MedPAC: March 2026 Report to Congress
MedPAC Reports; 3/12/26
Medicare Benefit: National health care spending grew rapidly in 2023 and 2024, by 7 percent in each of these years. By 2024, national health care spending totaled $5.3 trillion. Health care spending has made up an increasing share of the country’s gross domestic product (GDP) over time, rising from about 13 percent of GDP in 2000 to 18 percent in 2024. Medicare spending grew more rapidly than national health care spending in 2023 and 2024 (by 9 percent and 8 percent, respectively), in part due to changes in Part D financing that shifted more of the cost of prescription drug coverage from beneficiaries to the federal government. By 2024, Medicare spending totaled $1.1 trillion—equivalent to 21 percent of national health care spending and 3.8 percent of GDP. (Please see the full report here for additional detail.)

Hospice Chapter here. Highlights include:

• For fiscal year 2027, the Congress should eliminate the update to the 2026 Medicare base payment rates for hospice.
• In 2024, more than 1.8 million Medicare beneficiaries (including more than half of decedents) received hospice services from about 6,700 providers, and Medicare hospice expenditures totaled $28.3 billion. 
• The share of decedents using hospice increased to 52.9 percent in 2024, up from 51.7 percent in 2023, reaching a new high.
• The aggregate FFS Medicare margin for 2023 was 8.0 percent, down from 9.8 percent in 2022. In 2024, cost growth slowed, with hospices’ average cost per day increasing by 1.1 percent. The projected 2026 FFS Medicare margin is 9 percent.

• Calculations based on Tables 10-1, 10-8, and 10-9 (based on 6,706 total hospices in 2024):

• For profit hospices accounted for 82% of hospices (N= 5,497) in 2024; average total cost per day= $147; FFS margin= 13.7% in 2023.
  Nonprofit hospices accounted for 16% of hospices (N= 1,070) in 2024; average total cost per day= $214; FFS margin= -1.3% in 2023.
  Government hospices accounted for 2% of hospices (N= 130) in 2024.
  Urban hospices accounted for 88% of hospices (N= 5,877) in 2024; average total cost per day= $170; FFS margin= 8.3% in 2023.
  Rural hospices accounted for 12% of hospices (N= 829) in 2024; average total cost per day= $156; FFS margin= 5.3% in 2023.

Alliance concerned by MedPAC’s misguided 2026 home health and hospice payment recommendations 
National Alliance for Care at Home, Alexandira, VA and Washington, DC; Press Release; 3/13/26
The National Alliance for Care at Home (the Alliance) is deeply concerned by the Medicare Payment Advisory Commission’s (MedPAC) March 2026 Report to Congress: Medicare Payment Policy. MedPAC’s congressionally mandated report provides analysis and recommendations on various Medicare programs, including home health and hospice. The Commission’s findings focus on payment adequacy, access to care, quality, financial performance, and projections for 2026 and beyond. The Alliance previously expressed concern in response to MedPAC’s vote in January 2026.

Call for applications: Investigator in Residence Program
ASCENT press release; 3/2/26
The Advancing the Science of Palliative Care Research Across the Lifespan (ASCENT) Consortium invites applications for its 2026 Investigator in Residence Program. The goal of this program is to increase the number of palliative care investigators, expand the range of institutions where palliative care research is performed, and develop scientific and leadership capabilities leading to future successful grant proposals, both through ASCENT and extramurally. Applications due Thursday, March 26 at 5:00 pm PT.

Hospice fraud explodes in California after state ‘crackdown’: 742 flagged providers, $105 million overbilled, and ghost offices 
California Globe; by Megan Barth; 3/11/26 
California investigative reporter Christian Hartsock, in collaboration with California State Assembly woman Alexandra Macedo for the California Courier, released a breaking undercover investigation just days ago, exposing dozens of suspicious hospice and home healthcare agencies in Los Angeles. Their on-site visits revealed hundreds of companies registered to crumbling buildings with no ramps, no handicap parking, disconnected phones, and signs reading “Out to Lunch.” Hartsock’s footage highlights how over $3.5 billion in Medi-Cal fraud has been identified in Los Angeles County alone, with 31% of all U.S. hospices registered there despite only 2% of the nation’s aging seniors residing in the area. 

[Spain] Queen Letizia supports universal access to palliative care 
Aragon Health Research Institute | Biomedical Research Center; Press Release; 3/16/26 
Her Majesty Queen Letizia received a delegation from the Spanish Society of Palliative Care (SECPAL) with representatives from all essential professional profiles in palliative care. During the meeting, they conveyed to Queen Letizia the current situation of palliative care in Spain as well as the important challenges that persist ... Queen Letizia showed her sensitivity and commitment towards ... those facing advanced illnesses or who are at the end of their lives, and conveyed to SECPAL her support for initiatives aimed at strengthening the development of palliative care in Spain. ... Faced with this reality, SECPAL handed the queen over a decalogue [ten-point plan] which outlines the priorities for the development of palliative care in our country, such as ensuring that there are sufficient resources and appropriately trained teams at all levels of care.

Will Scotland be the first [in the UK] to legalise assisted dying? 
BBC News; by James Cook, Scotland editor; 3/16/26 
For more than a year, Scottish politicians have been grappling with matters of life and death as they debated one of the most contested bills in the history of devolution. Tuesday's (3/10) final Scottish Parliament vote on the Assisted Dying for Terminally Ill Adults (Scotland) Bill is seen as too close to call. But, if it passes, Scotland could become the first nation in the UK to legalise assisted dying. ... Critics of the bill have called it dangerous and say MSPs should focus instead on improving end-of-life care. ... [Supporters of the bill have] said the result was a "bulletproof" bill which amounted to "the toughest and most comprehensively-safeguarded" such legislation in the world.

