Literature Review

3 strategies for hospice GIP compliance Hospice News; by Jim Parker; 10/21/24 Utilization of the general inpatient level of care (GIP) is frequently the subject of audits by Medicare Administrative Contractors (MACs), and avoiding or responding to that scrutiny requires strict compliance to a complex web of rules. Audits are becoming more frequent in the hospice space, and GIP is an increasing focus, including ​for the most common types — Supplemental Medical Review Contractor (SMRC) and Targeted Probe and Educate (TPE). In a survey earlier this year, more than half of hospice providers reported having undergone multiple types of audits within a six-month period. ... In addition to these routine MAC audits, the U.S. Department of Health and Human Services Office of the Inspector General (GIP) has been performing a national audit of GIP utilization, as well as an additional investigation into management of the associated payment cap. The inpatient cap limits the number of days of inpatient care for which Medicare will pay to 20% of a hospice’s total Medicare patient care days, according to OIG. If GIP billing exceeds that metric, the hospice must refund those payments to Medicare.

Managing the hospice payment cap by balancing Length of Stay Hospice News; by Jim Parker; 10/15/24 Careful management of the hospice aggregate cap is key to providers’ sustainability as regulatory scrutiny continues to heat up. The cap is designed to prevent overuse of hospice, put controls on Medicare spending and foster greater access to care among patients. For Fiscal Year 2024, the U.S. Centers for Medicare & Medicaid Services set the cap at $33,394. In 2025, this will rise to $34,465. “While the cap is a beneficiary driven cap, meaning the reimbursement allowed per Medicare beneficiary, it is not assessed at the beneficiary level, but rather in the aggregate at the agency provider number level for all beneficiaries served by the agency in the cap,” Rochelle Salinas, vice president of operations for CommonSpirit Health at Home, said. “This allows for greater flexibility in providing care to those in need.” ... [Click on the title's link to continue reading.]

Empath Health established Hurricane Helene Assistance Fund to support colleagues South Florida Hospital and Heaclthcare Report; by Victoria Tanner; 10/6/24 At Empath Health, we believe that caring for our colleagues is just as essential as caring for our patients and families. In response to the recent devastation caused by Hurricane Helene, we have established a special Hurricane Helene Assistance Fund within our Colleague Assistance Fund (CAF) to offer immediate financial relief to colleagues who have been impacted by the storm. This fund is designed to help those facing unexpected expenses, such as temporary housing, home repairs, and other essential needs that have arisen in the wake of the hurricane. By creating this targeted fund, we aim to ensure that our team members can access the resources they need to recover and rebuild during this difficult time. “Our colleagues are the heart of our mission, and in times of crisis, we stand by them just as they stand by our patients,” said Jonathan Fleece, President and CEO of Empath Health. “This fund allows us to help those who give so much to others, ensuring they have the support they need when it matters most.” ... Hurricane Helene, which impacted West Central Florida on [September 26], stands as the most severe storm to hit the region in over a century. Empath Health, with over 3,000 colleagues, serves communities across 20 counties, stretching from Collier County in the south to Marion County in the north. Editor's note: We understand that contributions are made by Empath's colleagues. For other, hospice contributions (especially links where the general public can contribute to hospice staff and/or hospice needs, please contact us via these links, Editor and/or Publisher. Thank you.

Medicare Advantage Value-Based Insurance Design Model Calendar Year 2025 Model Participation CMS Newsroom; Fact Sheet; 9/27/24 The Centers for Medicare & Medicaid Services (CMS) is announcing the Calendar Year (CY) 2025 participants in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model. As part of the VBID Model, MA plans offer additional supplemental benefits and/or reduced cost sharing (in some cases to zero). MA plans participating in the VBID Model may also use reward and incentive programs. ... For CY 2025, the VBID Model has 62 participating Medicare Advantage Organizations (MAOs) testing the model in 48 states, D.C., and Puerto Rico through 967 plan benefit packages (PBPs). All 62 participating MAOs prepared Health Equity Plans on how they will address potential inequities and disparities in access, outcomes, and/or enrollee experience of care as it relates to their participation in the VBID Model. 

Blumenauer proposes overhaul to Hospice Benefit: If enacted, the legislation would be the single most significant update to the hospice benefit and payment structure since its inception in 1982. 

Spending on home healthcare outpaces others for 4th consecutive month McKnights Senior Living; by Kathleen Steele Gaivin; 9/26/24 Spending on home healthcare continued to outpace the rest of the sector in August, according to Altarum’s monthly Health Sector Economic Indicators brief, released Wednesday. “This is the fourth successive month in which we have observed such rapid growth. Year-over-year home healthcare spending growth for the four-month period from April through July was 19.7%,” George Miller, PhD, Altarum fellow and research team leader, told the McKnight’s Business Daily. Overall, healthcare costs were 2.7% higher last month than they were in August 2023 and 0.2% percent lower than they were in July, according to Altarum. ... Nursing and residential care employment, however, declined by 2,600 jobs in August. ...

