Literature Review

What you need to know about the HOPE Tool HomeCare; by Jennifer Kennedy and Kimberly Skehan; 2/10/25 The Hospice Outcomes and Patient Evaluation (HOPE) assessment tool is scheduled to be implemented Oct. 1, 2025, meaning the clock is ticking for hospice providers to complete internal preparations. Providers can collect and submit hospice item set (HIS) data until Sept. 30, 2025, after which only HOPE data will be accepted for all patients admitted or discharged on or after Oct. 1, 2025. The HOPE tool is a standardized interdisciplinary assessment that aims to meet these goals from the Centers for Medicare & Medicaid Services (CMS): [click here for goals] ... CMS said it is important for providers to ensure their documentation software vendor maintains CoP content while building their HOPE content. The HOPE tool will replace the HIS content, but the core of the HIS data items will be captured in the HOPE tool. Additionally, CMS posted a change table that compares the HIS and HOPE data elements.

UnitedHealth Group withdraws motion to dismiss antitrust challenge Competition Policy International; by CPI; 2/8/25 UnitedHealth Group has withdrawn its motion to dismiss the Justice Department’s antitrust lawsuit challenging its proposed acquisition of Amedisys, a home care and hospice provider. According to the , the healthcare giant stated that new information provided by the government in late January rendered its initial motion moot. ... On January 29, the Justice Department responded to the motion by filing a list of 381 service areas where it alleged the acquisition would negatively impact competition. UnitedHealth Group, in its latest filing, acknowledged that this submission “finally identified” the locations in question, leading the company to withdraw its motion.

DOGE probes CMS for Medicare, Medicaid fraud: WSJ Becker's Hospital Review; by Rylee Wilson; 2/5/25Members of Elon Musk's Department of Government Efficiency have been granted access to payment and contracting systems at CMS, The Wall Street Journal reported Feb. 5. Department representatives have been on-site at CMS' offices this week, examining spending data for potential fraud or waste and reviewing the agency's organization and staffing, unnamed sources told the Journal. ... DOGE aims to cut federal spending by $1 trillion, with Medicaid emerging as a likely target, according to The New York Times. CMS spent more than $1.5 trillion on healthcare programs in fiscal year 2024, accounting for 22% of total federal spending, according to the agency's 2024 annual report. "Yeah, this [CMS] is where the big money fraud is happening," Mr. Musk wrote on X in response to the Journal's article.  

Man pleads guilty in connection with $17m Medicare hospice fraud and home health care fraud schemes Office of Public Affairs - U.S. Department of Justice; Press Release; 2/3/25A California man pleaded guilty today to health care fraud, aggravated identity theft, and money laundering in connection with a years-long scheme to defraud Medicare of more than $17 million through sham hospice companies and his home health care company. According to court documents, Petros Fichidzhyan, 43, of Granada Hills, engaged in a scheme with others to operate a series of sham hospice companies. Fichidzhyan, along with co-schemers, impersonated the identities of foreign nationals to use as the purported owners of the hospices — including using the identities to open bank accounts and sign property leases — and submitted false and fraudulent claims to Medicare for hospice services that were not medically necessary and not provided. In submitting the false claims, Fichidzhyan and his co-schemers also misappropriated the identifying information of doctors ... [Click on the title's link to continue reading.]

‘Small but significant’ keys to amplifying hospice grief support Hospice News; by Holly Vossel; 1/29/25 Grief support service lines can be an important pathway for hospices to reach communities outside of their patient populations. Building strong bereavement programs comes with myriad considerations around community outreach, collaboration development and strategic planning. ... Similar to many hospices nationwide, Angela Hospice offers bereavement services to its hospice patient families and across communities throughout its service region. The hospice provider’s bereavement program includes one-on-one counseling sessions, group therapy, as well as education and informative online and in-person workshops. Angela Hospice additionally offers an annual summer grief camp for children, Camp Monarch. Editor's note: The CMS Hospice Conditions of Participation (CoPs) require each hospice to provide bereavement/grief support patients' families, both before the death and after. The CMS Hospice CoPs identify "bereavement" and/or "grief" 155 times. 

Hospice rationale should be reassessed, says ethicist Medscape; by Arthur L. Caplan, PhD, Medical Ethics at NYU’s Grossman School of Medicine; 1/23/25 ... Decades ago, I first found out about the idea that came from England and a nurse, Cicely Saunders, to change the setting in which people die. ... I think that was a wonderful idea, and it has revolutionized end-of-life care. We have many excellent, superb hospice programs. ... The hospice institution is decades old, and it’s time to take another look at what’s going on there.  ... Private equity is all over this area, buying up hospice chains and home care hospice — looking to make big profits but not looking to maintain the quality requirements that ought to be there or to do more than is minimally required to set up and staff hospice. ... ... For reasons of serving the best interests of hospice patients, we should be rechecking the fairness of reimbursement, not overburdening families with care that ought to be provided by hospice programs, and making sure that those who are dying are monitored adequately and receiving checkups regularly. ...

