Literature Review

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.

Hospice community responds to proposed DEA telehealth prescribing rule Hospice News; by Jim Parker; 3/20/25 A proposed rule by the U.S. Drug Enforcement Administration (DEA) could impede timely access to medications for hospice and palliative care patients, according to members of the hospice community. ... If finalized, this proposed rule would require prescribers to register with the DEA before they are allowed to prescribe schedule II-V controlled substances, along with some monitoring and other requirements.  ... Implementation of the proposed rule would have adverse consequences for hospice and palliative care patients, according to the National Alliance for Care at Home. ... The Alliance made several recommendations to the DEA regarding the proposal: 

Congress extends telehealth flexibilities: 5 notes Becker's Health IT; by Naomi Diaz; 3/17/25 Congress has passed a federal spending bill that extends telehealth provisions through Sept. 30, 2025. ... Here are five key telehealth-related elements of the bill:

Medicare Payment Advisory Commission [MedPAC] releases report to Congress on Medicare Payment Policy 2025 report 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) eleases 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.]

MedPAC’s flawed recommendations would harm patients and increase costs National Alliance for Care at Home, Alexandria, DC and Washington, DC; Press Release; 3/14/25 The National Alliance for Care at Home (the Alliance) released the following statement on the Medicare Payment Advisory Commission’s (MedPAC) March 2025 Report to Congress: Medicare Payment Policy. ... “MedPAC’s recommendations are based on flawed and incomplete analyses with conclusions unsupported by all the available facts. These recommendations severely undervalue the critical role that home health and hospice providers play in ensuring the health and well-being of Medicare beneficiaries,” said Alliance CEO Dr. Steve Landers. “Recommending unthinkable cuts for home health and stagnant payment rates for hospice in the face of workforce shortages and inflation threaten access to these vital services for our aging population and undermine the dedicated providers who support them. ..."

Empath Health CEO to Congress: Invest in home-based care Hospice News; by Jim Parker; 3/11/25The federal government must invest further in home-based care, Empath Health CEO Jonathan Fleece told lawmakers at a hearing with the U.S. House of Representatives Ways & Means Health Subcommittee. leece was among several post-acute care leaders who appeared at the hearing, representing home health, hospice, skilled nursing facilities, rehabilitation hospitals and other stakeholders. In opening remarks, Fleece pointed to the benefits of home-based care for patients and families, as well as the sector’s ability to reduce health care costs. 

Amid huge growth in Southern Nevada’s hospice industry, lawmaker pushes for more oversight The Nevada Independent; by Tabitha Mueller; 3/5/25 The number of licensed hospice providers in Southern Nevada jumped by more than 350 percent since 2020 — a proliferation combined with minimal industry regulation that health care experts warn harms patients and leads to fraud. To address the issue, Assm. Rebecca Edgeworth (R-Las Vegas) is sponsoring AB161, which is scheduled for a hearing Wednesday. The measure, Edgeworth said, is a way to “raise the bar” for hospice providers and protect patients. “In the last few years, there has been this horrendous influx of charlatans and flimflam artists,” Edgeworth told The Nevada Independent.

Here's how the federal funding freeze is impacting Kodiak organizations KMXT, Kodiak, AL; by Davis Hovey; 2/28/25 Billions of dollars in federal funding going to Alaska nonprofits and other entities are in jeopardy after a funding freeze implemented by the Trump administration. The fallout in Kodiak is impacting domestic violence shelters, agriculture programs and many other organizations. ... And then there are indirect impacts. For example, Hospice & Palliative Care of Kodiak relies partially on money from entities who have had their funding frozen. Hospice is a non-medical entity and the only one providing end-of-life services for those experiencing serious illness, death and bereavement in Kodiak. Executive director Diane Ibarra explained the organization’s funding structure during a local public affairs show, ... "So although we’re not directly reliant on federal funds, the people that often donate to us are. So if federal funding goes out the window, there goes our funding," Ibarra explained.

