Literature Review

Improving the Quality Of Quality Metrics Health Affairs; by Aditya Narayan, Bob Kocher, and Nirav R. Shah; 3/19/24... The landscape of health care quality measures is dynamic, reflecting efforts to enhance patient care, safety, and outcomes. These measures are developed and reimbursed by a variety of stakeholders, including government agencies such as the Centers for Medicare and Medicaid Services (CMS), health care organizations, and independent bodies such as the National Quality Forum and the Agency for Healthcare Research and Quality (AHRQ). The development process involves rigorous research, stakeholder engagement, and consensus-building to ensure measures are evidence-based, applicable across different health care settings, and meaningful to patient care.Editor's Note: Read and share this informative, big-picture article about the evolution of healthcare's quality metrics, its tools, and best practices. 

New legislation proposes national expansion of integrated care modelsHealth Affairs, by Laura M. Keohane; 3/20, 24 This article is the latest in the Health Affairs Forefront major series, Medicare and Medicaid Integration. The series features analysis, proposals, and commentary that will inform policies on the state and federal levels to advance integrated care for those dually eligible for Medicare and Medicaid.  ... On March 14, a bipartisan group of senators—members of the Senate Duals Working Group—released legislation (The DUALS Act: Delivering Unified Access to Lifesaving Services Act of 2024) that commits to ambitious goals for aligning Medicare and Medicaid coverage ... Would the integration measures proposed in this bill be more successful [than previous programs] in achieving these goals? This Forefront article highlights the key components of the legislation and assesses its ability to advance better outcomes for dual-eligible beneficiaries.

New ACO model paves way for innovative home-based primary care services: CMS McKnights Home Care, by Adam Healy; 3/20/24 The Centers for Medicare & Medicaid Services on Tuesday unveiled a new person-centered care payment model that expands how and where beneficiaries can receive primary care. “People whose primary care provider participates in the ACO PC Flex Model may get care in more convenient ways, like care based at home or through virtual means, extra help managing chronic diseases, and more preventive health services to keep them healthy,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Not only will people with Medicare receive more coordinated, seamless care that addresses their unique needs, but CMS is supporting primary care clinicians and giving them more flexibility to provide person-centered care.”

Home-based care employment exceeding pre-pandemic levels Hospice News, by Jim Parker; 3/19/24 Employment in the home-based care sector rose above pre-pandemic levels in 2023, according to the Medicare Payment Advisory Commission (MedPAC). The U.S. Department of Commerce defines this sector to include hospices, home health agencies, private duty, pediatric agencies and other providers of care in the home. ... Nevertheless, workforce pressures and associated costs are overwhelmingly the industry’s most damaging headwind, including the associated wage hikes, enhanced benefits and bonus programs. The shortages also have reduced clinical capacity, which has contributed to drops in patient census and length of stay for many providers.

Medi-Cal Update - Hospice Care Program BulletinMedi-Cal, March Bulletin[Topics include:]

Personal care workers received most Medicaid fraud convictions in 2023: OIG McKnights Home Care, by Adam Healy; 3/15/24 More personal care workers were convicted for Medicaid fraud than any other provider type last year, according to a new report released Thursday by the Department of Health and Human Services Office of the Inspector General. OIG found that 279 personal care services (PCS) attendants were convicted of Medicaid fraud in 2023 — far more than the next four highest provider types combined. These convictions amounted to more than $10.5 million in criminal charges. 

For-profit nursing homes are cutting corners on safety and draining resources with financial shenanigans − especially at midsize chains that dodge public scrutinyThe Conversation, by Sean Campbell and Charlene Harrington; 3/14/24 ... Overall, private-equity investors wreak havoc on nursing homes, slashing registered nurse hours per resident day by 12%, outpacing other for-profit facilities. The aftermath is grim, with a daunting 14% surge in the deficiency score index, a standardized metric for determining issues with facilities, according to a U.S. Department of Health and Human Services report.The human toll comes in death and suffering. A study updated in 2023 by the National Bureau of Economic Research calculated that 22,500 additional deaths over a 12-year span were attributable to private-equity ownership, equating to about 172,400 lost life years. The calculations also showed that private-equity ownership was responsible for a 6.2% reduction in mobility, an 8.5% increase in ulcer development and a 10.5% uptick in pain intensity.

Dual eligibles, PACE expansion bill draws bipartisan support, industry endorsements McKnights Home Care, by Adam Healy; 3/18/24A bipartisan group of senators introduced legislation that would improve care coordination for dual-eligible beneficiaries and expand the Program of All-Inclusive Care for the Elderly to a larger share of people. The legislation’s primary function would be to require every state to develop a comprehensive, integrated health plan for dual-eligible beneficiaries, according to a summary. The bill also would require every state to allow PACE programs to be established, open up enrollment to any time in a given month, and extend PACE coverage to people under 55 years of age. 

Should the DOJ break up UnitedHealth Group? MedCity News, by Marissa Plescia; 3/17/24 The U.S. Department of Justice has reportedly recently launched an antitrust investigation of UnitedHealth Group, which begs the question of whether the healthcare giant should be broken up. Experts have varying opinions.

California Leads the State-Level Battle Against Hospice Fraud Hospice News, by Jim Parker; 3/13/24As hospice program integrity remains in the spotlight, California remains the only state to take action on curbing the problem. Beginning in 2021, numerous reports emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona. California’s Department of Justice (CDOJ) in 2021 issued a report detailing the state’s history of lax oversight.

A fond farewell: Musings on the end of the Medicare Advantage Hospice Carve-In Demonstration Husch Blackwell, podcast with Meg Pekarske and Chris Comeaux; 3/14/24It came as a surprise to our team when we learned that the Centers for Medicare & Medicaid Services (CMS) was ending the hospice component of Value-Based Insurance Design (VBID) on December 31, 2024. Upon learning this, Husch Blackwell’s Meg Pekarske contacted Chris Comeaux, the president and CEO of Teleios Collaborative Network, to see if he wanted to share his thoughts on this unexpected turn of events and what may be on the horizon. This is a forward-looking conversation where we explore how the lessons learned can galvanize new advocacy on the best ways to care for patients with advanced illnesses.

Nearly 53% of hospices undergo multiple audits simultaneouslyHospice News, by Jim Parker; 3/12/24Program integrity and an onslaught of audits are top of mind for many hospice providers in 2024. The nation’s four largest hospice industry organizations — LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO) and the National Partnership for Healthcare and Hospice Innovation (NPHI) — in late 2023 conducted a 133-respondent provider survey focused on regulation. ... About 52.9% reported having multiple audits, each of a different type, within six months of one another, and 31% said they were required to submit the same charts for each of these audits.