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All posts tagged with “Palliative Care Provider News | Operations News | Financial.”
Research digs into costs, opportunities in hospice, palliative care
09/15/25 at 03:00 AMResearch digs into costs, opportunities in hospice, palliative care Hospice News; by Jim Parker; 9/9/25 Researchers have recently uncovered significant financial trends taking shape in hospice and palliative care. Issues examined relate to cost-effectiveness, Medicare Advantage spending patterns, caregivers’ financial challenges and the cost-effectiveness of palliative care.
Nursing homes can disrupt ‘rehabbed to death’ cycle with PDPM-based palliative care
09/11/25 at 02:00 AMNursing homes can disrupt ‘rehabbed to death’ cycle with PDPM-based palliative care Skilled Nursing News; by Kristin Carroll; 9/7/25 ... Skilled nursing facilities can leverage the Patient Driven Payment Model (PDPM) to provide more palliative care to people near the end of life, helping to drive value-based care goals while improving the patient experience. However, much more needs to be done on the policy level to disrupt the current status quo, in which people commonly go through several care transitions near the end of life, driving up costs across the health care system while patients receive services that are not aligned with their own goals. Enabling concurrent SNF and hospice care is one change that could lead to improvement. These are assertions in the recent article “Rehab and Death: Improving End-Of-Life Care for Medicare Skilled Nursing Facility Beneficiaries,” published in the Journal of the American Geriatrics Society.
CMS: Annual Change in Medicaid Hospice Payment Rates—ACTION
09/09/25 at 03:00 AMCMS: Annual Change in Medicaid Hospice Payment Rates—ACTIONCMS, Department of Health and Human Services; email from Rory Howe, director; 9/5/25The Centers for Medicare and Medicaid Services (CMS) has released the Medicaid hospice rates for FY 2026. They are slightly different than the Medicare rates and should be used when billing for Medicaid hospice patients. This memorandum contains the Medicaid hospice payment rates for federal fiscal year (FY) 2026. The rates reflect changes made under the final Medicare hospice rule published on August 1, 2025 (CMS-1835-F). Please inform your staff and all state agencies in your jurisdiction of these new payment rates, which are effective October 1, 2025. We expect state agencies to share the Medicaid hospice payment rates for FY 2026 with the hospice providers in their state.
Navigating the Wage Index: Insights from industry experts
08/21/25 at 03:00 AMNavigating the Wage Index: Insights from industry experts Teleios Collaborative Network (TCN); podcast by Chris Comeaux with Annette Kiser and Judi Lund Person; 8/20/25 The healthcare landscape is transforming before our eyes, shifting away from hospital-centered care toward home-based models. This fundamental change raises urgent questions about Medicare's outdated reimbursement systems, particularly for Hospice providers facing a mere 2.6% rate increase while battling significant inflation. Join us in this illuminating conversation and in-depth discussion with industry experts Annette Kiser, Chief Compliance Officer with Teleios, and Judi Lund Person, Principal, Lund Person & Associates LLC, as they sit down with Chris and explore the complexities of the final 2026 Hospice Wage Index and its impact on Hospice organizations.
The Medicare Advantage, ACA and No Surprises Act lawsuits to watch
08/20/25 at 03:00 AMThe Medicare Advantage, ACA and No Surprises Act lawsuits to watch Modern Healthcare; by Bridget Early; 8/18/25 Legal challenges to Medicare Advantage marketing, health insurance exchange regulations and the No Surprises Act are working their way through the courts with major implications for the healthcare sector. Here are some key cases that could change how health insurance companies sell Medicare plans, how insurers and providers resolve out-of-network billing disputes, how consumers sign up for health insurance exchange plans, and how preventive healthcare is covered.
Aveanna beefs up advocacy efforts, leans into preferred payer strategy
08/19/25 at 03:00 AMAveanna beefs up advocacy efforts, leans into preferred payer strategy Home Health Care News; by Joyce Famakinwa; 8/15/25 Amid an uncertain reimbursement environment and sea of recent policy updates, Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH) remains focused on the strategies that have been helping the company achieve success. ... This means ramping up the company’s efforts around advocacy, as well as actively working with various state Medicaid programs. Home Health Care News caught up with Jim Melancon at last month’s National Alliance for Care at Home Financial Summit to learn more. Melancon serves as senior vice president of government affairs at Aveanna. ... The company has 327 locations across 34 states.