Montana House considers bill to put more sideboards on medical assistance in dying NBC KPVI-6, Pocatello, ID; by Darrell Ehrlick; 2/26/25 ... On Wednesday, in a hearing of the House Judiciary Committee that was full of as much testimony as tears, opponents and supporters of medical aid in dying, sometimes called “physician-assisted suicide,” discussed House Bill 637, which would codify requirements for physicians to use the process. ... Demonstrating the often complex political issue that can’t be broken down by party lines, Rep. Ed Stafman, D-Bozeman, who is also a lawyer and rabbi, said he was truly conflicted on the bill, and wondered how Juras, also an attorney, viewed the proposed legislation in light of the state constitution’s right to dignity. ... Testimony from medical professionals ranged from strong support to opposition,  ... [Click here for] Here's what [Montana] House Bill 637 would do ...

Palliative care advocates at the World Health Organization executive board meeting ehospice; by Stephen Connor, Executive Director WHPCA; 2/19/25 The World Health Organization (WHO) is in turmoil with the planned withdrawal of funding and membership from the USA. About 20% of the WHO budget is from the US and withdrawal of all USAID funding is causing serious problems worldwide. Many member states are increasing their dues to WHO to help offset this loss, but these are difficult times for public health. These issues were front and center at the meeting of the WHO Executive Board 3-11 February.

‘End-of-Life Options Act’ moving forward The Famuan - Florida A& M University; by Myah Canidate; 2/22/25 In a world where medical advancements have extended life, the question of how we choose to end it has become increasingly pertinent. House Bill 471, commonly known as the Florida End-of-Life Options Act,  proposes a significant shift in how terminally ill patients can approach their final days. This legislation would allow qualified individuals the right to request medication to end their lives peacefully, igniting a complex debate around autonomy, ethics and healthcare practices. ... Supporters of HB 471 argue that it offers a compassionate choice for those enduring unbearable suffering. ... Critics argue that vulnerable patients may feel pressure to choose this option, particularly in situations involving financial strain or family dynamics. 

[West Virginia] House HHR Committee holds hearing on CON Wrap Up - Official Blog of the West Virginia Legislature; by Cheyenne DeBolt; 2/20/25 The [West Virginia] House Health and Human Resources Committee met [Thursday Feb. 20] for a lengthy committee hearing on certificate of need repeal. Several people showed up to speak about CON and questions about patient choice, patient access, and affordability came up. House Bill 2007 repeals the certificate of need (CON) process on January 1, 2026. The bill also terminates the WV Health Care Authority, transferring its assets and powers to the Secretary of the Department of Health. The bill was advanced to markup. ... Every state around West Virginia except Pennsylvania and Ohio has CON meaning WV could only go into two other states but all the states around us could come into WV. There are seven hospice houses in West Virginia which are all nonprofit. There are 18 hospice providers throughout the state, which are divided based on the CON processes.

Health policy challenges for 2025 and beyondJAMA Health Forum; Lanhee J. Chen, JD, PhD; 1/25Despite multiple reform attempts, the US health care system is still burdened by high costs, limited access to quality care, and policies that have resulted in the inefficient delivery of care. However, technological advances, insights from the COVID-19 pandemic, and approaching policy deadlines, such as expiration at the end of 2025 of enhanced coverage subsidies available through the Affordable Care Act (ACA), offer policymakers a reason to act. The next few years will present policymakers with opportunities to address key health care challenges, including the future of Medicare, the continuing implementation of the ACA, and the health care provisions included in the federal tax code. The new administration and Congress will have their hands full in 2025 because the expiring tax and subsidy provisions are action-forcing events. Lawmakers will face a unique opportunity to reform the system in a way that improves accessibility and affordability and enforces some measure of fiscal discipline, and to make decisions that could positively affect the future of health care for millions of individuals in the US.