliative and hospice care across 30 states. The home-based provider also offers advanced care management and skilled nursing facility-at-home services. Joint ventures with health systems have been an important part of expanding Compassus’ footprint and reaching patients in need of greater support in the home, said CEO Michael Asselta. Hospice News recently sat down with Asselta to discuss the company’s growth plans after he stepped into his new role in May. ... [Click on the title's link to continue reading.]

Community making strides to reopen Owatonna's Hospice House Owatonna People's Press, Faribault, MN; by Annie Harman; 10/8/24 ... Allan and Randee Radel smiled as they remembered the days they relied on the Homestead Hospice House to care for Randee’s mother, Kaye Mahlman, during the final days of her life. “It was wonderful. It was good for her, and it was good for the family,” Randee said, looking at the house as visitors strolled inside. ... It has been more than a year since the Hospice House has cared for a patient, but there is movement being made to open the doors once again as a full-service residential hospice care facility. And thanks to the Radels, that dreaming has taken a significant step toward reality. The couple handed over a check this week to the HHH Board to put toward the $850,000 fundraising goal to reopen the house. While the couple has decided they’d rather just call it a “very generous donation,” in lieu of sharing the actual number, those involved in the fundraising efforts are not shy to say with confidence that, thanks to the Radels and others like them, they are making “significant progress” in reaching that goal. ...

Hospice ‘license flipping’ still plagues sector, though regulations help Hospice News; by Jim Parker; 10/3/24  “Shady” brokers allegedly continue to facilitate “license flipping” among fraudulent hospices, though new regulations have started bearing down on the practice. Soon after obtaining them, or before regulators can act on alleged malfeasance, according to several industry sources who spoke with Hospice News. The practice appears to stem from a rash of newly licensed hospices that have emerged in California, Nevada, Texas and Arizona – states identified by federal watchdogs as hotspots for hospice fraud. Many of these sales involve certain brokers who move the licenses between owners. “There’s a lot of shady people out there, and they put a high value on their agencies. Right now they’re selling like hot tamales from anywhere between $300,000 to $500,000 per license,” one former hospice leader told Hospice News on condition of anonymity. “They’re all done through the same brokers and the same people.”  

Top News Stories of the Month, September 2024

The road ahead: 2 pressures framing the future of hospice care Hospice News; by Jim Parker; 10/1/24 The workforce shortage and value-based care will shape the future of hospice, according to some providers. The health care reimbursement environment is moving towards significant change. The U.S. Centers for Medicare & Medicaid Services (CMS) has signaled its intention to align every Medicare beneficiary with a value-based payment system by 2030. To keep pace, hospice providers must start preparing now, according to Phil Ward, president and CEO of Community Hospice of Northeast Florida. We’re implementing quality movement projects now. So that when these changes come we’re not taken by surprise,” Ward said at the National Hospice and Palliative Care Organization (NHPCO) Annual Leadership Conference. ... The second major force that could mold the industry’s future is the staffing shortage, Leigh Anderson, medical director for Our Hospice of Indiana, said during the NHPCO conference. This includes issues like turnover, nurse-to-patient ratios and health care worker burnout, she said.

BREAKING NEWS 10/1/2024, 12:30pm - Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements; Correction Federal Register - The Daily Journal of the United States Government; Centers for Medicare & Medicaid Services  (CMS), Department of Health and Human Services (HHS); 10/1/24 This document corrects technical and typographical errors in the final rule that appeared in the August 6, 2024 Federal Register titled “Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements”.I. Background: In FR Doc. 2024-16910 of August 6, 2024 (89 FR 64202), there were a number of technical and typographical errors that are identified and corrected in this correcting document. The provisions in this correction document are effective as if they had been included in the final rule that appeared in the August 6, 2024 Federal Register . Accordingly, the corrections are effective October 1, 2024.II. Summary of Errors: ...Given these errors, we are republishing the FY 2025 Hospice Wage Index file accordingly on the CMS website at: https://www.cms.gov/​medicare/​payment/​fee-for-service-providers/​hospice/​hospice-wage-index effective October 1, 2024.

Teleios Collaborative Network develops Quintuple Aim Strategy to enhance hospice care Business Insider / Markets Insider, Flat Rock, NC; Press Release; 9/27/24 Teleios Collaborative Network (TCN) has officially announced the launch of its Quintuple Aim Strategy, aimed at setting a new standard for excellence in hospice and serious illness care. This initiative addresses the pressing need for improved quality of life for patients nearing the end of life, as many hospices face challenges in providing comprehensive care. ... The Quintuple Aim Strategy emphasizes five key goals: improving patient experience, enhancing population health, reducing costs, promoting provider well-being, and advancing health equity. This holistic approach enables member organizations to focus on their core mission of delivering high-quality, compassionate care. One of the key components of TCN’s model is the provision of comprehensive back-office support services. By offering shared resources in areas such as credentialing, billing, marketing, and finance, TCN allows its members to minimize administrative burdens and prioritize patient care. In just seven years, TCN has grown to include 15 member organizations across 10 states, and it has been recognized as one of Modern Healthcare’s Best Places to Work for four consecutive years, underscoring its commitment to fostering a supportive and effective work environment. ...

Final HOPE materials releasedNAHC email; 9/17/24Hospices will begin completing the Hospice Outcome & Patient Evaluation (HOPE) on October 1, 2025. The final HOPE item sets – HOPE Admission v1.00, HOPE Update Visit (HUV) v1.00, HOPE Discharge v1.00 and HOPE ALL Item v1.00 – and accompanying HOPE Guidance Manual v1.00 were released on September 16. These documents can be accessed from the downloads section on the Centers for Medicare & Medicaid Services (CMS) HQRP HOPE webpage.[Accessing full article may require membership login.]

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.