Literature Review

Health systems invest in productivity Becker's Hospital Review, by Laura Dyrda; 3/6/24 Productivity is a buzzword for most workplaces today, and healthcare is no different. U.S. productivity measures showed big increases for the first time in years, according to a report in The New York Times, as organizations leverage artificial intelligence and aim to do more with less. For [health systems], many experiencing staffing shortages and tight margins, developing a culture of increased productivity is imperative. 

UnitedHealthcare, Humana, Aetna continue to outgain peers in Medicare Advantage Home Health Care News, by Andrew Donlan; 3/6/24In 2023, Medicare Advantage (MA) plan members represented more than half of all Medicare beneficiaries for the first time. In 2024, while penetration continues, there are other trends within MA that home-based care providers should be paying attention to. ... A few of the top companies continue to gain market share. Specifically, UnitedHealth Group (NYSE: UNH), Humana Inc. (NYSE: HUM) and CVS Health (NYSE: CVS) – through Aetna – continue to outpace competitors. 

Lower reimbursement a leading cause for poor margins, CFOs say Becker's Hospital CFO Report, by Madeline Ashley; 3/6/24 A recent report from the Healthcare Financial Management Association and Eliciting Insights, a healthcare strategy and marketing research company, found that 84% of health systems have cited lower payer reimbursements as a leading cause for low operating margins. [Click on the title's link for six more findings from the report.]

MA’s cost-management tools may be hurting home healthcare quality, outcomesMcKnights Long-Term Care News, by Adam Healy; 3/5/24Medicare Advantage’s use of cost-reducing tools such as copays, prior authorizations and restricted provider networks may be preventing home healthcare providers from delivering higher-quality care, according to one home healthcare leader. 

The top strategies healthcare organizations can use to reduce denials MedCityNews, by Laxmi Patel; 3/5/24Here are six actionable steps healthcare organizations can take to reduce their likelihood of denials and write-offs.

Change Healthcare's temporary funding program 'not even a Band-Aid,' AHA says Becker's Health IT, by Giles Bruce; 3/4/24 The American Hospital Association called Change Healthcare's temporary funding program for providers affected by the cyberattack on the UnitedHealth Group subsidiary inadequate, while a U.S. Senate leader asked CMS to speed up payments to hospitals. Change Healthcare set up the funding assistance March 1 for providers facing cash-flow issues after losing access to its payer systems, which have been down since the Feb. 21 ransomware attack. However, AHA President and CEO Rick Pollack wrote in a March 4 letter to UnitedHealth Group that the program is "not even a Band-Aid on the payment problems you identify."

Home health disparities: Medicare Advantage patients receive fewer visits, worse outcomes Home Health Care News, by Patirck Filbin; 3/1/24Home health patients under Medicare Advantage (MA) plans have worse functional outcomes compared to traditional Medicare patients, likely as a result of receiving fewer visits, according to a new study.

Home Health & Hospice secures over $1 million in grants for innovative health care initiatives VB VermontBiz, by The University of Vermont Health Network Home-Health & Hospice; 2/29/24Home Health & Hospice (HHH) is pleased to announce the receipt of two grants from the Vermont Agency of Human Services, totaling $1.18 million. Vermont received funding through the American Rescue Plan Act of 2021 to enhance, expand, and strengthen home and community-based services (HCBS) and allocated a portion of those funds to offer grants to HCBS providers that serve Medicaid members. 

CMS upends Medicare Advantage supplemental benefits data reporting for payers DLA Piper, by Daivd Kopans and Sua Yoon; 2/27/24 On February 21, 2024, the Centers for Medicare & Medicaid Services (CMS) issued new guidance via a memorandum to Medicare Advantage (MA) organizations, Program of All-Inclusive Care for the Elderly (PACE) organizations, and Demonstration Organizations (collectively, Plans) that upends how these Plans have been reporting (or not reporting) encounter information for their covered supplemental benefits. The guidance in the memorandum is effective retroactively to January 1, 2024. [In this article] is a Q&A explaining the top points of the guidance and highlight its impact on companies across industries.

Why not-for-profit health systems need positive margins: Deloitte Becker's Hospital CFO, by Andrew Cass; 2/28/24Health system margins are the "lifeblood of a healthy, patient-centered, innovative health care system and community," according to a report from consulting firm Deloitte.  "Claims that profits are not important in fact undermine the ability to fund the mission, serve the community, and deliver better, equitable care," Deloitte said in the report. ... "[Systems] should consider a holistic approach that integrates margin drivers to create a balanced transformation portfolio, according to the report. Timing and sequencing are important within each driver and "a full understanding of the dollar impact and priority of each is necessary for margin improvement to be successful."

CMS finalizes important changes to Medicare enrollment requirements for hospice, home health providersJDSupra; 2/28/24The US Centers for Medicare & Medicaid Services (CMS) finalized important changes to the Medicare enrollment regulations applicable to hospices and home health agencies (HHAs), including increasing the level of screening that hospice providers are subject to and limiting a Medicare-enrolled hospice’s ability to change majority ownership to once every 36 months.

Where hospices are investing their 2024 recruitment, retention dollars Hospice News, by Holly Vossel; 2/20/24As hospices zero in on their investments in staff engagement and operational efficiencies, organizational culture is becoming a higher priority. ... Some have leveraged technology to streamline their operations and reduce documentation burdens, while others have poured resources into sculpting their organizational culture and developing training and career pathways.Notable mentions: Tanya Marion, Enhabit; Craig Dresang, YoloCares; Cooper Linton, Duke HomeCare & Hospice.

Providers urge CMS to use caution in midst of hospice VBID implementationMcKnights Home Care, by Adam Healy; 2/23/24With the Medicare Advantage Value-Based Insurance Design (MA VBID) model, which allows MA organizations to participate in the hospice benefit, underway, advocates have voiced concerns that critical safeguards be put in place.