Literature Review

Study uncovers racial inequalities in hospice utilization, length of stayMcKnight’s Home Care DailyDecember 12, 2023Blacks and Hispanics are less likely to use hospice services, and those who do often have shorter lengths of stay than white patients, according to a new study published in JAMA Health Forum. ... Minority patients also generally experienced shorter hospice lengths of stay. Hispanic patients in particular were more than twice as likely to stay in hospice care for seven days or less, compared to the average white Medicaid beneficiary. Still, short length of stay was relatively common across the board at about 40%, which suggests “room for improvement in referring all Medicaid recipients to hospice earlier in the course of terminal illness,” the study’s authors wrote. As to possible reasons for these disparities, the researchers noted that language barriers, mistrust of hospice programs or cultural differences might be at play. But also, the inequity might also reflect “potential racial biases that affect who a physician is more likely to refer to hospice,” according to the study. Specific, targeted efforts to encourage hospice services for Medicaid and dual-eligible beneficiaries who show low rates of utilization may help to overcome these disparities.

Hospice CEO, Chief Compliance Officer Collaborations Key to QualityHospice NewsDecember 11, 2023The lines of communication between hospice leaders and compliance executives need to be open and transparent in today’s regulatory environment. ... The ability to both understand and navigate shifts in regulations requires a solid relationship between a hospice executive team and its compliance leaders, according to Avow Hospice President and CEO Jaysen Roa. To achieve this, compliance and senior executive teams should foster interlocking collaboration and careful communication, he stated in a recent Husch Blackwell podcast. “It’s having compliance be part of the fabric,” Roa said. “Whether it is redoing some policies and procedures, looking at our code of ethics or how we respond to audits ... it’s all these things that can be esoteric to us [leaders]. When speaking to peers, whether it’s the C-suite, leadership teams or the board, [it’s doing] it in a way where it’s relatable and they understand not only why it’s important, but also the impact of why we’re readying for this. [If] we’re not constantly learning, then that’s a problem—especially in an industry like ours where it’s dynamic and changing every single day.” ... Strong ties between compliance and executive teams are crucial, according to [Chief Compliance Officer and Senior Vice President of Engagement, Kerri Ervin] Ervin. Having honest and transparent communication between compliance officers and hospice executives is key, she said. 

‘Hospice is more about living better’ transitional care director says of misunderstood programTribune-Review (Pittsburgh, PA)December 11, 2023... There is an assumption a patient entering hospice care is not expected to live beyond six months, a guideline that is tied to Medicare coverage. But the experience of individual patients can vary widely, as evidenced by [senior living residents] the Pattersons [Robert, 97, and Joyce, 90,] and by former president Jimmy Carter and his late wife, Rosalynn. Like many who elect to receive hospice care, Rosalynn Carter entered the program toward the very end of her life—just days before her death Nov. 19, at 96. But it’s also possible for patients to beat the odds and have hospice care extended. Jimmy Carter was 98 when he entered hospice in February and continues to endure. 

Passions run high during hospice talksDaily Gate City (Keokuk, IA)December 12, 2023Keokuk, IA—Emotions ran high as Lee County Supervisors and Lee County Health Department staff discussed the future of LCHD-Hospice and home health care services at a work session Monday. Supervisor Chairman Garry Seyb said all departments and services are being scrutinized in light of the new state legislation that calls on counties to reduce general tax levies to $3.50 per $1,000 assessed property valuation. Lee County is currently at $5.85—the second highest in the state. In response, Seyb has asked all department heads to look over their budgets and list any services that are not mandated by state code, but are offered elsewhere through the private sector. 

MedPAC draws fire with draft recommendations for massive home health cut, hospice rate freezeMcKnight’s Home Care DailyDecember 12, 2023The Medicare Payment Advisory Commission offered initial recommendations for Congress to cut home health reimbursement by 7% and pause hospice payment updates in 2025. “The 2022 [home health] margins remain above 20%, higher than the long-run average of 16.8% since 2001,” Evan Christman, senior analyst at MedPAC, said during last Friday’s public meeting, according to a transcript. “Overall, these margins indicate that Medicare fee-for-service continues to pay well in excess of cost.” Part of the reason home health agencies reportedly saw margins of 22.2%, on average, according to Christman, is a decline in the number of visits per 30-day period. Since the implementation of the Patient-Driven Groupings Model in 2020, these visits have declined more than 15%; between 2021 and 2022, visits per 30 days declined 3.5%. Home health advocates were quick to dispute MedPAC’s claims. “There are many shortfalls in MedPAC’s home health margins report—starting with the fact that MedPAC’s analysis only captures a declining fraction of the Medicare home health population, ignoring that overall margins are low,” Joanne Cunningham, chief executive officer of the Partnership for Quality Home Healthcare, said in a statement. ... The Partnership and National Association for Home Care & Hospice cited poor methodology and data in the recent home health final rule, which contained a Medicare cut related to PDGM. MedPAC also recommended that Congress eliminate any payment updates for hospice providers in 2025. 

