Literature Review
All posts tagged with “Palliative Care Provider News | Operations News | Financial.”
Spending on home healthcare outpaces others for 4th consecutive month
09/27/24 at 03:00 AMSpending 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. ...
The ROI of interoperability in home health
09/19/24 at 03:00 AMThe 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.
The ‘Holy Grail’ of palliative care payment through ACOs
09/13/24 at 03:00 AMThe ‘Holy Grail’ of palliative care payment through ACOs Hospice News; by Jim Parker; 9/11/24 As opportunities to provide palliative care through Accountable Care Organization (ACO) relationships continue to arise, operators will likely need to understand the varying types of reimbursement that exist in that arena. ACOs are groups of physicians, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients. Hospices and palliative care providers can collaborate with ACOs by becoming members of those organizations themselves, or by contracting with them through a preferred provider network. Community-based palliative care’s track record of reducing costs and hospitalizations could make providers of those services attractive to ACOs, according to Edo Banach, partner at Manatt Health, a division of the law firm Manatt, Phelps & Phillips, LLP.
A wave of change is coming for healthcare benefits — are hospitals ready?
09/05/24 at 03:00 AMA wave of change is coming for healthcare benefits — are hospitals ready? Becker's Hospital CFO Report; by Jakob Emerson; 9/3/24Surveys of employers are making one thing clear: Healthcare costs are rising faster than they did before the pandemic, and those costs are being driven by inflation, the increasing use of weight loss medications, and higher overall medical expenses. ... As financial pressures mount, many employers are exploring or expanding alternative payment and coverage models, a trend that could significantly alter hospital's revenue streams. ... The average cost of employer-sponsored coverage is expected to jump 9% from 2024 to 2025, according to estimates from Aon published in August. Healthcare costs per employee are projected to surpass $16,000 per employee in 2025, driven by rising employment levels, inflation and rising pharmaceutical costs. In 2024, employers budgeted an average of $14,823 per employee for healthcare costs. These costs have risen by more than 20% over the past five years and by 43% over the past decade.
Editorial: Palliative care can drive change via new payment models
08/29/24 at 03:00 AMEditorial: Palliative care can drive change via new payment models Hospice News; by Jim Parker; 8/27/24 A range of emerging payment model demonstrations are integrating principles traditionally associated with “palliative care” into their structures, but without using that term. The Center for Medicare & Medicaid Innovation’s (CMMI) has unveiled a series of models that incorporate elements designed to provide patient-centered care to improve seriously ill patients’ quality of life. Examples include the Guiding an Improved Dementia Experience (GUIDE), the Kidney Care Choices and Enhancing Oncology models. The GUIDE model, for example, includes language requiring “person-centered care meant to improve quality of life, delivered by interdisciplinary teams.” Thus, one could argue that palliative care principles are becoming more integrated into the larger system, even if stakeholders are not using the same terminology. ...
Biden administration says Medicare negotiated price discounts on 10 prescription drugs
08/16/24 at 03:00 AMBiden administration says Medicare negotiated price discounts on 10 prescription drugs USA Today; by Ken Alltucker; 8/15/24 ... The Biden administration announced Thursday that Medicare had negotiated discounts with pharmaceutical companies on 10 drugs prescribed to treat blood clots, cancer, heart disease and diabetes. The drugs are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and the insulins Fiasp and NovoLog. The discounts will range from 38% to 79% when the negotiated prices take effect in 2026. The bargaining will save Medicare $6 billion when the price cuts are implemented in two years, according to U.S. Department of Health and Human Services estimates.
Capitalizing palliative care startups
08/16/24 at 03:00 AMCapitalizing 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. ...
The tangled web of pediatric palliative care payment and policy
08/15/24 at 03:00 AMThe tangled web of pediatric palliative care payment and policy Hospice News; by Holly Vossel; 8/13/24 A complex web of state regulations and reimbursement systems can challenge pediatric palliative care access for seriously ill children and their families. The nation’s fragmented health care system lacks clear guidance when it comes to navigating chronic, complex conditions in children, adolescents and young adults, according to Jonathan Cottor, CEO and founder of the National Center for Pediatric Palliative Care Homes. Much of the current state palliative regulations and reimbursement pathways focus on adult patient populations, representing a significant barrier to improved quality and support in the pediatric realm, Cottor said.
Hospice market surge: Expected to hit $182.1 billion by 2033
07/31/24 at 03:00 AMHospice 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.
