Literature Review

‘Churning’ hospice patients yields no significant financial benefits, study find McKnights Home Care; by Adam Healy; 9/22/25 Hospices that try to game Medicare payment rules by “churning” patients are producing negligible financial benefits, according to a new study published in the Journal of Public Economics. Researchers used Medicare hospice claims data from 2000 to 2019 to identify instances of providers churning patients. “Churning” refers to the practice of rapidly enrolling and discharging beneficiaries as a means of undercutting Medicare payment caps. ... For FY 2026, the hospice cap amount is $35,361.44, an increase of 2.6% from FY 2025, the Centers for Medicare & Medicaid Services said in the hospice final rule. ... Hospices may try to “game” the system by rapidly enrolling and discharging patients to raise their payment cap, the researchers noted. ... Previous research has indicated that churning may be associated with worse end-of-life outcomes for Medicare beneficiaries, researchers noted. 

Morphine shortage impacts Massachusetts patients, hospice care and pharmacies GBH; by Marilyn Schairer; 9/16/25 Pharmacists and hospice care providers in Massachusetts say the industry is experiencing a shortage of morphine, a powerful prescription opioid painkiller. And while the causes of the shortage are unknown, it’s already affecting people who use the drug to treat severe pain, including cancer patients and people in hospice care. “There is a shortage,” said Dina Breger, pharmacy manager at Greater Boston Long Term Care Pharmacy in Walpole. She said it’s been at least a few weeks since the pharmacy was able to get morphine to patients that need it. Guest Editor's Note, by Drew Mihalyo, PharmD: Massachusetts’ morphine shortage highlights a worsening national crisis. These shortages stem from multiple factors—from DEA production quotas (with 2026 levels expected next week) to fragile supply chains and thin profit margins that discourage manufacturing. Without strong pre-arranged access systems, even hospice and cancer patients can be left without essential pain relief. Healthcare is not just about treatment—it’s about preserving dignity for those who need us most. Fixing this requires systemic change: national reserves, better incentives to sustain production, and stronger oversight—transparency in manufacturing, smarter quota setting, and rapid-response mechanisms to ensure patients are never left without care at the end of life.

Transforming healthcare: A conversation with Rita E. Numerof Teleios Collaborative Network (TCN); pod/videocast by Chris Comeaux with Rita E. Numerof; 9/17/25 Are we headed for a healthcare train wreck?  The warning signs are flashing: skyrocketing premiums, looming Medicaid cuts, significant reductions in home health funding, and major insurers experiencing substantial stock losses.  These aren't isolated issues but symptoms of fundamental structural flaws in our healthcare system. Rita E. Numerof, co-founder and president of Numerof & Associates, returns to TCNtalks with a powerful analysis of the healthcare industry's trajectory and a bold vision for transformative change.  As an "equal opportunity critic" with over 30 years of experience spanning the entire healthcare ecosystem, Numerof offers a uniquely comprehensive perspective on why our current system is failing and what must change. 

Medicare cuts & tech gaps drive home health nurse exodus Access Newswire - Regulatory; by Black Book Survey; 9/16/25 Black Book Research today released 2025 survey findings from U.S. home health executives, finance leaders, and clinical directors showing that technology inefficiencies are a primary driver of nurse attrition. Respondents also warn that proposed Medicare home health payment reductions totaling 6.4% over 2026-2027 will intensify workforce pressure unless agencies can invest in modern IT.Key 2025 Survey Findings (U.S. Home Health & Hospice):

Digital twins give cyber defenders a predictive edge siliconANGLE.com; by Isla Sibanda; 9/13/25 The front line of cybersecurity has always been uneven. Attackers innovate with speed, testing new exploits daily, while defenders struggle to keep up with outdated playbooks. What enterprises lack isn’t more tools — it’s foresight.  Digital twins, virtual replicas that learn and evolve in real time, are giving security teams a way to see threats before they strike. For the first time, organizations can stage tomorrow’s attacks today, turning defense from a reaction into a rehearsal. 

