Literature Review

Capitalizing palliative care startups Hospice News; by Jesse Floyd; 8/14/24 As a sector, most standalone palliative care providers are still maturing from startups into long-term, sustainable businesses. ... This means gathering the necessary startup capital to take a new palliative care provider from idea to execution is often the first tangible goal for hopeful entrants into the space. When Jonathan Fluhart and Tiffany Hughes set about getting PalliCare, their Texarkana, Texas-based palliative care provider from theory to reality, they ran headlong into this obstacle. ... “Initially, what we thought we would do is build a palliative program that would nest between the home health and hospice,” Fluhart said. “We started to go into the community to talk with facilities and places that we felt would benefit from our services. Once they learned that we were tied to a home health provider, especially a hospice, it turned them off.” They decided the answer was two-fold: Sever ties with the hospice care provider they worked for; then start casting about for investors. ... 

Inside one hospice’s battle for survival as it faces ‘incoming tsunami’ of need SwiftTeleca in South Boston, Virginia, with this article about Swindon, United Kingdom; by Shawn Butlere; 8/13/24Swindon’s Prospect Hospice is facing a £1million deficit this year. Hospices are receiving “woefully inadequate” funding to deal with an “incoming tsunami” of patients needing end-of-life care, a desperate sector leader has warned. ... Chief executive Jeremy Lune ... said: “Hospice funding is woefully inadequate at the moment – that is a fact. In the last 10 years, the amount that we receive from the NHS has not increased in real terms at all. “The cost of living crisis and so on mean that in real terms, it has decreased. And the need for hospice services is increasing. With an ageing population, people are living longer, they’re living with more conditions, and the funding simply doesn’t reflect that.”Editor's Note: USA hospice leaders, what themes and potential threats to our hospices are you seeing, especially in light of the new CMS Hospice Final Rule?

Free CHAP Webinar: CMS Posts Final Hospice Rule - Quality changes and regulatory requirement Community Health Accreditation Partner (CHAP); taught by Dr. Jennifer Kennedy; posted 8/13/24, webinar will be 8/21/24, 1:00-2:00 pm EDTCMS posted the final rule for hospice providers which drives big changes into motion for 2025.  [Click here for the] Final FY 2025 Hospice Wage Index and Payment Rate Update/Quality Reporting Rule  (CMS-1810-F), posted on the Federal Register on August 7, 2024. This free webinar will be taught by Jennifer Kennedy, Vice President, Quality, Compliance and Standards, CHAP. She spent many years as a leader and nurse in diverse healthcare settings with the past 25 years in hospice and palliative care. Dr. Kennedy came to CHAP in 2021 with a vision of moving the organization’s quality forward as “the” accreditation partner of choice for the majority of community-based providers. She believes no matter what type of care a patient receives or how many times they receive care, every experience should be of the highest quality. Webinar Objectives:

Major acquisition fuels earnings success for VITAS in Q2McKnight's Home Care; by Adam Healy; 7/25/24VITAS Healthcare Corporation, the hospice subsidiary of Chemed Corporation, produced impressive second quarter earnings driven by workforce investments and a big-ticket acquisition [Covenant Health] that closed in April. In the quarter ended June 30, VITAS’ net income skyrocketed by 88.5% year-over-year to $49.2 million, according to an earnings report. Its revenues improved 16.7% to $374.5 million as patient admissions and average daily census increased by 11% and 14.4%, respectively, compared to the prior year quarter.

Hospice market surge: Expected to hit $182.1 billion by 2033 Market.us Media; by Trishita Deb; 7/29/24 The global hospice market is projected to grow significantly from USD 72.8 billion in 2023 to around USD 182.1 billion by 2033, achieving a CAGR of 9.6%. This expansion is primarily driven by an aging population requiring increased palliative and end-of-life care. The demographic shift necessitates services that address chronic illnesses and provide compassionate care, predominantly offered by hospices. Additionally, technological advancements, particularly in telemedicine, facilitate broader access to comprehensive care, especially in remote areas. Interdisciplinary approaches in palliative care are also pivotal, involving collaborative efforts from doctors, nurses, social workers, and chaplains. This holistic method not only enhances the quality of care but also boosts patient and family satisfaction, key metrics in healthcare evaluations. 

