Literature Review

Medicare Payment Advisory Commission [MedPAC] releases report to Congress on Medicare Payment Policy Medicare Payment Advisory Commission, Washington, DC; News Release, contact Stephanie Cameron; 3/13/25Today [3/13/25], the Medicare Payment Advisory Commission (MedPAC) releases its March 2025 Report to the Congress: Medicare Payment Policy. The report presents MedPAC’s recommendations for updating provider payment rates in fee-for-service (FFS) Medicare for 2026, providing additional resources to acute care hospitals and clinicians who furnish care to Medicare beneficiaries with low incomes, and eliminating certain Medicare coverage limits on stays in freestanding inpatient psychiatric facilities. The report reviews the status of ambulatory surgical centers (ASCs), the Medicare Advantage (MA) program (Medicare Part C), and the Part D prescription drug program (Medicare Part D). ... Fee-for-service payment rate update recommendations. ... MedPAC recommends ... payment reductions relative to current law for hospice providers, skilled nursing facilities, home health agencies, and inpatient rehabilitation facilities.  [Click on the title's link to continue reading.]

Hospice of Redmond presents a Welcome Home Vietnam Veterans Day CeremonyCascade Business News; by CBN; 3/18/25... Did you or someone you know serve in the military between 1955 and 1975? Hospice of Redmond would like to thank you for your service. This year marks the 50th anniversary for the end of the Vietnam War. The Scottish American Military Society will present veterans and their spouses with a Vietnam Lapel pin which was established in 2011 by Congress and administered by the DOD. Editor's note: Click here for more about this 50th Anniversary, National Vietnam War Veterans Day, March 29, 2025

Less wealth at death linked to more end-of-life symptoms McKnights Long-Term Care News; by Kristen Fischer; 3/10/25 Older people with less wealth showed a higher burden of symptoms when they approached the end of their lives compared with those who had more wealth, a study found. The report was published in JAMA Network Open on March 6. Investigators looked at data from 8,976 older adults. The team evaluated 12 end-of-life symptoms including difficulty breathing, frequent vomiting, low appetite, difficulty controlling arms and legs, depression, and severe fatigue or exhaustion.Then they correlated symptoms to individuals’ wealth. Wealth was broken into three categories: low wealth was having less than $6,000; medium wealth was having between $6,000 and $120,000; and high wealth was considered having more than $120,000 at the time of death. Of respondents, 22.5% had low wealth, 50.5% had medium wealth and 27.1% had higher wealth. People who had less wealth were more likely to have a higher burden of symptoms compared to those who had more money. Functional impairment, multimorbidity and dementia were factors that affected the association, data revealed.Editor's note: Click here for this important JAMA article, posted in our Saturday Research issue 3/15/25, "Wealth disparities in end-of-life symptom burden among older adults."

End-of-life conversations: ‘When they open the door, you have to go in’ Oncology Nursing News; video by Pattie Jakel, MN, RN, AOCN; 3/13/25Oncology nurses have a unique relationship with patients that allows for difficult but essential end-of-life conversations, says expert Patricia Jakel, MN, RN, AOCN. Jakel, one of the editors in chief of Oncology Nursing News, emphasized that following up with patients and ascertaining what answers and support they need comes with the close bonds that oncology nurses form with patients with cancer. ... [Jakel describes:] We play a really important role. And sometimes patients ask us difficult questions, and we have to be prepared for it. I remember a lovely young patient I had, she had 2 little girls, and she was very sick. And things weren’t going well for her in the hospital, and she just—she looked up at me and she said, "Am I dying today?" And I thought, "She’s opening the door. She needs to have this conversation.” [Click here to hear this nurse describe the gentle interaction that unfolded.]Editor's note: Share this significant, sensitive video/article from Oncology Nursing News with your nurses. What communication education and support do you provide for your nurses? Explore this similar article from Oncology Nursing News, "APPs, Oncologists Work Together for End-of-Life Discussions," 11/2/24.

U.S. House Committee on Ways and Means Hearing Health Subcommittee  “After the Hospital: Ensuring Access to Quality Post-Acute Care” U.S. House of Representatives Documents (Federal Information & News Dispatch, Inc.); by Jonathan D. Fleece, President & CEO Empath Health; 3/11/25 Chairman Buchanan, Ranking Member Doggett, and distinguished Members of the Subcommittee. Thank you for the opportunity to be here today. ... As President and CEO of Empath Health, one of the nation’s largest not-for-profit home-based care organizations, it is an honor and privilege to serve one in five Floridians who need hospice care. ... My commitment to this mission is deeply personal. After losing my first daughter at birth, I dedicated my life’s work to ensuring that no family faces serious illness or loss without the support, dignity, and compassion they deserve. That experience shaped my belief that health care must do more than treat symptoms—it must care for the whole person and those who love them. ... Today, as the leader of Empath Health, I remain committed to advancing that vision—ensuring that patients and families have access to the right care, at the right time, in the place they call home. That is the foundation to my testimony: to speak for the millions of Americans who rely on home-based care and the policies that make it possible. ...

MedPAC 2025 Annual Report ReleasedMedPAC Report; 3/15/25 - sent 3/18/25 @ 3:00 PM ETFor fiscal year 2026, the Congress should eliminate the update to the 2025 Medicare base payment rates for hospice. In 2023, more than 1.7 million Medicare beneficiaries (including more than half of decedents) received hospice services from about 6,500 providers, and Medicare hospice expenditures totaled $25.7 billion. [Click the title's link to download and read MedPAC's most recent Report to Congress - Hospice chapter.]

