Literature Review

U.S. health care spending reaches $4.9 trillion Hospice News; by Jim Parker; 12/20/24 The nation’s total health expenditures rose 7.5% to $4.9 trillion in 2023, a new analysis by the U.S. Centers for Medicare & Medicaid Services (CMS) found. This growth took place at a faster pace in 2023 than prior years. In 2022, health care spending rose at a rate of 4.6%. Total Medicare hospice spending accounted for $25.7 billion last year, according to a separate report from the Medicare Payment Advisory Commission (MedPAC). ... About 21% of U.S. health care spending in 2023 was via Medicare, with private insurance representing a 30% share. Medicaid accounted for 21%, and the remaining 10% were out-of-pocket costs. “Hospital care, physician and clinical services, and nursing care facilities and continuing care retirement communities, which collectively accounted for 33% of all out-of-pocket spending in 2023, were the main contributors to the faster growth in 2023,” CMS indicated.

MedPAC advises cutting home health payments by 7 percent, freezing hospice payments in ’26 McKnights Home Care; by Liza Berger; 12/16/24 The Medicare Payment Advisory Commission (MedPAC) on Friday issued draft recommendations that entail cutting payments to home health agencies by 7% and freezing hospice payments in 2026. The body, which advises Congress on Medicare payment issues, issued the same recommendations last year. Providers, once again, were not pleased. “The recent recommendations by MedPAC regarding Medicare home health and hospice policy are misguided and deeply troubling,” Steve Landers, MD, CEO of the National Alliance for Care at Home, said in a statement to McKnight’s Home Care Daily Pulse. “Medicare hospice spending has not kept up with labor inflation in the past five years and the typical length of stay and proportion of beneficiaries accessing hospice has stagnated. With respect to home health, the recommendation for drastic cuts is based on a flawed analysis of agency margins that fails to account for all payers and the true financial health of the home health system.”

CGS Administrators, LLC, did not reopen and recalculate most selected hospices’ caps for years prior to 2020 USA HHS Ofice of Inspector General (OIG), Washington, DC; issued 11/27/24, posted 12/4/24Why OIG Did This Audit: ... Our audit determined whether CGS accurately calculated cap amounts and collected cap overpayments in accordance with CMS requirements. This audit is part of a series that reviewed MAC calculations and collections of hospice aggregate and inpatient cap overpayments.What OID Recommends: [... that CGS] 

Michael Dowling: We've revolutionized care for aging adults, but is America's health system ready for the senior population boom? Becker's Hospital Review; by Michael J. Dowling, President and CEO, Northwell Health; 12/2/24 Like many baby boomers and those from earlier generations, I have vivid memories from my younger years of my grandparents and other aging adults struggling with an assortment of ailments that their doctors told them were just an inevitable part of growing old. ... The transformative advancements made over the past half-century in meeting the physical and emotional health needs of the nation's rapidly aging population are remarkable — and that's especially important because more Americans are turning age 65 now than in any other time in our history (4.1 million in 2024, or 11,200 a day). And as we move toward a new year, every healthcare executive must examine whether we are collectively prepared to care for them in the years and decades ahead and take steps to recruit the medical specialists we need to meet burgeoning demand. ... Lastly, all clinicians must embrace palliative care as part of their standard practice in managing the health of aging adults with serious illness. ... 

Seven of thirty hospices reviewed did not comply or may not have complied with terms and conditions and federal requirements for Provider Relief Fund payments HHS Office of Inspector General; issued on 11/8/24, posted on 11/14/24Why OIG Did This Audit: The Provider Relief Fund (PRF), a $178 billion program, provided funds to eligible providers for health care-related expenses or lost revenue attributable to COVID-19. ... This audit is part of a series reviewing PRF payments to various provider types. Specifically, this audit assessed whether 30 selected hospices expended taxpayer funds in accordance with Federal and program requirements. ... What OIG Found: ... Of the 30 selected hospices, 23 hospices used PRF funds for allowable expenditures and lost revenues attributable to COVID-19; however, 7 hospices did not comply with or may not have complied with Federal requirements. Of these seven hospices, which received $98.1 million in PRF payments, six hospices claimed a total of $8.3 million of unallowable PRF expenditures and inaccurately reported $1.5 million of lost revenues, and one hospice claimed $4 million in expenditures that may not have been allowable. ... What OIG Recommends: We made two recommendations to HRSA, including that it require the selected hospices to return any unallowable expenditures to the Federal Government or ensure that the hospices properly account for these expenditures. ...

Long-term care market to grow by USD 394.8 billion from 2024-2028, as aging population drives demand with AI impact on market trends - Technavio Cision; by PR Newswire; 11/8/24 Report on how AI is redefining market landscape - The global long-term care (LTC) market size is estimated to grow by USD 394.8 billion from 2024-2028, according to Technavio. The market is estimated to grow at a CAGR of over 3.21% during the forecast period. Growing demand for long-term care from aging population is driving market growth, with a trend towards expansion and growth of several healthcare domain. However, lack of skilled nursing staff for long-term care  poses a challenge.Key market players include Abri Health Care Services LLC, Amedisys Inc., Brookdale Senior Living Inc., CareOne Management LLC, Diversicare Healthcare Services Inc., Extendicare Canada Inc, FCP Live In, Genesis Healthcare Inc., Honor Technology Inc., Illumifin Corp., Kindred Health Holdings LLC, Life Care Centers of America Inc., Revera Inc., SeniorLiving.org, Sonida Senior Living Inc., Sunrise Senior Living LLC, and Wickshire Senior Living.