Readers write: Why RCM is the most interesting opportunity in healthcare HIStalk - Healthcare IT News & Opinion; by Kim Waters, MBA; 7/22/24 Revenue cycle management (RCM) isn’t for everybody, but it certainly is for me. ... In a 2023 study, HFMA reported on the rising cost of claims, with as much as 60% of claims not resubmitted and the average denial rate’s total percentage of gross revenue at 11%. What’s more is that they found that the cost per claim appealed is $118 and the denial rate is increasing 20% year over year. In an era when budgets are tight and margins are lower, organizations need to improve on these numbers to survive and eventually thrive. Opportunities for improvement can be easy to see. Reconsider any processes or solutions that:

7 arrested in Arizona on hospice, behavioral health fraud charges Hospice News; by Jim Parker; 7/19/24 Seven individuals in Arizona face federal charges for their alleged roles in defrauding Medicare out of hundreds of millions of dollars in total. The charges for the most part stem from submitting Medicare claims for patients who were not eligible for hospice care, as well as fraud related to behavioral health services. The arrests were the result of a two-week nationwide federal law enforcement action that resulted in criminal charges for 193 individuals for a total of more than $2.75 billion in alleged false claims, as well as opioid abuse schemes. ... “These cases involve not just massive fraud to steal public funds, but also exploitation of vulnerable victims and the misappropriation of resources earmarked for Native American communities,” said U.S. Attorney Restaino, in a statement. “The U.S. Attorney’s Office and our investigative partners will pursue justice against those who perpetrate these sorts of schemes with the utmost vigor.”

Navigating Aging: Lack of affordability tops older americans’ list of health care worries KFF Health News - Northern Kentucky Tribune; by Judith Graham, KFF News; 7/5/24 What weighs most heavily on older adults’ minds when it comes to health care? The cost of services and therapies, and their ability to pay. ... A new wave of research highlights the reach of these anxieties. When the University of Michigan’s National Poll on Healthy Aging asked people 50 and older about 26 health-related issues, their top three areas of concern had to do with costs: of medical care in general, of long-term care, and of prescription drugs. More than half of 3,300 people surveyed in February and March reported being “very concerned” about these issues. 

10 key Medicare Advantage updates in 2024 Becker's Payer Issues; by Rylee Wilson; 6/27/24 The first half of 2024 brought shifting trends for Medicare Advantage. Payers continued to warn of rising medical costs in the MA population, and some are predicting they will lose members next year. Insurers picked up a win in June when CMS said it would recalculate star ratings for 2024. Here are 10 key Medicare Advantage updates to know: 

National health expenditure projections, 2023–32: Payer trends diverge as pandemic-related policies fade Health Affairs - Research Article - Costs & Spending; by Jacqueline A. Fiore, Andrew J. Madison, John A. Poisal, Gigi A. Cuckler, Sheila D. Smith, Andrea M. Sisko, Sean P. Keehan, Kathryn E. Rennie, and Alyssa C. Gross; 6/12/24 Health care spending growth is expected to outpace that of the gross domestic product (GDP) during the coming decade, resulting in a health share of GDP that reaches 19.7 percent by 2032 (up from 17.3 percent in 2022). National health expenditures are projected to have grown 7.5 percent in 2023, when the COVID-19 public health emergency ended. This reflects broad increases in the use of health care, which is associated with an estimated 93.1 percent of the population being insured that year. ... Amonth eh major payers, Medicare has the highest projected ten-year average spending growth rath, mainly because of enrollment into the program. [Click on the title's link to examine this article's content and tables.]

How the Supreme Court’s Chevron Decision could help stop home health cuts Home Health Care News; by Andrew Donlan; 6/28/24 On Friday, the U.S. Supreme Court upended the Chevron doctrine precedent. For home health industry purposes, that means a potentially weakened Centers for Medicare & Medicaid Services (CMS) moving forward. The news comes just two days after the home health proposed payment rule was released, which included significant cuts for the third straight year. Broadly, moving away from the Chevron precedent – usually known as the Chevron doctrine – will mean less regulatory power for government agencies. Government agencies often take their own interpretations of certain laws and statutes, and then act upon those interpretations. ... The National Association for Home Care & Hospice (NAHC) already filed a lawsuit against the U.S. Department of Health & Human Services (HHS) and CMS over rate cuts in 2023. “In our own analysis, we believe that providers of home health have been underpaid as it relates to budget neutrality,” NAHC President William A. Dombi said when the lawsuit was filed. “At minimum, we would expect to see the rate cuts from 2023, that were permanent readjustments to the base rate, and the one proposed for 2024, along with the temporary adjustments … to go away. The end product of that is that we would have a stable system to deliver home health services to Medicare beneficiaries.”

‘Lot of work to be done’: What home health leaders expect from payment rulemaking in 2024Home Health Care News; by Joyce Famakinwa; 6/24/24 In recent years, home health care has faced relentless cuts from the Centers for Medicare & Medicaid Services (CMS). It has plagued the industry, but providers and advocates alike are still hopeful a light at the end of the tunnel is ahead. ... Home Health Care News recently caught up with PQHH CEO Joanne Cunningham and David Totaro, the president and executive director of Hearts for Home Care. ... [Cunningham said,] "I anticipate that what we will see, given CMS’s posture and prior rulemaking cycles, is the continuation of the policy that will put in place permanent cuts to the Medicare home health program. We’re bracing ourselves for an additional sizable permanent cut. We don’t know exactly what CMS has planned for the temporary cuts, otherwise known as the clawback cuts. We will certainly see, at a minimum, CMS identify what their new projected value of the temporary cuts are. ...