Literature Review

Advocates rally in DC for the future of hospice: NHPCO and HAN amplify provider voices on Capitol Hill NHPCO; Press Release; 6/13/24 More than 100 hospice and palliative care advocates from across the country met with over 150 congressional offices this week to discuss key legislative and regulatory priorities for ensuring and expanding access to hospice and palliative care. The meetings were part of Hospice Action Week, hosted in Washington, DC by the National Hospice and Palliative Care Organization (NHPCO) and its advocacy affiliate, the Hospice Action Network (HAN). “The cornerstone of effective advocacy is storytelling. It’s about sharing why hospice holds personal significance and why serious illness and end-of-life care policy should resonate with our lawmakers,” said Logan Hoover, NHPCO’s VP of Policy & Government Relations. “From Hawaii to Rhode Island, advocates from 35 diverse states came to DC this year. The relationships they’re building with Members of Congress hold the potential to shape the future of the healthcare landscape.” 

Hawaiʻi is the first state to provide palliative care coverage EIN Presswire; by Governor JOsh Green, MD; 4/4/24 Governor Josh Green, M.D., and the Department of Human Services (DHS) Med-QUEST Division are pleased to announce that the Centers for Medicare and Medicaid Services (CMS) approved a new State Plan Amendment (SPA) to cover community palliative care services through Medicaid, making Hawaiʻi the first state in the nation to do so.  ... “After several years of hard work and collaboration with many community members and experts in the field, I am proud to announce that Med-QUEST is the first Medicaid program in the country to get this benefit approved,” said Governor Green. “This will greatly improve the quality of life and health outcomes for thousands of people who face serious medical conditions in our state. Hawaiʻi continues to lead the nation in innovations in health and health care.”  

Healthcare sees highest Chapter 11 bankruptcy filings in 15 years: reportMcKnights Senior Living; by Kathleen Steele Gaivin; 5/20/24Chapter 11 bankruptcies in healthcare, including senior living reached a multiyear high in the first quarter of 2024. That’s according to the newest Polsinelli-TrBK Distress Indices Report, published Wednesday. “We continue to see intense stress in senior living,” Jeremy R. Johnson, a bankruptcy and restructuring attorney at Polsinelli and co-author of the report, said in a press release issued in conjunction with the report. ... The Southeast continues to outpace the rest of the country as the busiest region for bankruptcy filings, according to the report. The Southeast region reported 33.4% of the filings in the first quarter, followed by Northeast and Delaware at 30.8% and 16.1%, respectively. Since the benchmark period of 2020, the Northeast has shown the biggest increase in filings.

21 hospitals, health systems raising workers' pay Becker's Hospital Review; by Kelly Gooch; 5/20/24 The following hospitals and health systems have announced or shared plans for raising workers' pay this year. Note: This is not an exhaustive list. This webpage was last updated May 20. [Click on the title's link for the detailed list.]

Senate ramps up push to reform doctors' Medicare pay Modern Healthcare; by Michael Mcauliff; 5/20/24Declining doctors' pay in Medicare is getting its most serious look in nearly a decade in the Senate, with a bipartisan push launched Friday by the Senate Finance Committee. Doctors have grown especially vocal in recent years about falling Medicare reimbursement. Groups including the American Medical Association have estimated doctors were effectively getting paid 26% less in 2023 than in 2001 because the physician fee schedule set by the Centers for Medicare and Medicaid Services is not adjusted for inflation. Physicians have also called for more flexibility within the pay system.

Humana, Aetna likely to lose Medicare Advantage members Modern Healthcare; by Nona Tepper and Lauren Berryman; 5/14/24 Industry heavyweights CVS Health Aetna and Humana foresee Medicare Advantage membership losses next year. Anticipated changes to health plan offerings and benefit design to achieve long-term business profitability could mean losing a significant portion of their Medicare Advantage membership, executives told investors at the Bank of America Securities Healthcare Conference on Tuesday. ... Headed into next year, Aetna may adjust benefits, tighten its prior authorization policies, reassess its provider networks and exit markets, CVS Health Chief Financial Officer Tom Cowhey told investors.  ... [Humana Chief Financial Officer Susan Diamond] anticipates losing about 5% of its 6.1 million Medicare Advantage members, ... Conversely, UnitedHealth Group’s UnitedHealthcare insurance business appears to be better positioned for growth heading into 2025 ... , executives said. UnitedHealth Group CEO Andrew Witty said, ... “The thing we don't want is unsustainable ups and downs in our performance in any particular regard. ... You should just expect more of the same from us in terms of what we’re doing.” 