Over 240 advocates rally in DC for the future of care at home: National Alliance for Care at Home hosts Inaugural Advocacy Week on Capitol Hill National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 9/12/25 More than 240 care at home care advocates from across the country met with over 275 congressional offices this week to discuss key legislative and regulatory priorities for expanding access to home-based care services. The meetings were part of the 2025 National Alliance for Care at Home’s inaugural Advocacy Week. Alliance Advocacy Week brings together leaders, advocates, and supporters to unite as one voice for care at home, driving positive legislative change and shaping the future of care to ensure broader access to the life-changing home care services for all Americans. 

Caregiving under the Medicare Hospice Benefit JAMA Internal Medicine - Viewpoint Agind and Health; by Helen P. Knight, MD; Richard E. Leiter, MD, MA; Harry J. Han, MD; 9/8/25 As palliative care physicians, we frequently refer patients to hospice care. When we do so, we often worry about them. How will they and their families manage custodial care—the day in, day out, physical and financial demands of caregiving—on top of navigating the inherent challenges of end of life? We know that high-quality hospice agencies provide patients and their families with invaluable support for symptomatic, emotional, and spiritual needs. But in the US, due to constraints of Medicare reimbursement, hospice agencies provide only limited custodial care support; this lack of assistance often is an unwelcome surprise to our patients and families and profoundly shapes their end-of-life experience.

The keys to building solid disease-specific hospice programs Hospice News; by Holly Vossel; 9/8/25 Understanding the most prevalent medical conditions among aging patient populations is a significant part of developing disease-specific programs that better address physical, emotional and practical needs. ... Community needs assessments play a large role in steering the direction of a disease-specific program, said Evan Dressel, director of strategy, program development and innovation at Lower Cape Fear LifeCare.  ... Navigating service needs, strategic execution and establishing successful care collaborations are crucial components to consider when building a disease-specific program, according to Kelly Gadison, vice president of clinical practice, strategy and programs at Amedisys. ... 

Hospice Insights Podcast - Where’s the line: When does poor quality create false claims liability JDSupra; by Meg Pekarske and Jonathan Porter; 8/27/25 Substandard quality care is the subject of survey citations and lawsuits, but it has also been used by the Justice Department to support false claim liability. While historically these cases were rare, a recent multi-million dollar settlement puts “worthless services” on the radar. Join Husch Blackwell’s Meg Pekarske and Jonathan Porter as they explore what the “worthless services” theory of liability is, when it has been used, and whether the recent settlement could signal a resurgence of these types of cases. 

Seasons Hospice closing Hospice House in Rochester to focus on in-home care ABC News KAALTV-6, Rochester, MN; by KAALTV; 9/4/25 On September 4, Seasons Hospice announced it will be closing the Hospice House after more than 25 years of service. Seasons Hospice cited an exclusive focus on in-home hospice care as the reason for the closure. Seasons Hospice said it will remain fully operational in providing home-based hospice services without interruption. “This is not an end to our mission. It is a continuation of our mission in a new way,” said Dawn Beck, Seasons Hospice Board of Directors President, via a press release. ... The closure will go into effect on Friday, October 10. 

Conversational AI in hospice care: risks and benefits Hospice News; by Jim Parker; 8/29/25 Numerous types of artificial intelligence (AI) have gained a substantial foothold in health care, including hospices, with conversational AI among them. Conversational AI uses natural language processing and machine learning to develop virtual assistants and chatbots that can automate certain functions. ... The use of conversational AI in health care for the most part falls into two categories — delivery of remote health services and administrative assistance to health care providers, according to 2024 research published in the Journal of Medical Internet Research. ... However, the technology has limitations, the study found. These include ethical challenges, legal and safety concerns, technical difficulties, user experience issues and societal and economic impacts.

Alliance submits comments in response to CY 2026 Home Health Proposed Rule National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 8/29/25 As the federal comment period draws to a close, the National Alliance for Care at Home (the Alliance) has joined an unprecedented number of providers and patients in submitting formal feedback to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed 9% cut to the home health payment rate for 2026. The unusually high volume of responses collected throughout the comment window underscores broad concern that the $1 billion payment reduction will limit access to care at home, compromise patient safety, and burden the wider healthcare system.