State Medicaid coverage policies for community-based palliative care: Lessons from NASHP’s State Institute
08/13/25 at 03:00 AMState Medicaid coverage policies for community-based palliative care: Lessons from NASHP’s State Institute National Academy for State Health Policy; by Ella Taggart, Wendy Fox-Grage; 8/11/25 Six states recently participated in NASHP’s two-year State Policy Institute to Improve Care for People with Serious Illness (the Institute): Colorado, Maine, Maryland, Ohio, Texas, and Washington. ... Specifically, the six participating states received guidance on policy mechanisms to cover palliative care services in the community and completed cost analysis on palliative care services for Medicaid beneficiaries. While all the states balanced the same forces and demands, ... each state modeled a benefit that was responsive to its particular needs and circumstances. ... CBIZ Optumas and TFA Analytics then designed a cost calculator for each state to help with different scenarios.
Insurance companies’ Medicare pullback is here: Insurers are planning to scale back benefits, trim plans and exit from markets. Investors are cheering
08/07/25 at 03:00 AMInsurance companies’ Medicare pullback is here: Insurers are planning to scale back benefits, trim plans and exit from markets. Investors are cheering The Wall Street Journal; by David Wainer; 8/5/25 Many seniors enjoy the perks that come with Medicare Advantage. But those extras—like dental coverage and free gym memberships—are being scaled back. Insurers are cutting benefits and exiting from unprofitable markets, and Wall Street is cheering them on. Once rewarded by investors for rapid expansion in the lucrative privatized Medicare program, companies are now being applauded for showing restraint amid rising medical costs and lower government payments.
By the Bay Health CEO on stretching home health dollar, surviving proposed rate cuts
07/29/25 at 03:00 AMBy the Bay Health CEO on stretching home health dollar, surviving proposed rate cuts Home Health Care News; by Joyce Famakinwa; 7/25/25 ... By the Bay Health CEO Skelly Wingard aims to improve the quality and accessibility of the company’s home health care line by enhancing the company’s clinical informatics and collaborating across service lines and managed care. These initiatives emerge amid regulatory uncertainty, as proposed Medicare home health rate cuts have raised alarms across the industry. Wingard warned that such cuts could force many providers out of business.By the Bay Health is an affiliate of the University of California San Francisco Health. The organization’s service lines include hospice, palliative, pediatric and skilled home health care. The company serves the entire Bay Area.
51 health systems with strong finances
07/28/25 at 03:20 AM51 health systems with strong finances Becker's Hospital Review; by Andrew Cass; 7/21/25 Here are 51 health systems with strong operational metrics and solid financial positions, according to reports from credit rating agencies Fitch Ratings and Moody’s Investors Service released in 2025. This is not an exhaustive list. Health systems were compiled from credit rating reports [and are listed alphabetically.]
Where UnitedHealthcare, Humana rule the Medicare Advantage market
07/25/25 at 03:00 AMWhere UnitedHealthcare, Humana rule the Medicare Advantage market Modern Healthcare; by Tim Broderick; 7/22/25 Medicare Advantage competition was meager in 97% of counties last year, where beneficiaries could choose among just a handful of dominant insurers. The health policy research institution KFF analyzed Centers for Medicare and Medicaid Services data on the plans available across the U.S. and Puerto Rico in 2024. The findings indicate that Medicare enrollees have few options in most areas. Market share was “highly concentrated” in 79% of counties and “very highly concentrated” in another 18%, KFF found, using metrics similar to those the Federal Trade Commission and the Justice Department employ to measure competitiveness. ... Ninety-three percent of Medicare-eligible people lived in “highly concentrated” or “very highly concentrated” counties. ... [Click here and scroll down for the national map with] the level of Medicare Advantage market concentration for each county and the market share for each county's top insurer.