Alzheimer’s definitions, biomarkers, and antibodies: Halima Amjad, Barak Gaster, and Heather Whitson
GeriPAL podcast; by Alex Smith, Eric Widera, Halima Amjad, Barak Gaster, Heather Whitson; 3/12/26
It’s an era of breakthroughs in Alzheimer’s research, yet for many clinicians, it’s also a time of profound uncertainty. We are currently navigating competing definitions of the disease, multiple new biomarkers coming on market seemingly every week, and the clinical rollout of new amyloid antibodies. How do we translate this rapid-fire science into daily practice? On this week’s GeriPal podcast... we dive deep into:

• The evolving definitions of Alzheimer’s disease. Does someone have Alzheimer’s disease if you have only an abnormal biomarker as defined by the Alzheimer’s Association, or is amyloid pathology necessary but not sufficient to define Alzheimer’s as per the International Working Group (IWG) recommendations?
• Where do blood-based biomarkers for Alzheimer’s fit into the diagnostic workup, and should they be used at all in primary care? FYI – here is my take on that question in a recent JAMA IM article titled “The Limited Role of Alzheimer’s Disease Blood-Based Biomarkers in Primary Care.”
• What’s the role of amyloid antibodies in the care of individuals with Alzheimer’s disease, including who to use them on?

Pediatric Resource Guide
The HAP Foundation press release; 3/16/26
Our team with the Lynda P. Bollman’s Pediatric Program collected as many resources as we could find to assist patients, families, and practitioners. Our goal is for this Resource Guide to be an efficient and effective tool to aid in caring for children with a serious illness and their families navigating their journey... The Pediatric Resource Guide is divided into several categories (i.e., financial support, transportation support, emotional wellness support, etc.) to ease navigation. You will also be able to break some sections into subcategories (i.e., Midwest, East, West, etc.)...

Metro East hospice aide caring for her own son with rare terminal disorder 
First Alert 4, Collinsville, IL; by Jeffrey Bullard; 3/13/26 
A Collinsville mother has worked as a hospice care aide for more than 13 years, and soon she will be placing her son in that care. “She is the best,” said Brenda McGarvey of Amber Mers, her coworker at Unity Hospice Care. “If you didn’t know Amber personally, you would never know what she is going through,” explained Beverly Lee. Amber is facing a mother’s worst nightmare. Her son Emil is dying.

Dignity in motion: How hospice care and wheelchair transportation shape senior comfort in Tacoma 
US Culture & Style Today, Tacoma, WA; Press RElease; 3/11/26 
For seniors approaching the most sensitive stages of life, the quality of care is defined not only by what happens inside a home or medical facility but also by how individuals move between places. Transportation during hospice care and assisted living transitions must protect dignity, emotional calm, and physical safety. When medical transportation is handled with respect and patience, the entire care experience becomes gentler for both seniors and their families. ... 

Alliance submits comment letter on the Department of Education’s notice of proposed rulemaking, ‘Reimagining and Improving Student Education’ (RISE) 
National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 3/3/26 
The National Alliance for Care at Home (the Alliance) has submitted a response to The Department of Education’s proposed rule, titled Reimagining and Improving Student Education (RISE).  While the Alliance appreciates the Department’s aim of promoting fiscally responsible spending, the comment letter expresses concern that the proposed rule’s narrow definition of professional degree, and the resulting exclusion of nursing, physical therapy, physician assistant, occupational therapy, and social work advanced degree programs, would have a unintended consequence for the healthcare workforce and the millions of Americans who depend on care delivered in the home.

What does moral agency mean for nurses in the era of artificial intelligence?
Hastings Center Report; by Connie M Ulrich, Oonjee Oh, Sang Bin You, Maxim Topaz, Zahra Rahemi, Liz Stokes, Lisiane Pruinelli, George Demiris, Patricia Flatley Brennan; 2/26
Being a moral agent was once thought to be an irreplaceable, uniquely human role for nurses and other health care professionals who care for patients and their families during illness and hospitalization. Today, however, artificial intelligence systems are often referred to as “artificial moral agents,” “agentic,” and “autonomous agents.” As these systems begin to function in various capacities within health care organizations and to perform specialized duties, the question arises as to whether the next step will be to replace nurses and other health care professionals as moral agents. Focusing primarily on nurses, this essay explores the concept of moral agency, asking whether it remains exclusive to humans or can be conferred on AI systems. We argue that AI systems should not supplant nurses’ moral agency, as patients come to hospitals or any other health care setting to be heard, seen, and valued by skilled professionals, not to seek care from machines.
Editor's Note: Pair this with yesterday's article, ""Black box" artificial intelligence for mortality prediction: a mixed-methods study of palliative care team, patient, and caregiver perspectives."

It is not the critic who counts: not the man who points out how the strong man stumbles or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes up short again and again, because there is no effort without error or shortcoming, but who knows the great enthusiasms, the great devotions, who spends himself in a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who, at the worst, if he fails, at least he fails while daring greatly, so that his place shall never be with those cold and timid souls who knew neither victory nor defeat. ~Theodore Roosevelt, Speech at the Sorbonne, Paris, April 23, 1910