Literature Review

Hospice social worker and nurse perceptions of the usability of a hospice live discharge protocol (LDP)American Journal of Hospice & Palliative Medicine; by Stephanie P. Wladkowski, Susan Enguídanos, Tracy A. Schroepfer; 9/25Live discharges from hospice are often distressing for patients, caregivers, and hospice providers alike, disrupting care continuity and leading to emotional and logistical challenges. Despite Medicare’s discharge planning requirement, no standardized process currently exists for hospice-initiated discharges, resulting in variable quality of care transitions.  An explicit Live Discharge Protocol has strong potential to enhance the quality and consistency of a live discharge from hospice care. The LDP provides a framework to help smooth the transition from hospice care and provides patients and families with post-discharge support. Feedback from hospice professionals affirmed the relevance and usability of each step within the LDP, while also identifying opportunities for refinement for future implementation.

Hospice exec evaluates possible ‘path forward’ for MA hospice carve-inMcKnight's Newsmakers Podcast; by Liza Berger, Joe Shega; 10/15/25The so-called “carve-in” failed when the Centers for Medicare & Medicaid Services halted the hospice portion of the Value-Based Insurance Design program last year. And just last month, providers were speaking out against the carve-in to lawmakers at the annual fly-in for the National Alliance for Care at Home. But the two value-based care programs — hospice and MA — are not necessarily incompatible, according to Joe Shega, MD, chief medical officer for hospice provider VITAS Healthcare. As long as all the stakeholders agree about the parameters — that benefits remain intact, that there is no delay in access — there can be a “path forward” for hospice to be part of the MA benefit, he told McKnight’s Home Care in a Newsmakers podcast.

Rural Health Transformation Program must consider care at home, Alliance tells CMS McKnights Home Care; by Adam Healy; 10/17/25 As stakeholders compete for funding from the Rural Health Transformation Program, the Centers for Medicare & Medicaid Services’ $50 billion rural healthcare grant initiative, home care providers are asking for their cut. “The RHTP represents a chance to reshape rural health systems around a continuum of care that extends beyond hospital walls,” Steve Landers, MD, chief executive officer of the National Alliance for Care at Home, said Wednesday in a letter to CMS. “The National Alliance for Care at Home strongly urges CMS to view home-based care not as an adjunct, but as an essential partner in the transformation of rural health delivery.”

Size of the financial incentives in Medicare’s Skilled Nursing Facility Value-Based Purchasing ProgramJAMA Network Open; Robert E. Burke, Franya Hutchins, Jonathan Heintz, Syama R. Patel, Scott Appel, Julie Norman, Atul Gupta, Liam Rose, Rachel M. Werner; 9/25The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program seeks to reduce all-cause 30-day readmissions from SNF for traditional Medicare beneficiaries recently discharged from the hospital. Under SNF VBP, most SNFs receive a financial bonus or penalty up to 2% of their total traditional Medicare revenues each year, on the basis of their performance on 30-day readmission rates compared with other SNFs, or their own improvement in readmission rates over time. In this cohort study, we found that the size of the financial incentives at the SNF level are relatively small in terms of dollars and as a proportion of net operating income, and that most SNFs experienced substantial variability from year to year in their incentive payments. These 2 factors may have contributed to the relative lack of effectiveness of the SNF VBP program. First, if the level of the penalty is not sufficient to hire additional staff, purchase equipment (such as an x-ray machine or laboratory testing), or invest in new care processes, then SNFs will not be able to improve their ability to manage changes in patient condition. 

The government shutdown’s impact on Medicare Advantage: As clear as mud? JD Supra; by Jeffrey Davis and Lynn Nonnemaker; 10/16/25 Over the last couple of weeks, stakeholders have raised many questions about how the government shutdown will affect different healthcare initiatives and programs, and Medicare Advantage (MA) is no exception. The Centers for Medicare & Medicaid Services (CMS) has provided guidance related to Medicare claims processing, telehealth services, and other operations, but most of that has pertained to Medicare fee-for-service (traditional Medicare). MA plans have been largely responsible for figuring out how the information applies to them. About half of Medicare beneficiaries are in MA, meaning more than 35 million Medicare beneficiaries and the providers who care for them rely on MA plans to communicate how benefits and coverage have, or have not, changed. As the shutdown drags on, CMS’s work to establish future MA policies and payment rates through rulemaking and notices also could be impeded. To discuss some of the ways that the shutdown has impacted MA and may continue to do so, I’m bringing in my colleague Lynn Nonnemaker. ...

Medicare aborts apparent plan to pause all physician payments during shutdown MedPageToday; by Shannon Firth; 10/16/25 Amid the federal government shutdown, the Centers for Medicare & Medicaid Services (CMS) on Wednesday appeared to announce a pause on all Medicare payments to doctors, but then quickly backed off. An initial notice stated that CMS had instructed all Medicare Administrative Contractors to temporarily hold "all claims paid under the Medicare Physician Fee Schedule, ground ambulance transport claims, and all Federally Qualified Health Center claims" with dates of service of Oct. 1 and later. ... But within hours, the agency issued another notice saying it would only stop processing claims related to expired programs such as certain telehealth and hospital-at-home services, both of which had been expected ahead of the shutdown.