CMS launches new model to target wasteful, inappropriate services in original Medicare
07/07/25 at 03:00 AMCMS launches new model to target wasteful, inappropriate services in original Medicare CMS Newsroom; 6/27/25 The Centers for Medicare & Medicaid Services (CMS) is announcing a new Innovation Center model aimed at helping ensure people with Original Medicare receive safe, effective, and necessary care. Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to Original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars. This model builds on other changes being made to prior authorization as announced by the U.S. Department of Health and Human Services and CMS on [6/23].
Medicaid provisions threaten home and community-based services for millions of vulnerable Americans
07/07/25 at 03:00 AMMedicaid provisions threaten home and community-based services for millions of vulnerable Americans National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 7/3/25The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the House’s passage of the “One Big Beautiful Bill Act,” also known as the Reconciliation bill, which now heads to President Trump’s desk for his signature. “The Alliance is deeply troubled by the Medicaid provisions within the One Big Beautiful Bill Act, which has passed both chambers of Congress and now awaits President Trump’s signature,” said Alliance CEO Dr. Steve Landers. “These provisions—including work requirements, reduced provider taxes, and new cost-sharing mandates—prioritize short-sighted budget savings over the health and wellbeing of our most vulnerable citizens who rely on home and community-based services (HCBS).” The home care community advocated throughout the legislative process for Congress to mitigate these harmful Medicaid provisions.
The greatest financial threat to hospitals, per revenue cycle leaders
07/02/25 at 03:00 AMThe greatest financial threat to hospitals, per revenue cycle leaders Becker's Hospital Review; by Andrew Cass; 7/1/25Nearly half of hospital revenue cycle leaders view payer denials as the single greatest threat to their organization’s financial performance, according to a report from RCM company Knowtion Health, featuring joint research with Healthcare Financial Management Association. The report is based on a nationwide survey of 147 revenue cycle leaders, according to a June 26 Knowtion news release.
189 hospital and health system CFOs to know | 2025
07/02/25 at 03:00 AM189 hospital and health system CFOs to know | 2025Becker's Hospital Review; by Anna Falvey; 6/30/25 The chief financial officers featured on this list are leading the financial strategy and operations for hospitals and health systems across the nation. These accomplished leaders play a pivotal role in driving strategic planning, overseeing expansions and guiding joint ventures. Tasked with ensuring financial stability and long-term sustainability, these CFOs are essential to the overall success and growth of their organizations. Note: Becker’s Healthcare developed this list based on nominations and editorial research. This list is not exhaustive, nor is it an endorsement of included leaders or associated healthcare providers. Leaders cannot pay for inclusion on this list. Leaders are presented in alphabetical order.
Inside the Archives: How George Soros Changed End-of-Life Care in America
06/30/25 at 03:00 AMInside the Archives: How George Soros Changed End-of-Life Care in AmericaOpen Society Foundations; by Elizabeth Rubin; 6/27/25The Project on Death in America (PDIA) ran from 1994 to 2003, with an ambitious goal: to transform the experience of dying in the U.S. Journalist Elizabeth Rubin spoke with Dr. Kathy Foley, the physician George Soros chose to lead it, to reflect on its impact... Soros’s fundamental belief was simple: Death deserves the same careful attention we give to life... [Dr. Kathy Foley commented] “We had to educate people that palliative care isn’t just about dying, but about supporting patients with serious illnesses and improving their quality of life.”Notable mentions: Kathy Foley, Susan D. Block, Robert ("Bo") A. Burt, Andy Billings, Robert N. Butler, David J. Rothman, Joanne Lynn, Patricia Prem, Ana Dumois, William Zabel, James Tulsky, Tony Back, Bob Arnold, Diane E. Meyer, Center to Advance Palliative Care, R. Sean Morrison, National Palliative Care Research Center, Richard Payne, Angola Prison Project, Lewis Cohen, Judy Nelson, Steve Pantalat, Tammy Quest, Robert Wood Johnson Foundation, the Kornfeld Foundation, Bill Moyers, and On Our Own Terms: Moyers on Dying.