Alliance Statement on MACPAC Report National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 3/18/25 On Thursday, March 13th, the Medicaid and CHIP Payment and Access Commission (MACPAC) released its semi-annual report, which included three chapters and five recommendations. (See analysis from the National Alliance for Care at Home HERE and HERE.) Two recommendations in the MACPAC report concern home and community-based services (HCBS):

[Germany] Web-based educational tools and decision aids for patients with advanced cancer: A systematic reviewPatient Education and Counseling; Phoebe Ullrich, Henrike Voß, Laura Unsöld, Michael Thomas, Matthias Villalobos; 2/25In advanced cancer care, patient involvement in decision-making is complex. Web-based solutions are promising because of easy accessibility and dissemination and the ability to adapt information to patients' needs and new treatment developments. Still, only a few evidence-based web-based educational tools and decision aids are available. Filling this gap is essential to empower patients to make informed and goal-concordant treatment decisions.

Employer-sponsored digital health platforms for mental wellness—A good investmentJAMA Network Open; Molly Candon, PhD; Rebecca E. Stewart, PhD; 2/25The authors evaluate an employer-sponsored digital health platform (Spring Health; Spring Care Inc) that screens employees for mental health conditions and, when warranted, connects them to treatment. Hawrilenko et al found a reduction in health care spending among digital health platform users compared with a matched comparison group. These findings contribute to a broader literature that considers the economic value of employer-sponsored interventions aimed at mental wellness ... There are broader implications of the study by Hawrilenko et al, because employer-sponsored digital health platforms are among the quickest and easiest pathways to grant a majority of US individuals accessible mental health care. 

Evaluating performance of the Surprise Question to predict 12-month mortality in patients with end-stage liver diseaseAmerican Journal of Hospice and Palliative Care; Sarah Homann, MD; Jamie Pfaff, MD; Elizabeth Stovicek, MD; Rajiv Agarwal, MD, MSC;, Sumathi K. Misra, MD, MPH; Jill M. Pulley, MBA; Justin K. Siemann, PhD; Ashley Spann, MD, MSCAI; Stacey Tillman, MD; Cheryl L. Gatto, PhD; Mohana Karlekar, MD; 2/25ESLD [end-stage liver disease] is associated with significant morbidity and mortality. Early PC engagement has been proposed as a solution to improve the physical and psychological burden associated with ESLD. ... hepatologists were asked the SQ [surprise question]: “Would you be surprised if this patient were to die in the next 12 months?” as a prompt to consider consultation to specialty PC [palliative care]. While the SQ should not be solely used as a prognostic indicator of death, our study proves that the SQ can be utilized by hepatologists as a screening tool with good sensitivity for identifying patients with ESLD who may be at higher risk of death and therefore may benefit from PC co-management.

Perceptions of patient-clinician communication among adults with and without serious illnessJAMA Network Open; Carine Davila, Sarah Nouri, Stephanie H Chan, Brian Feltz, Anna Gosline, Zamawa Arenas, Jane Kavanagh, Joanna Paladino, Lindsay A Dow, Vicki A Jackson, Rebecca Sudore, Christine S Ritchie, Elizabeth Lindenberger; 3/25In this cross-sectional study, adults with serious illness more often had worse patient-clinician communication experiences. Compared with adults without serious illness, adults with serious illness were more likely to report leaving a visit unsure about next steps ...; being afraid to ask questions or speak up ...; believing they were talked down to or made to feel inferior...; and believing that they were treated unfairly by clinicians ... Further research is needed to better understand and develop interventions to improve perceptions of patient-clinician communication experiences for adults with serious illness.

Prevalence of depression and anxiety among adults with chronic pain-A systematic review and meta-analysisJAMA Network Open; Rachel V. Aaron, PhD; Scott G. Ravyts, PhD; Nicolette D. Carnahan, PhD; Kavya Bhattiprolu, BS; Nicole Harte, MClinPsychol; Claire C. McCaulley, BA; Lauren Vitalicia; Alexandria B. Rogers, PhD; Stephen T. Wegener, PhD; Joanne Dudeney, PhD; 3/25Chronic pain, defined as pain that persists for more than 3 months, is a prevalent and disabling condition affecting 21% of adults. In this systematic review and meta-analysis of depression and anxiety among individuals with chronic pain, approximately 40% of adults had clinically significant depression and anxiety. Women, younger people, and people with nociplastic pain were most likely to have depression and anxiety. The co-occurrence of chronic pain with depression and anxiety is a significant public health concern necessitating routine screening in clinical settings, equitable access to specialty care, and innovative treatment development. 

Disparities in end-of-life symptom burden linked to complex interplay among wealth, health, and social supportJAMA Network Open; Peter A. Boling, MD; 3/25On average, US health care spending in the last year of life alone was $80,000, with 12% ($9,500) being out of pocket and mostly incurred before the final 6 months. This problem worsened in the past decade when the nonspecific diagnosis of failure to thrive was removed as a condition eligible for hospice care and more stringent definitions were applied for dementia, which became the next bubble as the hospice balloon was squeezed. Hospice care is a means of reducing symptom burden, but the Medicare payment model discourages prolonged enrollment during slowly progressing advanced chronic illness and effectively limits funding of social support during hospice care, which is particularly problematic for patients with cognitive and functional impairment and for their friends and families. Considering suffering as a medical condition warranting treatment rather than a social problem requiring support services might help with the evolution of a Medicare policy that might provide a more graduated approach to end-of-life care.