Is ‘medical aid in dying’ an ethical, moral choice?By Richard Feldman, MD, ColumnistCourier & Press (Evansville, IN)December 11, 2023One of my best friends, Jim, in South Bend died of an unusual intestinal cancer. This experience moved me to explore the issue of “medical aid in dying,” or MAID. Is MAID ethical and moral? Is it the right and justified choice for some individuals? After a time, unfortunately, Jim’s cancer progressed with a vengeance leaving him with extensive intestinal obstructions. Further chemo would be of little help, and further surgery was impossible. Toward the end, my friend couldn’t receive any real nutrition and could only tolerate water. He lost 65 pounds in 10 weeks and was essentially skin over bone. Jim was Catholic and religious. He was a splendid husband and father to his nine children. He worked hard, was responsible, and was a good citizen. He was a good man. The best. When I last saw him, I told him that I envied both his courage and his faith. Jim had no doubt that in passing, he was entering the next phase of his life and that he would be with God. Jim’s character and faith sustained him. His religious beliefs would not allow him to consider anything but a natural death. So, he never would have considered MAID. And of course, it’s not legal in Indiana. ... Although unmanageable symptoms despite optimal hospice care is a reason to utilize MAID, autonomy and maintaining dignity are the primary reasons MAID is chosen. These patients want control, without dependence on others for care. ... MAID is controversial, but dynamic, in the medical community. ... Although it will be a long time before Indiana considers MAID legislation, the majority of the Americans support MAID for terminal illness. Is MAID a slippery slope, an unconscionable act, or a caring act of compassion? Difficult questions.

Norton Healthcare ransomware attack exposes 2.5M peopleHealthcare DiveDecember 11, 2023Norton Healthcare said sensitive data on 2.5 million people was exposed by a ransomware attack in May, the clinic and hospital group said Friday in a data breach notification filed with Maine’s attorney general. Norton Healthcare discovered the cyberattack on May 9, which it later determined was ransomware. The threat actors had access to some network storage devices between May 7–9, but the healthcare group’s medical record system was not compromised, the company said in the filing. An investigation into the attack, which was completed in mid-November, determined names, contact information, Social Security numbers, dates of birth, health and insurance information, and medical ID numbers were compromised. .... [Kentucky-based] Norton Healthcare said it did not make a ransom payment and has not detected any additional indicators of compromise since it began restoring its systems from backups on May 10. The delayed disclosure, seven months after the intrusion was detected, underscores the complicated nature of post-incident investigations. 

Cigna Calls Off Humana Pursuit, Plans Big Stock BuybackWall Street JournalDecember 10, 2023Cigna Group abandoned its pursuit of a tie-up with Humana after shareholders balked at a deal that would have created a roughly $140 billion giant in the health-insurance industry. The companies couldn’t come to agreement on price and other financial terms, according to people familiar with the matter. In the near term, Cigna is turning its focus toward smaller, so-called bolt-on, acquisitions.

Nurses at University Medical Center vote to unionize, a Louisiana firstTimes-Picayune (New Orleans, LA)December 10, 2023LCMC Health’s University Medical Center nurses voted to join National Nurses United, the largest U.S. union for registered nurses, after a three-day vote that ended Saturday night. The union will be Louisiana’s first among health care workers. It is also one of the state’s largest, with 598 eligible members. More than 90% of eligible nurses voted in the election. Of those who voted, 82% voted in favor of the union, according to National Nurses United. ... Officials at UMC acknowledged the union and said they would “continue to work with the National Labor Relations Board and operate consistently with the processes established by the National Labor Relations Act.” ... Next, the union will be certified by the National Labor Relations Board. Negotiations and bargaining on a contract come after that. ... The union includes registered nurses who are full-time, part-time and per diem, along with clinic nurses and nurse practitioners.

Unemployment rate dips to 3.7 percent in NovemberMcKnight’s Senior LivingDecember 11, 2023The national unemployment rate declined from 3.9% October to 3.7% in November, according to the monthly unemployment report from the Bureau of Labor Statistics. ... Additionally, the economy added 199,000 new jobs in November, with gains in healthcare, government and manufacturing. Healthcare added 77,000 jobs, which the BLS noted is above the average monthly gain of 54,000 over the prior 12 months. Nursing and residential care facilities added 17,000 jobs, ambulatory healthcare services gained 36,000 jobs and hospitals gained 24,000 jobs last month.

Aging population requires ‘bold leadership’ to protect human dignity—LeadingAge to House SpeakerMcKnight’s Senior LivingDecember 11, 2023The growing population of older adults requires “bold leadership” to ensure aging with dignity, as well as access to care and support, according to an open letter from LeadingAge to Speaker of the House Mike Johnson (R-LA). The changing demographics and need to support older adults where they live and receive services presents a unique opportunity for Johnson to demonstrate leadership and commitment to “protecting human dignity,” according to the letter from LeadingAge President and CEO Katie Smith Sloan. ... “The US healthcare system is navigating a new and unfamiliar landscape in the wake of the COVID-19 public health emergency,” Sloan wrote. “Three years of sustained stress and increasing workloads have caused a dramatic shift in staffing patterns and an alarming rise in burnout across health professions.”

Maine nursing homes lead in meeting proposed staffing standardsMaine MonitorDecember 10, 2023Maine nursing homes are closer to meeting the Biden administration’s proposed minimum staffing standards than their counterparts in most other states, but recent payroll data show that still fewer than one in 10 are meeting these proposed standards every day. And while some long-term care advocates said the national standards should go further, nursing home industry leaders said it would be difficult for a rural state like Maine to find the workers to meet the required minimums, which could lead to more closures. ... During the second quarter of 2023—from April to June—Maine nursing homes met the proposed minimum care hours from both registered nurses and nurse aides an average of 59 out of 91 days in the quarter, according to analysis from The Maine Monitor, USA TODAY and Big Local News at Stanford University, the latest federal staffing data. ... However, only 8% of Maine nursing homes met both standards on all 91 days of the quarter.