HopeHealth CMO: Hospice rules for ‘unrelated care’ getting stricter Hospice News; by Jim Parker; 9/25/24 Dr. Ed Martin began working in hospice in 1987 after hearing families talk about their experiences with those services. Today, he is chief medical officer of Rhode Island-based HopeHealth. The more than 50-year-old nonprofit organization also serves parts of Massachusetts. Martin recently spoke about the complicated issue of care that is deemed “unrelated” to a patient’s terminal diagnosis at the National Hospice and Palliative Care Organization’s Annual Leadership Conference in Denver. Hospice News sat down with Martin at the conference to discuss how he and his organization are addressing the matter of unrelated care, as well as the efficacy of requirements for an addendum to the election statement. [Click on the title's link to continue reading this interview.]

The ROI of interoperability in home health Home Health Care News; by Elizabeth Ecker; 9/16/24 Today’s home-based care organizations know there is value in interoperability among their technology vendors. Allowing for seamless data integration as well as ease-of-use for staff and clinical professionals, interoperability is an important consideration for technology decisions in today’s operating environment. But what is the true value of interoperability, and how can home-based care agencies measure their return on investment? Several leading professionals share their perspectives on how they approach ROI calculations in their organizations.

More home health providers sunset relationships with largest Medicare Advantage players Home Health Care News; by Andrew Donlan; 9/13/24 Essentia Health--a regional nonprofit health system with a substantial home health arm--announced this week that it will no longer serve as an in-network provider for UnitedHealth Group. ... Dr. Cathy Cantor, Essentia’s chief medical officer for population health, said in a statement ... “The frequent denials and associated delays negatively impact our ability to provide the timely and appropriate care our patients deserve. This is the right thing to do for the people we are honored to serve.” Headquartered in Duluth [MN], Essentia Health provides care across Minnesota, Wisconsin and North Dakota. Its network includes about 15,000 employees, 14 hospitals, 78 clinics, six long-term care facilities, six assisted living and independent living facilities, and much more. It also has a robust home health and hospice business. The company has informed patients that it will no longer serve as an in-network provider for the above-mentioned MA payers beginning Jan. 1. ... Sanford Health, a health system based in Sioux Falls, South Dakota, announced a similar plan this week. 

Humana to depart 13 Medicare Advantage markets Modern Healthcare; by Lauren Berryman; 9/4/24 Humana previewed its Medicare Advantage strategy for the coming plan year, including a decision to quit 13 counties where performance has been unsatisfactory, at the Wells Fargo Healthcare Conference on Wednesday. The Medicare Advantage heavyweight, which had 6.2 million members in those plans as of the second quarter, expects to lose a few hundred thousand enrollees in 2025 as it prioritizes profitable markets, Chief Financial Officer Susan Diamond told investors at the event in Everett, Massachusetts. In addition to leaving those 13 counties, Humana will offer fewer plans in some other areas, Diamond said. About 560,000 members will have to choose new policies for 2025, most of whom will have other Humana plans available to them, she said. ... Diamond did not specify what markets will be affected, but Humana will continue selling Medicare Advantage plans in every state. The company is committed to a presence in certain favorable regions, including south Florida, she said. 

Hospice ‘pausing’ Martin-Linsin Residence while expanding home-care model OrleansHub.com, Orleans County, NY; by Tom Rivers; 9/3/24 The Martin-Linsin Residence has temporarily closed or is on “pause” following a thorough analysis that showed “significant financial losses due to the increasing operational costs” at the residence, according to a statement this evening from Niagara Hospice, which is running Hospice of Orleans. The eight-unit residence opened in 2012 following a $2.3 million capital campaign. Martin-Linsin used to have a waiting list, but was down to one resident last week. No new residents had been admitted for about three weeks. The clinical staff also was laid off last week after the death of the remaining resident at Martin-Linsin, a Hospice employee said. Niagara Hospice, in its statement, said it is dedicated to caring for the local community, and hospice care “continues to be delivered throughout Orleans County without interruption.”

Hospice CARE Act would create reimbursement for high-acuity hospice services Hospice News; by Holly Vossel; 8/19/24 If enacted, the Hospice Care Accountability, Reform and Enforcement (Hospice CARE) Act could open up reimbursement pathways for high-acuity palliative services during a time when demand and costs are rising. Developed by U.S. Rep. Earl Blumenaur (D-Oregon) and announced in June at the Hospice News Elevate conference, the bill proposed massive reimbursement and regulatory changes to the Medicare Hospice Benefit. Currently in a discussion draft phase, the bill includes ways for hospice providers to have clearer definitions and improved payment for more intensive forms of palliation, such as radiation therapy, blood transfusions or dialysis, among others.

Hospice care for those with dementia falls far short of meeting people’s needs at the end of life University of Michigan; by Maria J. Silveira; 8/18/24 ... Strikingly, only 12% of Americans with dementia ever enroll in hospice. Among those who do, one-third are near death. This is in stark contrast to the cancer population: Patients over 60 with cancer enroll in hospice 70% of the time. In my experience caring for dementia patients, the underuse of hospice by dementia patients has more to do with how hospice is structured and paid for in the U.S. than it does patient preference or differences between cancer and dementia. ... In the U.S., ... Medicare’s rules and regulations make it hard for dementia patients to qualify for hospice when they and their families need support the most – long before death. In Canada, where hospice is structured entirely differently, 39% of dementia patients receive hospice care in the last year of life. ...