High-cost cancer drug use in Medicare Advantage and Traditional MedicareJAMA Health Forum; Cathy J. Bradley, PhD; Rifei Liang, MA; Richard C. Lindrooth, PhD; Lindsay M. Sabik, PhD; Marcelo C. Perraillon, PhD; 1/25Traditional Medicare’s (TM) fee-for-service reimbursement encourages clinicians to provide higher-cost care, including prescribing expensive drugs when similar less expensive drugs are available. Medicare Advantage (MA) plans, where beneficiaries receive managed care almost exclusively from in-network hospitals and clinicians, were designed to reduce costs by paying a risk-adjusted capitated amount per member. In this cohort study of 4,240 patients with colorectal cancer (CRC) or non–small cell lung cancer (NSCLC), those with local or regional CRC who were insured by MA were less likely to receive a cancer drug, and of those patients, were less likely to receive a high-cost cancer drug than similar patients who were insured by TM. Patients diagnosed with distant NSCLC were less likely to receive a cancer drug if insured by MA compared to TM. MA appears to reduce high-cost drug utilization to treat patients with CRC, but not to treat those with NSCLC, in which few low-cost treatments exist.

The HOPE Assessment Tool Series: Understanding the Required Timed VisitsCHAP blog; by Jennifer Kennedy; 1/25It’s January 2025, and we are counting down to the implementation of the HOPE Assessment Tool on October 1, 2025. That date may seem far away, but there is much preparation you need to do in the coming months for a seamless launch on the “go-date”. Your staff will need consistent education about the assessment tool content and their responsibility for the administration and completion of the timed visits. [Click the link above to read the entire story.]

Up to $212,500 funding now available to researchers investigating health disparities CMS.gov - Health Equity - Grants & awards; Minority Research Grant Program; via email 1/21/25, retrieved from the internet 1/21/25 The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) is pleased to release the Minority Research Grant Program (MRGP) 2025 Notice of Funding Opportunity (NOFO). This grant awards funding to health equity researchers at minority-serving institutions (MSIs) investigating health disparities and improving the health outcomes of minority populations.As a grantee, you will enhance your impact and visibility in the research community, support our mission to advance health equity, and join a prestigious group of awardees whose collective MRGP-funded research has been cited in more than 190 publications. CMS will award up to six grants, totaling up to $1,275,000, in 2025. Review the notice of funding opportunity CMS-1W1-25-001 and submit your application on grants.gov by April 1, 2025.

Public healthAlzheimer's and Dementia; Stephanie Frilling; 12/24A Medicare Voluntary Advance Directive Framework (Framework) would enable the creation, storage, and sharing of advance directive documents, ensuring end-of-life care appropriately honors the individual and their care wishes, while supporting healthcare teams and family members in making care decisions for their patients and loved ones. With Medicare enrollment reaching over 65 million beneficiaries in 2023, and Alzheimer's becoming one of the most expensive conditions - CMS policy makers have a growing responsibility to improve care quality at end-of-life. 

CMS Health Equity Data Book U.S. Centers for Medicare and Medicaid Services - Office of Minority Health; by CMS Office of Minority Health; published December 2024, email notifications 1/15/25 One of the six pillars of the Centers for Medicare & Medicaid Services (CMS) 2023 Strategic Plan is to, “Advance health equity by addressing the health disparities that underlie our health system.” The CMS Office of Minority Health (OMH) aims to advance health equity by providing broader access to data about the state of health equity across CMS’ programs. This Data Book presents summary information on disparities within CMS programs as demonstrated by data related to prevalence. ... This Data Book is intended for use as a readily-available information source on health disparities within the Medicare, Medicaid, and the Health Insurance Marketplace populations. This Data Book is organized into five key sections – CMS at a Glance, Demographics, Chronic Conditions, Behavioral Health, and Social Determinants of Health – so that Data Book users can jump to the section most relevant to their data needs. Within each section, data are presented by each population type.

The Alliance on CMS Hospice Special Focus Program Implementation: “Doubling down on a dangerous decision, eager to work with incoming administration to fix” National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 1/16/25 The National Alliance for Care at Home (the Alliance) issued the following statement in response to the news of hospice providers filing litigation against the Centers for Medicare & Medicaid Services (CMS) over their flawed implementation of the Hospice Special Focus Program (SFP). The Alliance and the broader hospice community, who have been engaged on this program since its inception, have repeatedly shared concerns directly with CMS staff at all levels. They warned that this approach would inflict unnecessary harm to patient care, cause confusion to families when selecting a hospice provider to care for their loved ones at the end of life, and will cause some providers to sustain irreparable damage. These concerns have been echoed by lawmakers, providers, and the leading national hospice trade organizations. “With CMS doubling down on a dangerous course of action by proceeding with the Hospice SFP in its current state—and offering no due process or administrative recourse to address or mitigate its flaws—some hospice providers will suffer irreparable harm and have no choice but to seek justice through the courts on behalf of their patients and mission,” said Dr. Steve Landers, CEO of the Alliance. [Click on the title's link to continue reading.]

Special Bulletin – CA Wildfires Public Health EmergencyCommunity Health Accreditation Partner (CHAP); Special Bulletin; 1/14/2025 HHS Declares Public Health Emergency for California to Aid Health Care Response to Wildfires. The declaration follows President Biden’s major disaster declaration and gives the Centers for Medicare & Medicaid Services’ (CMS) health care providers and suppliers greater flexibility in meeting the emergency health needs of Medicare and Medicaid beneficiaries. HHS has waived sanctions and penalties for violations of certain provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule against hospitals in the emergency area. [Click on the title's link to continue reading]