Telepalliation creates a sense of security: A qualitative study of patients with cancer receiving palliative carePalliative Medicine; by Jarl Voss Andersen Sigaard, Elisabet Dortea Ragnvaldsdóttir Joensen, Una Rósa Birgisdóttir, Helle Spindler, Birthe Dinesen; 10/7/25 ... The aim of this study was to explore patients' experiences with the functionality of the Telepalliation program while receiving specialized palliative care. ... Results: Four key themes emerged: "Sense of coherence," "Telepal platform," "Roles of spouse/partner and relatives," and "Cross-sector collaboration." The program improved patients' sense of security and coherence by enhancing communication with healthcare professionals. ... The platform also successfully integrated relatives into the care process. Editor's Note: While this research was conducted in Denmark, it surely resonates with patient care in the US. Reference articles in the uncertainties of government shutdowns, legislative needs to extend telehealth, and more: 

Healthcare AI in the United States — navigating regulatory evolution, market dynamics, and emerging challenges in an era of rapid innovation The National Law Review; by Nadia de la Houssaye, Andrew R. Lee, Jason M. Loring, Graham H. Ryan of Jones  Walker LLP; 10/2/25 The use of artificial intelligence (AI) tools in healthcare continues to evolve at an unprecedented pace, fundamentally reshaping how medical care is delivered, managed, and regulated across the United States. As 2025 progresses, the convergence of technological innovation, regulatory adaptation (or lack thereof), and market shifts has created remarkable opportunities and complex challenges for healthcare providers, technology developers, and federal and state legislators and regulatory bodies alike. ...

The CMS activities that will, won’t continue during the shutdown Becker's Hospital Review; by Andrew Cass; 10/2/25 CMS has outlined the activities that will and won’t continue during the federal government shutdown. The federal government shut down at 12:01 a.m. Oct. 1 after lawmakers failed to reach a spending deal. CMS is retaining 53% of its staff, 3,311 employees, during the shutdown. Here is what the agency said will and won’t continue during a lapse in appropriations: ... Editor's Note: While this article is for the broader healthcare community, we posted extensive hospice-specific information for you in yesterday's issue, Government shutdown impact on telehealth for hospice and palliative care providers, by Judi Lund Person. Click here to download her complete PDF report.  

Home health industry welcomes CMS’ repeal of nursing home staffing mandate Home Health Care News; by Joyce Famakinwa; 9/20/25 Earlier this month, the Centers for Medicare & Medicaid Services (CMS) drafted a rule that would repeal the federal staffing mandate for nursing homes – a move that would send ripple effects through the home health industry. The rule was controversial among nursing home operators, but it also received pushback from home health providers who were concerned that the mandate would lead to further staffing scarcity. “The repeal is positive for home health agencies,” Katy Barnett, director of home care and hospice operations and policy at LeadingAge, told HHCN in an email. 

Commentary: New York must act now to protect quality hospice care Times Union; by Cara Pace, Liz Krueger and Amy Paulin; 9/30/25 When your loved one is entering the final stage of their life, who would you rather manage their care: a nonprofit solely dedicated to providing the highest quality care possible? Or a private entity seeking to maximize profits? ... However, for-profit hospices now account for 70% of the market, up from 5% 35 years ago. This comes despite studies showing that for-profit hospices provide fewer essential services, employ less skilled staff, receive a higher volume of complaints and contribute less to their communities than their nonprofit counterparts. ... That's why we introduced legislation (S.3437/A.565) to prohibit the state from approving new applications for the establishment, construction or increased capacity of for-profit hospice entities. The two existing for-profit providers would not be touched, though their capacity to expand would be limited. The legislation now awaits Gov. Kathy Hochul’s signature.Editor's Note: For-profit or non-profit status alone does not speak to the quality of care provided by the individual hospice. Some for-profits provide excellent care; some non-profits do not. This article speaks to evidence-based data, quality scores, patterns, trends, and cumulative results from CAHPS, HIS (which is being replaced by the HOPE Tool, effective today), and more. Examine quality scores in your services with the National Hospice Locator (ranked by scores), provided by National Hospice Analytics.

Expert: In preparation for debut of HOPE tool Wednesday, hospices should provide training, adhere to timelines McKnights Home Care; by Adam Healy; 9/28/25 With the Hospice Outcomes and Patient Evaluation (HOPE) tool scheduled to roll out Wednesday, hospice providers need to get up to speed, ... Katy Barnett, director of home care and hospice operations and policy at LeadingAge, told McKnight’s Home Care Daily Pulse ... "To be successful with the new tool, providers need to adhere to a few best practices. ... Providers should have a designated staff member making sure that their assessments are uploaded within 30 days of completion and that they are accepted by the iQIES system,” she said. “In the first quarter of implementation, meeting the 90% threshold for timely reporting of data is key.” Barnett added, “Providers need to make sure they’re meeting the two-day timeline for symptom follow-up visits and that they’re tracking completion either within their EMR or externally. This is really important since the visits will count towards publicly reported quality measures starting in January.”Guest Editor's Note, from Judi Lund-Person: For patients who are already on service on October 1, hospices will only use the HOPE discharge process and will not use the HUV or SFV visits.  Have you registered for iQIES yet? There is still time….. although every hospice will want to pay close attention to the 90% compliance threshold – if it is not met, there could be a 4% payment reduction for the following year. Good luck with your final preparations!

Reimbursement changes and home health outlook Levin Associates; by Dylan Sammut; 9/22/25 Over the summer, the home health industry was hit with some new potential headwinds. On June 30, the Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2026 proposed rule for the home health prospective payment system, which proposes significant rate adjustments. In this article, we’re going to explore what the most significant changes are and how they will impact the home health market. ...