Literature Review

Strategies for managing rising healthcare premiums with Jason Bradshaw Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Jason Bradshaw; 10/29/25 In this episode of TCNtalks, host Chris Comeaux welcomes back Jason Bradshaw, a seasoned benefits consultant with USI Insurance Services. Together, they unpack why healthcare premiums are rising, where volatility is coming from, and how employers can regain control without gutting benefits.  Jason shares practical funding models, transparency tools, and a playbook for building a cost culture that actually moves behavior.

Ames hospice center to close due to decline in patient numbers, rising costs We Are Iowa, Des Moines, IA; by Caleb Geer;10/23/25 After more than 25 years of service in central Iowa, the Israel Family Hospice House is preparing to close its doors, according to Mary Greeley Medical Center. The decision will be effective on Dec. 31, 2025, pending approval by the hospital's Board of Trustees during their Oct. 28 meeting. "After careful consideration, and in light of a steady decline in patient numbers, increased competition from for-profit providers, insufficient reimbursements, and rising operational costs, we have made the difficult decision to close the hospice house," a post on the Mary Greeley Facebook account says in part. Reasons for the pending closure include declining patients, increased competition and increasing deficit, according to an FAQ document provided by the hospital.

Rural Health Transformation Program must consider care at home, Alliance tells CMS McKnights Home Care; by Adam Healy; 10/17/25 As stakeholders compete for funding from the Rural Health Transformation Program, the Centers for Medicare & Medicaid Services’ $50 billion rural healthcare grant initiative, home care providers are asking for their cut. “The RHTP represents a chance to reshape rural health systems around a continuum of care that extends beyond hospital walls,” Steve Landers, MD, chief executive officer of the National Alliance for Care at Home, said Wednesday in a letter to CMS. “The National Alliance for Care at Home strongly urges CMS to view home-based care not as an adjunct, but as an essential partner in the transformation of rural health delivery.”

AdventHealth saves $47.5M with redesigned nurse career ladderBecker's Clinical Leadership; by Mariah Taylor; 10/9/25 AdventHealth’s redesigned career ladder has prevented the departure of more than 700 nurses and saved the system an estimated $47.5 million in 2024. The Professional Excellence Program launched in 2022 to keep nurses at the bedside and counter the notion that they had to migrate into leadership, quality or safety roles to progress in their career. “Historically, to advance, nurses often felt they had to step away from the bedside because those roles didn’t fully recognize the specialized competencies they bring,” Trish Celano, RN, system chief nurse executive for the Altamonte Springs, Fla.-based system, told Becker’s. “The clinical ladder changes that.” 

Seasons Hospice hosts commemoration as it closes hospice house, forges ahead with in-home care KTTC, Rochester, MN; by Caitlin Alexander; 10/10/25 Local nonprofit organization Seasons Hospice hosted a somber but significant moment on Friday as it commemorated its hospice house. After more than 25 years, Seasons Hospice is closing the doors of the hospice house, as it now shifts its focus to serving patients and families with in-home hospice care. “I had a hard time at first accepting that and getting beyond it, but I did,” one of the founders, Sarah Oehlke, said. “I’m very grateful that you have sustained our quality-of-care standards for all of the years.” “We have together provided comfort, dignity and compassion to countless families during life’s most poignant moments,” Board President Dawn Beck said. ... Seasons Hospice previously spoke about a declining census at the hospice house, especially in recent years, noting the shift toward people wishing to spend their final days in their homes with loved ones.Editor's Note: This Seasons Hospice is in Rochester, Minnesota; not to be confused with other hospice organizations throughout the nation with "seasons" in its name. They gave their hospice house both a "good life" and "a good death." We draw attention to the shift they described "toward people wishing to spend their final days in their homes with loved ones," and will continue to be on the lookout for similar trends. To quote from an ancient poet, "To everything there is a season ..." We wish Seasons Hospice well through its continued transitions.