The Pennant Group to seek more hospice, home health deals in 2025 Hospice News; by Jim Parker; 11/7/24 The Pennant Group (Nasdaq: PNTG) has a “robust pipeline” of potential acquisitions in the wings for 2025 across its home health and hospice and senior living business segments. For prospective deals, Pennant scouts for agencies that show strong promise for organic growth that have “talented” local leaders or entrepreneurs in place, according to CEO Brent Guerisoli. Pennant then leverages the resources in its platform to foster growth. “Developing local leaders remains at the heart of our operating model,” Guerisoli said in a Q3 earnings call. “As the talent and experience operations and clusters deepens with strong portfolio companies, our efforts throughout our footprint, we are able to more quickly improve new acquisitions and grow seasoned operations, thus the significant investment we have made in our leadership and development programs is the catalyst for enduring momentum.” Pennant is the holding company for a cluster of independent hospice, home health and senior living providers located across 13 states. Year to date, the company has added more than 60 CEOs to its portfolio agencies as well as 40 internal clinical leaders.

Why home health deserts are spreading across rural states Modern Healthcare; by Diane Eastabrook; 11/1/24 Home health deserts are increasing at an alarming rate across some rural states as home health companies close or reduce services due to financial challenges. Home health companies in Maine, Nebraska and Minnesota say a proposed Medicare rate cut, low Medicare Advantage reimbursements and workforce shortages are forcing them to make difficult business decisions — leaving many communities with limited access or no access to post-acute care in the home. ...  Approximately 800 home health providers have closed over the past five years, according to the National Alliance for Care at Home, a trade group that represents the industry. Alliance CEO Dr. Steve Landers mostly blames a Medicare home health payment model that went into effect in 2020 for reducing Medicare reimbursements and causing financial stress for providers. “While closures are significant, we are also getting reports that providers are restricting the territory they serve as a first step to addressing their financial stresses,” Landers said in an email. “This appears to be especially concerning in rural areas where no other provider is available to step in.”

Longer hospice stays among dementia patients save Medicare dollars Hospice News; by Holly Vossel; 11/4/24 Hospice utilization has tripled among patients diagnosed with Alzheimer’s disease and related dementias (ADRD) during the past two decades. The trend has ignited concerns about these patients’ lengths of stay, as well as praise for hospices’ cost-savings potential. Massachusetts Institute of Technology (MIT) researchers analyzed Medicare fee-for-service claims spanning between 1999 and 2019, including data on hospice billing, patient enrollment, hospitalizations, health costs and chronic condition indicators. Roughly 14.7% of ADRD patients utilized hospices services in 2019, nearly triple the 4.4% of patients who received this care in 1999, according to the research, which was published in the National Bureau of Economic Research. The research compared billing claims among nonprofit and for-profit providers to explore spending associated with longer hospice stays among dementia patients. ...

CMS finalizes 2.9% cut in physician payments for 2025, including for palliative care Hospice News; by Jim Parker; 11/4/24 The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized a nearly 2.9% cut for 2025 in physician payment rates used to reimburse palliative care care practitioners, among other professionals. The final rule also states that the telehealth flexibilities implemented during the COVID-19 public health emergency will expire at the end of this year unless Congress intervenes. Physicians and other professionals will have to follow pre-COVID restrictions on telehealth, with few exceptions. Industry organizations were quick to denounce the pay cut. “To put it bluntly, Medicare plans to pay us less while costs go up. You don’t have to be an economist to know that is an unsustainable trend, though one that has been going on for decades,” American Medical Association President Dr. Bruce Scott said in a statement.

Medicare Part D paid millions for drugs for which payment was available under the Medicare Part A Skilled Nursing Facility Benefit HHS Office of Inspector General; Report Highlights; 10/27/24 What OIG Found: ... On the basis of our sample results, for 2018 through 2020, we estimated that up to the entire Part D total cost of $465.1 million was improperly paid for drugs for which payment was available under the Part A SNF benefit. Of that amount, we estimated that approximately $245.4 million was for drugs that the medical records showed were administered to Part D enrollees during their Part A SNF stays.What OIG Recommends: We made five recommendations, including that CMS work with its plan sponsors to adjust or delete PDEs, as necessary, and determine the impact to the Federal Government related to the Part D total costs of $953,370 for drugs associated with our sample items for which payment was available under the Part A SNF benefit; work with its plan sponsors to identify similar instances of noncompliance that occurred during our audit period and determine the impact to the Federal Government, which could have amounted up to an estimated $465.1 million in Part D total cost; and provide plan sponsors with timely and accurate information, such as dates of covered Part A SNF stays, to reduce instances of inappropriate Part D payment for drugs for which payment is available under the Part A SNF benefit. ... CMS concurred with all five recommendations.

Southern Tier Health helps HomeCare & Hospice, Total Senior Care on USDA grant Olean Times Herald, Olean, NY; by Kellen M. Quigley; 10/22/24 A collaboration between three local agencies looking out for the health and well-being of their clients is getting a modern technological boost thanks to a federal grant. The Southern Tier Health Care System, Inc. (STHCS) was recently awarded nearly $140,000 through the U.S. Department of Agriculture’s Rural Development Rural Utilities Service Distance Learning and Telemedicine Grant Program. This funding is meant to empower rural communities by leveraging advanced technology to connect residents and healthcare providers, overcoming the challenges of distance and low population density. Of the total grant, $114,606.80 was allocated to HomeCare & Hospice and Total Senior Care for state-of-the-art digital communication and remote learning tools, including high-definition displays, advanced cameras and integrated audio systems.