A Philadelphia pharmacy’s closure after 26 years highlights the industry’s growing challenges Times Daily; by Lizzy McClellan Ravitch, The Philadelphia Inquirerer; 5/11/24Last Monday, Friendly Pharmacy filled 318 prescriptions. For about 100 of them, insurance companies paid the pharmacy less than $3. In 22 instances that day, the reimbursement was less than the cost of the medication. ... [Managing pharmacist Brad] Tabaac plans to close his doors on May 31 after 26 years in business. ... Independent pharmacies like Friendly, as well as some chains, have been pinched by pricing and fees set by pharmacy benefit managers — the companies that handle prescription drug plans for health insurance. The three biggest pharmacy benefit managers are CVS Health, Optum Rx and Express Scripts. They control nearly 90% of the market, according to the National Community Pharmacists Association (NCPA), and some of their parent companies also own pharmacies.

Medicaid disenrollments higher than expected: Report Becker's Payer Issues; by Rylee Wilson; 5/2/24 The number of people disenrolled from Medicaid through the redeterminations process has surpassed original estimates from the Urban Institute and Robert Wood Johnson Foundation. According to a May 2 report, as of November 2023, nearly 9 million people had been disenrolled from Medicaid. The figure came out to 60.5% of the foundation's original estimate of 14.8 million people losing coverage, with several months remaining in the redetermination process. 

Thyme Care launches virtual palliative care program, appoints medical director MobileHealthNews; by Jessica Hagen; 5/2/24 Value-based cancer care platform Thyme Care is launching Enhanced Supportive Care, a virtual palliative care support program to assist its members and caregivers with managing physical and psychological symptoms accompanying cancer diagnosis and treatment. The program will be led by Dr. Julia Frydman, the company's first medical director for palliative care. Frydman previously worked in the geriatric and palliative medicine program at New York City's Mount Sinai Health System.

MultiPlan, insurance giants sued over out-of-network rates Modern Healthcare; by Nona Tepper; 4/29/24 A rural health system sued technology company MultiPlan and eight of the country's largest insurance companies over alleged schemes to strongarm providers into accepting low out-of-network rates. At issue in the proposed class-action suit are MultiPlan's repricing tools, which allegedly rely on insurers' data to deflate their out-of-network reimbursement payments. 

Drug discount program is exploiting poor patients while corporate giants profit Minnesota Reformer; by David Balto; 4/26/24 ... The federal 340B drug discount program was created three decades ago to help economically vulnerable Americans access affordable prescription medications and providers in underserved areas expand and improve services. Under the program, drug companies participating in Medicaid — known in Minnesota as Medical Assistance — provide sizeable discounts as high as 50% to these ‘safety net’ health care facilities. ... Unfortunately, over time, the tens of billions of dollars flowing through this program have proven irresistible to for-profit corporate entities, including giant health systems and big box chain pharmacies — and there is no guarantee those discounts are reaching patients. 

Generative AI is supposed to save doctors from burnout. New data show it needs more trainingSTAT+; by Casey Ross; 4/25/24After stratospheric levels of hype, early evidence may be bringing generative artificial intelligence down to Earth. A series of recent research papers by academic hospitals has revealed significant limitations of large language models (LLMs) in medical settings, undercutting common industry talking points that they will save time and money, and soon liberate clinicians from the drudgery of documentation.

Payment cuts are having a compounding, dire effect on the home health industry Home Health Care News; by Andrew Donlan; 4/25/24 Home health providers’ fight against cuts to fee-for-service Medicare payment has become a year-by-year battle. But the yearly cuts are compounding, which is exactly what industry advocates are trying to illustrate to Congress prior to the next payment rule proposal. ... Many of the cuts CMS has implemented are permanent, and multiple cuts on top of each other moving forward – plus unsatisfactory adjustments for inflation – are putting significant pressure on providers.