[England] One in five hospices ‘face a deficit of over £1m’ while many axe services – data MSN - The Irish News US; by  Jane Kirby and Ella Pickover; 10/9/25 One in five hospices in England have a deficit of more than £1 million, while many are cutting services, according to new data. Hospice UK said short-term Government funding has helped plug some gaps but the sector is still majorly struggling due to a lack of cash. Some 57% of hospices in England ended the last financial year (2024-25) in deficit, with a fifth having a deficit of more than £1 million.

Study: PE-owned hospices have highest profits, lowest spending on direct patient care McKnights Home Care; by Liza Berger; 10/8/25 Compared to publicly traded company-owned and other for-profit hospices, private equity (PE)-owned hospices reported the highest profits and lowest spending on direct patient care and nonsalary administrative services, a study published Tuesday in Health Affairs revealed. The study, which used 2022 Medicare cost reports, compared revenue and expense data across four hospice ownership models: PE-owned, publicly traded company-owned, other for- profit, and not-for-profit. The sample consisted of 2,989 freestanding hospices ... [Across] the board, not-for-profits spend about 20% more on direct patient care services than other for-profits. And that seems to be driven by a pretty big difference in nurse salaries, which to us implies that staffing tends to be better at or at least more robust at not-for-profits. ... A body of research has found that for-profit hospice ownership, including private equity, is associated with poorer quality, higher rates of complaints, a higher number of live discharges, and a higher hospitalization rate compared with not-for-profit ownership.

CMS telehealth waivers, virtual hospice re-certification, expire Hospice News; by Jim Parker; 10/1/25 The regulatory flexibilities related to telehealth that the U.S. Centers for Medicare & Medicaid Services (CMS) implemented during the COVID-19 pandemic have expired. This includes the ability of hospices to perform patient re-certification face-to-face encounters via telehealth. Also expiring are waivers that expanded the scope of practitioners eligible to provide telehealth services, as well as flexibilities that removed geographic requirements and expanded originating sites for telehealth services, including or federally qualified health centers and rural health clinics. The government’s failure to extend or make permanent the telehealth re-certification waiver is a “grave mistake,” according to Tom Koutsoumpus, CEO of the National Partnership for Healthcare & Hospice Innovation (NPHI).

‘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. 

Texas did not calculate or collect hospice cap overpayments totaling $10.5 million HHS-OIG; Report number: A-06-24-09001; Issued on 9/17/25, Posted on 9/22/5 

Serious falls resulting in hospitalization among Medicare-enrolled nursing home residents, July 2022–June 2023HHS Office of the Inspector General; Report number: OEI-05-24-0018; 9/18/25This OIG data snapshot accompanies the report, Nursing Homes Failed To Report 43 Percent of Falls With Major Injury and Hospitalization Among Their Medicare-Enrolled Residents, OEI-05-24-00180. The snapshot found that between July 1, 2022, and June 30, 2023, more than 42,000 Medicare-enrolled nursing home residents experienced serious falls resulting in major injury and hospitalization, and 1,911 died during their hospital stays. The data indicated that most residents had known fall risk factors prior to their injuries, and falls were more common among female, older, and short-stay residents. Nursing homes with lower nurse staffing levels and lower quality ratings had higher fall rates. These preventable events reduced residents’ quality of life and cost Medicare and enrollees over $800 million, underscoring the need for stronger fall prevention and quality improvement efforts in nursing homes. 

Wound care marketing can create confusion around hospice relatedness Hospice News; by Jim Parker; 9/16/25 Hospices provide wound care to many patients, but confusion can arise over questions of relatedness to the terminal illness. The goals of palliative wound care include primarily symptom management, comfort and dignity, but it does not always focus on healing the injury, a 2023 study indicated. This differs from general wound care, which does target healing. Palliative wound care is essential for hospice patients and most of the time should be considered related to the patient’s terminal condition, according to Felicia Walz, director of hospice quality for Colorado-based provider HopeWest. “Providing wound care to hospice patients is always appropriate,” Walz told Hospice News.

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):