Palliative care benefit work group
07/25/24 at 03:00 AMPalliative care benefit work group Office of the Insurance Commissioner - Washington State; 7/23/24 The Washington state Legislature has directed the Office of the Insurance Commissioner, in consultation with the Health Care Authority, to convene a work group to design the parameters of a palliative care benefit and payment model for fully insured health plans. The work group must submit a report to the Legislature detailing its work and any recommendations by November 1, 2025. The work group must consider the following elements of a palliative care benefit:
Why home health providers should expect to see a ‘less draconian’ final payment rule
07/25/24 at 03:00 AMWhy home health providers should expect to see a ‘less draconian’ final payment rule Home Health Care News; by Joyce Famakinwa; 7/22/24 As home health providers continue to digest the proposed payment rule for 2025, National Association for Home Care & Hospice (NAHC) President William A. Dombi believes that the industry will ultimately see a comparatively toned down final rule. “We believe we will not end up with this proposed rule as a final rule,” he said during the opening presentation at NAHC’s Financial Management Conference in Las Vegas on Sunday. “We will end up with something less draconian. The cuts will be reduced because, No. 1, that’s what they’ve done for the last several years, and, No. 2, it’s an election year.” Even with a prediction of a “less draconian” final payment rule, NAHC is still gearing up to fight against home health cuts and the Centers for Medicare & Medicaid Services’ (CMS) payment-setting methodologies.
Readers write: Why RCM is the most interesting opportunity in healthcare
07/25/24 at 03:00 AMReaders 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:
Keys to negotiating ACO palliative care contracts
07/23/24 at 03:00 AMKeys to negotiating ACO palliative care contracts Hospice News; by Molly Bookner; 7/22/24 Accountable Care Organizations (ACOs) are key for scaling palliative care through value-based models. Hospices and palliative care providers can collaborate with ACOs by becoming members of those organizations themselves, or by contracting with them through a preferred provider network. These arrangements allow for the negotiation of mutually beneficial terms that are tailored to the needs and characteristics of patient populations. However, successfully negotiating such contracts requires a strategic approach and a deep understanding of ACOs’ priorities. As the U.S. Centers for Medicare & Medicaid Services (CMS) moves to align all Medicare beneficiaries with an accountable care relationship, these negotiations will become even more paramount.
How well does Medicare cover end-of-life care? It depends on what type
07/23/24 at 03:00 AMHow well does Medicare cover end-of-life care? It depends on what type Medical Xpress; by Mark Harden, CU Anschutz Medical Campus; 7/19/24 Not all versions of Medicare are created equal—and when it comes to end-of-life care, some versions may serve a patient's needs better than others. That's the focus of newly published research by Lauren Hersch Nicholas, Ph.D., MPP, a University of Colorado Department of Medicine and CU Cancer Center health economist, and her colleagues. The researchers analyzed the experiences of more than a million people receiving Medicare-funded services in the last six months of their lives. ... Their paper was published July 19 in JAMA Health Forum. What Nicholas and her colleagues found is that the kind of Medicare a patient is enrolled in can make a difference in whether that patient gets certain treatments, and whether the patient dies in a hospital or in hospice care.
End-of-life care is a profound and essential aspect of medical practice
07/22/24 at 03:00 AMEnd-of-life care is a profound and essential aspect of medical practice Market.US Media, New York; by Samruddhi Yardi; 7/19/24 According to End-of-Life Care Statistics, End-of-life care, also known as palliative care, refers to the comprehensive medical, emotional, and psychological support provided to individuals who are nearing the end of their lives, often due to terminal illnesses or conditions. [This article includes data on the following:]
10 key Medicare Advantage updates in 2024
07/08/24 at 03:00 AM10 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:
Medicare Program: End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, etc.
07/08/24 at 03:00 AMMedicare Program: End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, etc. Federal Register; Proposed Rule by the Centers for Medicare & Medicaid Services; 7/5/24
States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model
07/08/24 at 02:00 AMStates Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model CMS.gov; 7/2/24 On July 2, 2024 CMS announced that Connecticut, Maryland, and Vermont will be the first state participants in the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. Hawaii will also participate, pending satisfaction of certain requirements. Applications to participate in Cohort 3 of the model are due August 12, 2024 at 3:00 p.m. EST (Cohort 3). Eligibility requirements and additional model details can be found in the NOFO. To stay up to date on model announcements, events, and resources, please sign up for the AHEAD Model listserv.