Scaling early palliative care in value-based community oncology: A technology-enabled approach
06/19/25 at 03:00 AMScaling early palliative care in value-based community oncology: A technology-enabled approach American Journal of Managed Care (AJMC); by Biqi Zhang, Samyukta Mullangi, Alphan Kirayoglu, Stephen G. Divers, Julia L. Frydman; 6/18/25 Key Takeaways:
Families demand end to Medicare waiting period for early-onset Alzheimer’s patients
06/17/25 at 03:20 AMFamilies demand end to Medicare waiting period for early-onset Alzheimer’s patients Washington Examiner; by Elaine Mallon; 6/15/25 Jason Raubach was diagnosed at 50 years old with early-onset Alzheimer’s disease — a diagnosis that affects nearly 200,000 Americans. He received the diagnosis in 2018, completely upending life for his family. His youngest child was just a freshman in high school. ... Shortly before receiving an official diagnosis, Jason Raubach lost his job, having to move his family onto a consolidated omnibus budget reconciliation act health plan, or COBRA plan, which allows a person to keep their health insurance even after losing their job. “It wasn’t cheap,” Elizabeth Raubach said.However, once diagnosed, Jason Raubach had to wait two and a half years before he could receive coverage under Medicare, health insurance for those 65 years and older or those with qualifying disabilities. But Elizabeth Raubach, along with dozens of other caretakers for people diagnosed with Alzheimer’s, called on Congress in a letter to eliminate the 29-month waiting period required for those under the age of 65 to receive coverage under Medicare. ...
Rosen introduces bipartisan bills to expand access to palliative care, hospice care
06/06/25 at 03:00 AMRosen introduces bipartisan bills to expand access to palliative care, hospice careJacky Rosen, U.S. Senator for Nevada, Washington, DC; 6/5/25 U.S. Senator Jacky Rosen, co-founder and co-chair of the bipartisan Senate Comprehensive Care Caucus, announced the introduction of a pair of bipartisan bills to expand access to palliative and hospice care. The Expanding Access to Palliative Care Act with Senators Barrasso (R-WY), Baldwin (D-WI), and Fischer (R-NE) would establish a demonstration project through Medicare to expand access to palliative care at the time of diagnosis of serious illness or injury. The Improving Access to Transfusion Care for Hospice Patients Act with Senators Barrasso (R-WY) and Baldwin (D-WI) would carve out payment for transfusion services within the Medicare hospice benefit, allowing for separate billing to Medicare for transfusions. This would improve access to hospice care for patients who rely on transfusion care to maintain quality of life.
CMS’ TEAM Payment Model: What hospices need to know
06/02/25 at 02:00 AMCMS’ TEAM Payment Model: What hospices need to know Hospice News; by Jim Parker; 5/30/25 A forthcoming alternative payment model for hospitals focuses on discharge planning and ensuring effective post-acute care, including hospice and palliative care when appropriate. The U.S. Centers for Medicare & Medicaid Services (CMS) late last year unveiled its new Transforming Episode Accountability Model (TEAM). Participation in the model will be mandatory for select hospitals. The program is set to launch on Jan. 1, 2026 and run through Dec. 31, 2030. CMS designed the program based on lessons learned from previous episode-based payment models, as well as input from stakeholders in response to a Request for Information published in 2023.
Inside the Medicare Advantage Reform Act
05/29/25 at 03:00 AMInside the Medicare Advantage Reform Act Hospice News; by Jim Parker; 5/28/25 A bill currently before Congress seeks to overhaul aspects of the Medicare Advantage program. Rep. David Schweikert (R-Ariz.) recently introduced the Medicare Advantage Reform Act. If enacted, the bill, numbered H.R. 3467, would make wholesale changes to the Medicare Advantage (MA). A key provision of the bill is a proposed requirement that MA plans pay for hospice care. Hospice is currently “carved out” of Medicare Advantage. The potential impacts of moving hospice into MA at this time would be “devastating,” according to the National Alliance for Care at Home. ... [Other] changes to MA included in the text could have serious implications for hospices and other providers that also offer home health, palliative care or other services. ...
