Literature Review

‘Churning’ hospice patients yields no significant financial benefits, study find McKnights Home Care; by Adam Healy; 9/22/25 Hospices that try to game Medicare payment rules by “churning” patients are producing negligible financial benefits, according to a new study published in the Journal of Public Economics. Researchers used Medicare hospice claims data from 2000 to 2019 to identify instances of providers churning patients. “Churning” refers to the practice of rapidly enrolling and discharging beneficiaries as a means of undercutting Medicare payment caps. ... For FY 2026, the hospice cap amount is $35,361.44, an increase of 2.6% from FY 2025, the Centers for Medicare & Medicaid Services said in the hospice final rule. ... Hospices may try to “game” the system by rapidly enrolling and discharging patients to raise their payment cap, the researchers noted. ... Previous research has indicated that churning may be associated with worse end-of-life outcomes for Medicare beneficiaries, researchers noted. 

Serious falls resulting in hospitalization among Medicare-enrolled nursing home residents, July 2022–June 2023HHS Office of the Inspector General; Report number: OEI-05-24-0018; 9/18/25This OIG data snapshot accompanies the report, Nursing Homes Failed To Report 43 Percent of Falls With Major Injury and Hospitalization Among Their Medicare-Enrolled Residents, OEI-05-24-00180. The snapshot found that between July 1, 2022, and June 30, 2023, more than 42,000 Medicare-enrolled nursing home residents experienced serious falls resulting in major injury and hospitalization, and 1,911 died during their hospital stays. The data indicated that most residents had known fall risk factors prior to their injuries, and falls were more common among female, older, and short-stay residents. Nursing homes with lower nurse staffing levels and lower quality ratings had higher fall rates. These preventable events reduced residents’ quality of life and cost Medicare and enrollees over $800 million, underscoring the need for stronger fall prevention and quality improvement efforts in nursing homes. 

The Alliance expresses concerns regarding MACPAC approach to HCBS rate setting National Care at Home, Alexandria, VA and Washington, DC; Press Release; 9/18/25 The National Alliance for Care at Home (the Alliance) released the following statement in response to the Medicaid and CHIP Payment and Access Commission’s (MACPAC) discussion regarding home- and community-based services (HCBS) rate-setting held during today’s September MACPAC meeting. The Alliance appreciates MACPAC’s interest in addressing issues related to worker pay in HCBS. These workers should receive higher wages and benefits as they are the backbone of the long-term care system in our country. ... Unfortunately, we are concerned about the draft recommendation MACPAC discussed during today’s meeting. Rather than seeking to address the root-cause of low worker wages, MACPAC’s recommendation instead focuses on collecting additional information that would further describe the issue. This approach increases administrative burden on states and providers without actually proposing solutions to this problem.

Wound care marketing can create confusion around hospice relatedness Hospice News; by Jim Parker; 9/16/25 Hospices provide wound care to many patients, but confusion can arise over questions of relatedness to the terminal illness. The goals of palliative wound care include primarily symptom management, comfort and dignity, but it does not always focus on healing the injury, a 2023 study indicated. This differs from general wound care, which does target healing. Palliative wound care is essential for hospice patients and most of the time should be considered related to the patient’s terminal condition, according to Felicia Walz, director of hospice quality for Colorado-based provider HopeWest. “Providing wound care to hospice patients is always appropriate,” Walz told Hospice News.

Transforming healthcare: A conversation with Rita E. Numerof Teleios Collaborative Network (TCN); pod/videocast by Chris Comeaux with Rita E. Numerof; 9/17/25 Are we headed for a healthcare train wreck?  The warning signs are flashing: skyrocketing premiums, looming Medicaid cuts, significant reductions in home health funding, and major insurers experiencing substantial stock losses.  These aren't isolated issues but symptoms of fundamental structural flaws in our healthcare system. Rita E. Numerof, co-founder and president of Numerof & Associates, returns to TCNtalks with a powerful analysis of the healthcare industry's trajectory and a bold vision for transformative change.  As an "equal opportunity critic" with over 30 years of experience spanning the entire healthcare ecosystem, Numerof offers a uniquely comprehensive perspective on why our current system is failing and what must change. 