National health expenditure projections, 2023–32: Payer trends diverge as pandemic-related policies fade
07/06/24 at 03:25 AMNational 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.]
Lawmakers say CMS should ban Medicare Advantage’s use of AI to deny care
07/03/24 at 03:00 AMLawmakers say CMS should ban Medicare Advantage’s use of AI to deny care McKnights Long-Term Care News; by Josh Henreckson; 6/26/24 The Centers for Medicare & Medicaid Services should consider banning artificial intelligence from being used to deny Medicare Advantage coverage pending a “systematic review,” a group of 49 congressional leaders is urging. ... Skilled nursing providers have been sounding the alarm for years on Medicare Advantage coverage access, especially when informed by AI and other algorithms. Sector leaders have frequently noted that these methods can deny or prematurely end coverage for patients who need it to afford necessary long-term care. Providers and consumer advocates both spoke out in favor of the lawmakers’ letter this week. “LeadingAge’s nonprofit and mission driven members … have firsthand experience of Medicare Advantage (MA) plans’ inappropriate use of prior authorization to deny, shorten and limit MA enrollees’ access to medically necessary Medicare benefits,” wrote Katie Smith Sloan, president and CEO of LeadingAge. ... “Implementation by [the] Centers for Medicare and Medicaid Services (CMS), which we fully support, would ensure MA plans fulfill their obligation to provide enrollees equitable access to Medicare services.”
How the Supreme Court’s Chevron Decision could help stop home health cuts
07/02/24 at 03:00 AMHow 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.”
HHS to impose penalties on providers that block patients’ health information
06/28/24 at 03:00 AMHHS to impose penalties on providers that block patients’ health information McKnights Home Care; by Adam Healy; 6/24/24In a bid to promote easier access and exchange of patients’ health records, the Department of Health and Human Services published a final rule Monday outlining penalties for providers that block access to electronic health information. ... Fragmented and inaccessible patient data can prevent long-term and post-acute care providers from seeing the full picture of a patients’ health. Hospitals, for example, are not required to share updates about a patient’s health with the patient’s post-acute care provider. As a result, home health and home care agencies frequently cannot access patients’ electronic health records to help assess and treat patients. Three disincentives: ... First, hospitals that commit information blocking can be subject to a reduction of three quarters of an annual market basket update. Second, clinicians eligible for the Merit-based Incentive Payment System will receive a zero score in the “promoting interoperability performance” MIPS category, which can be equivalent to roughly a quarter of the clinician’s MIPS score in a given year. Lastly, providers that participate in information blocking can have their Medicare Shared Savings Program or Accountable Care Organization eligibility revoked for at least one year. ...Editor's Note: Almost any solution raises additional challenges. How does HIPAA interface with this? How might a cyberattack at a hospital (or other healthcare agency) affect the patients' other agencies, putting them at risk as well?
[Updated] CMS proposes over 4% cut to Home Health Medicare payments in 2025
06/28/24 at 02:00 AM[Updated] CMS proposes over 4% cut to Home Health Medicare payments in 2025 Home Health Care News; by Andrew Donlan; 6/26/24 The U.S. Centers for Medicare & Medicaid Services (CMS) published its FY 2025 home health proposed payment rule Wednesday. With it, the agency signaled that more significant cuts could be on the way for providers. To rebalance the Patient-Driven Groupings Model (PDGM) and make it budget neutral, at least according to its internal methodology, CMS is proposing a permanent prospective adjustment to the CY 2025 home health payment rate of -4.067%. For CY 2023 and CY 2024, CMS previously applied a 3.925% reduction and a 2.890% reduction, respectively.
‘Lot of work to be done’: What home health leaders expect from payment rulemaking in 2024
06/27/24 at 03:00 AM‘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. ...
Garnet Health shutters palliative care program
06/27/24 at 03:00 AMGarnet Health shutters palliative care program Hospice News; by Jim Parker; 6/25/24 New York state-based Garnet Health has announced a restructuring plan that spells the demise of its inpatient palliative care services. The plan includes layoffs of about 1% of the health system’s workforce, numbering 26 employees. This is estimated to save Garnett $4.6 million in salaries and benefits. “[Garnet] continues to be challenged with significant labor expenses, inflation on supplies and equipment, and low payor reimbursement rates,” the health system indicated in a statement. The restructuring is the result of financial headwinds, including decreased demand. Patient volumes are gradually increasing, but not yet to pre-pandemic levels, the company stated in an announcement.