Care transformation in palliative care: Leveraging a payor-provider partnership to fast-track growth of a palliative program
05/24/25 at 03:40 AMCare transformation in palliative care: Leveraging a payor-provider partnership to fast-track growth of a palliative programJournal of Palliative Medicine; Emily Jaffe, Emily Hobart, Alexandra Aiello, Amber Shergill, Amanda Harpster-Hagen, Tyson S. Barrett; 5/25This study describes a unique partnership between an insurer and a provider to enhance the quality, availability, and access to palliative services. A retrospective cohort analysis of insurance claims data for patients receiving palliative care compared to a matched cohort not receiving palliative care services from 2019 through 2022. Outcomes demonstrated a total savings of $4,526,408 through reductions in costs for the treatment group compared to the control group for total cost of care ...., inpatient stays ($5,672 ... ) , outpatient visits ($229 ... ), professional claims ($1,243 ... ), and pharmacy fills ($17 ... ). The treatment group had lower skilled nursing facility ($1,049 ... ) and inpatient rehabilitation facility ($216 ... ) costs. The treatment group had higher rates of hospice care (83.7% in the treatment compared to 50.2% ... ) but had lower lengths of stay (four days compared to five ... ).Conclusions: Collaborative investment in a palliative program by a payor and provider system shows significant financial savings for an insurer when patients receive evidence-based palliative care near the end of life.
Securing philanthropic support for palliative care
05/23/25 at 03:00 AMSecuring philanthropic support for palliative care Hospice News; by Markisan Naso; 5/21/25 Fundraising has long been a necessity for many nonprofit organizations to provide palliative care programs. Currently, Medicare payment for palliative care only covers physician or licensed independent practitioner services and does not support the full range of interdisciplinary care, involving nurses, chaplains, aides and social workers. This shortage of funds has made community-based palliative care into a loss leader for many organizations. Palliative care is among the most “underfunded” services in the health care continuum, according to Deborah Johnson, chief philanthropy officer at Empath Health, a large non-profit post-acute care organization in Florida.
Podcast: Innovations and insights in the palliative care space
05/21/25 at 03:00 AMPodcast: Innovations and insights in the palliative care space Holland & Knight; podcast by Daniel Patten and Spencer Freeman; 5/20/25 In this episode of "Counsel That Cares," Daniel Patten, a partner in Holland & Knight's Healthcare Regulatory & Enforcement Practice, and Spencer Freeman, chief strategy officer at Gentiva, discuss the challenges and opportunities that come with delivering integrated palliative care services, highlighting the lack of a defined Medicare benefit for palliative care compared to more established models such as hospice. Mr. Freeman shares insights on building care models that serve high-risk patient populations through coordinated interdisciplinary teams and data-driven approaches, emphasizing the importance of collaboration with risk-based primary care providers. Mr. Patten adds a legal perspective on the evolving landscape of value-based care contracts, artificial intelligence (AI) integration and regulatory compliance. Together, they explore how innovative programs can improve patient outcomes, reduce acute care utilization and facilitate payer relationships, offering a comprehensive view of the future of palliative care within value-based healthcare delivery.
Downside risk, upside payment highlight new CMS innovation agenda
05/14/25 at 02:00 AMDownside risk, upside payment highlight new CMS innovation agendaModern Healthcare; by Bridget Early; 5/13/25The Centers for Medicare and Medicaid Services is rolling out a broad new agenda for its innovation center that could lead to requirements that participants in value-based care programs to take on downside risk, the agency announced ... The Center for Medicare and Medicaid Innovation plan prioritizes shared risk and prospective payments, streamlined quality measurement, artificial intelligence and other technologies, and Medicare Advantage payment models, Director Abe Sutton said in an interview Friday [5/9]. Notably, CMS is walking away from a goal set four years ago to have all fee-for-service Medicare beneficiaries under accountable care arrangements by 2030, Sutton said. CMS provided Modern Healthcare an advance look at the new innovation center platform. ... Designing models that require providers to accept at least some downside risk could be the most consequential action stemming from the plan. Subjecting participants to potential financial losses, not just potential benefits, is key to driving cost savings and quality improvement, Sutton said.