Medicare Advantage plan spending and payments under the hospice carve-outJAMA Network Open; by Meghan Bellerose, Andrew M Ryan, Claire K Ankuda, David J Meyers; 8/25In 2021, the Centers for Medicare & Medicaid Services implemented a Value-Based Insurance Design (VBID) model to test the impact of including hospice services in the Medicare Advantage (MA) benefits package. In December 2024, the VBID was ended following widespread dissatisfaction ... Under the carve-out model, after an MA enrollee elects hospice, health care related to their terminal illness is paid for by fee-for-service (FFS) Medicare. MA plans stop receiving the inpatient and outpatient portions of that enrollee's capitated payment but continue to receive premium and rebate payments. In this cross-sectional study, MA plans received high premium and rebate payments for beneficiaries enrolled in hospice despite low health care spending after enrollees elected hospice. To reduce excess payments, the Centers for Medicare & Medicaid Services could require MA plans to submit information on enrollees' use of supplemental benefits and adjust payments made after election of hospice to align with spending.

Home health agency sues HHS over $34m Medicare payment recoupment Home Health Care News; by Morgan Gonzales; 9/8/25 Infinity Home Care of Lakeland, a Florida-based home health provider and affiliate of Amedisys, has sued the U.S. Department of Health and Human Services over Medicare recoupments. The Florida-based home health agency alleged that HHS completed “shoddy expert work” that led the agency to conclude that Medicare overpaid Infinity by $34 million for services from 2014 to 2016. According to the lawsuit, a contractor, Zone Program Integrity Contractors (ZPIC), reviewed 72 of the agency’s claims in 2017 and denied all 72 on the basis of errors with the face-to-face encounter documentation, that home health services were not medically reasonable and necessary or a lack of medical records. 

Nursing homes can disrupt ‘rehabbed to death’ cycle with PDPM-based palliative care Skilled Nursing News; by Kristin Carroll; 9/7/25 ... Skilled nursing facilities can leverage the Patient Driven Payment Model (PDPM) to provide more palliative care to people near the end of life, helping to drive value-based care goals while improving the patient experience. However, much more needs to be done on the policy level to disrupt the current status quo, in which people commonly go through several care transitions near the end of life, driving up costs across the health care system while patients receive services that are not aligned with their own goals. Enabling concurrent SNF and hospice care is one change that could lead to improvement. These are assertions in the recent article “Rehab and Death: Improving End-Of-Life Care for Medicare Skilled Nursing Facility Beneficiaries,” published in the Journal of the American Geriatrics Society.

CMS: Annual Change in Medicaid Hospice Payment Rates—ACTIONCMS, Department of Health and Human Services; email from Rory Howe, director; 9/5/25The Centers for Medicare and Medicaid Services (CMS) has released the Medicaid hospice rates for FY 2026. They are slightly different than the Medicare rates and should be used when billing for Medicaid hospice patients. This memorandum contains the Medicaid hospice payment rates for federal fiscal year (FY) 2026. The rates reflect changes made under the final Medicare hospice rule published on August 1, 2025 (CMS-1835-F). Please inform your staff and all state agencies in your jurisdiction of these new payment rates, which are effective October 1, 2025. We expect state agencies to share the Medicaid hospice payment rates for FY 2026 with the hospice providers in their state.

Bipartisan home health legislation introduced to protect Medicare beneficiaries and lower Medicare costs National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 9/4/25 The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the introduction of the Home Health Stabilization Act of 2025. This bipartisan legislation, introduced by Representatives Kevin Hern (R-OK) and Terri Sewell (D-AL), would protect home health care by pausing the devastating payment cuts proposed in the Centers for Medicare & Medicaid Services’ (CMS) CY 2026 Home Health Prospective Payment System proposed rule. 

Protecting Florida's seniors: Fighting fraud and financial exploitation Targeted News Service; 8/29/25 The Senate Special Committee on Aging released the following testimony by Brandy Bauer, director of the Senior Medicare Patrol Resource Center, from an Aug. 7, 2025, field hearing entitled "Protecting Florida's Seniors: Fighting Fraud and Financial Exploitation": Chairman Scott, thank you for inviting me here today on behalf of the Senior Medicare Patrol program. The nation's 54 Senior Medicare Patrol, or SMP, programs are managed by the U.S. Administration for Community Living, with the mission to help empower and assist people to prevent, detect, and report Medicare fraud, errors, and abuse. ...

Alliance submits comments in response to CY 2026 Home Health Proposed Rule National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 8/29/25 As the federal comment period draws to a close, the National Alliance for Care at Home (the Alliance) has joined an unprecedented number of providers and patients in submitting formal feedback to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed 9% cut to the home health payment rate for 2026. The unusually high volume of responses collected throughout the comment window underscores broad concern that the $1 billion payment reduction will limit access to care at home, compromise patient safety, and burden the wider healthcare system.