Literature Review

Medicare Advantage will 'sink' rural hospitals, experts warn Modern Healthcare; by Michael Mcauliff; 5/14/24Studies by Chartis [Center for Rural Heaalth] and others paint the bleak picture for rural hospitals. According to a recent estimate by the nonprofit Center for Healthcare Quality and Payment Reform, about 700 rural hospitals are at risk of closing. A recent Chartis report estimated 167 rural hospitals have closed since 2010, with another 418 vulnerable to closure now. [Click on the title's link for patient care examples and more stats.]

Hospice remains underserved by Medicare Advantage, data showsBioMedWire; 5/13/24 While the Medicare Advantage space grows bigger, it is difficult for regulators and the medical industry to decide how best to integrate hospice into MA programs. This is a major concern because hospice care is the only segment of the healthcare sector that isn’t catered for in Medicare Advantage (MA). ... Almost 50% of all individuals (1.7 million) on MA programs that succumbed to their terminal illnesses in 2022 were recipients of hospice services. ... 

NAHC advocacy scores wins in CongressNAHC Newsroom; Press Release; 5/10/24Tireless advocacy by the National Association for Home Care & Hospice (NAHC) and our partners at the National Hospice and Palliative Care Organization, has resulted in the approval of the Preserving Telehealth, Hospital, and Ambulance Access Act (H.R. 8261) through the Ways & Means Committee of the U.S. House of Representatives. While the committee advanced the legislation, it will still need to be passed by the full House of Representatives and the Senate as well. This first step was crucial to get the bill on the pathway to its ultimate enactment into law. This legislation provides:

New DOJ task force to tackle competition-related concerns in healthcare McKnights Senior Living; by Kathleen Steele Gaivin; 5/13/24 The Justice Department said its Antitrust Division’s new Task Force on Health Care Monopolies and Collusion will consider “widespread competition concerns shared by patients, healthcare professionals, businesses and entrepreneurs, including issues regarding payer-provider consolidation, serial acquisitions, labor and quality of care, medical billing, healthcare IT services, access to and misuse of healthcare data and more.” The group’s mandate is to facilitate policy advocacy, investigations and, where warranted, civil and criminal enforcement in healthcare markets.

Health Equity Data Definitions, Standards, and Stratification: New resource available Centers for Medicare and Medicaid Services; by CMS; May 2024Resource of health equity-related data definitions, standards, and stratification practices ... This document serves as a technical resource that can be used by organizations and entities, such as providers, states, community organizations, and others, that wish to harmonize with CMS when collecting, stratifying, and/or analyzing health equity-related data. It may also clarify differences in results that may arise when different data standards and definitions are used. This document includes suggested definitions, standards, and stratification practices for the following sociodemographic elements:

Hospice Certifying Physician Medicare Enrollment InformationPalmetto GBA email; 5/6/24Pursuant to our authority under section 6405 of the Affordable Care Act, and as part of CMS' larger strategy to address hospice program integrity and quality of care, certifying physicians, including hospice physicians and hospice attending physicians, must be enrolled in or opted-out of Medicare for the hospice service to be paid. Effective June 3, 2024, (delayed from May 1, 2024) CMS will begin implementing edits to enforce this new rule and will deny hospice claims if the physician entered in the Attending field on the claim is not in the Provider Enrollment Chain and Ownership System (PECOS) as an enrolled or opted-out physician.

Medicare program suddenly ending leaves seniors in limbo Newsweek; by Suzanne Blake; 5/6/24 Some hospice patients on Medicare Advantage are now facing uncertainty after the government ended a pilot program. Medicare Advantage is one of the top programs for seniors looking for health insurance, and more than 50 percent of those eligible now use the privatized Medicare Advantage option instead of just traditional Medicare. ... According to the Medicare Payment Advisory Commission, around half of 1.7 million Medicare Advantage recipients who died in 2022 were in hospice for end of life care.

CMS: Advance health equity during National AANHPI Heritage Month CMS.gov; email 5/2/24 During May, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) recognizes National Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Heritage Month by highlighting disparities for Asian Americans, Native Hawaiians, and Pacific Islanders. These communities account for more than 7% of the U.S. population and have the fastest population growth rate among all racial and ethnic groups, having almost doubled since 2000. Between 2017 and 2019, the number of Asian Americans enrolled in Medicare grew by 11%, which was the highest percentage increase in enrollment compared to White, Black, and Hispanic enrollees. ... [Read for more descriptions, data and resources.]

What Hospice VBID’s ending means for palliative care Hospice News; by Markisan Naso; 5/1/24 The impending demise of the hospice component of U.S. Centers for Medicare & Medicaid Services’ value-based insurance design (VBID) model has largely been met with a sense of relief by providers as they plan new initiatives for palliative care in 2025. ... The program, which initially contained promising components designed to give patients better access to palliative care, instead became an increasing source of frustration for organizations. ... With the end date for the hospice component of the VBID model approaching, many palliative care providers are left with concern for their patients and questions about the coming transition, as they shift focus to what happens next.  Editor's Note: This article includes perspectives from Rory Farrand, Vice President of Palliative and Advanced Medicine at NHPCO, and Mollie Gurian, Vice President of Home-Based and HCBS Policy at LeadingAge.

Judi Lund Person: UnleashedTCN Talks; by Chris Comeaux; 4/18/24Judi Lund Person, former vice president of regulatory and compliance at NHPCO, shares her journey into the hospice industry and her passion for ensuring patients and families receive the care they need and want. Judi emphasizes the importance of addressing bad hospice care and uncovering fraud and abuse in the industry.  She discusses the proposed changes in the 2025 Hospice Wage Index and Payment Conditions; ... the HOPE tool and the revised hospice survey;  ... the sunset of the VBID demonstration; and the need to focus on accountable care organizations and quality reporting. This is a great listen for staff, leaders, and boards of hospice and palliative care organizations. Here’s a great quote from the discussion: “You never know when something you do or somebody you talk to changes the course of your life."

HHS issues new rule to strengthen nondiscrimination protections and advance Civil Rights in health careHHS Press Office; 4/26/24Today, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) issued a final rule under Section 1557 of the Affordable Care Act (ACA) advancing protections against discrimination in health care. By taking bold action to strengthen protections against discrimination on the basis of race, color, national origin, sex, age, and disability, this rule reduces language access barriers, expands physical and digital accessibility, tackles bias in health technology, and much more.

Federal Court halts lawsuit over Medicare home health payments Bloomberg Law; by Tony Pugh; 4/28/24 A federal court in Washington DC tossed a lawsuit against HHS over a disputed payment system that has slashed reimbursements for thousands of home health agencies since it was implemented in 2020. The US District Court for the District of Columbia ruled in a memorandum opinion on April 26 that plaintiffs in the suit by the National Association for Home Care & Hospice (NAHC) failed to exhaust their administrative rememdies because they "skipped the agency's process for seeking expedited judicial review." Because of that, the court "will grant the federal government's motion for summary judgment." [Additional content may require subscription.]

Congresswoman Kat Cammack introduces legislation to block 80-20 Rule Home Health Care News; by Joyce Famakinwa; 4/26/24 ... On Thursday, Congresswoman Kat Cammack (R-Fla.) introduced a bill to block the U.S. Department of Health and Human Services (HHS) from finalizing the 80-20 provision. Additionally, the legislation would also block HHS from implementing any similar rules that place a minimum requirement for how much of Medicaid spending on HCBS goes towards direct workers’ wages. Cammack’s reason for introducing this legislation is her belief that the 80-20 provision will severely limit access to care at a time when providers are already struggling to serve patients.