Literature Review

National Alliance’s Scott Levy: Hospices need ‘regulatory relief’ to protect ‘sacred benefit’ Hospice News; by Holly Vossel; 3/21/25 The hospice industry is undergoing a transformative period of rising demand and regulatory changes. Providers of all sizes and types are facing mounting operational challenges and financial strains with limited recourse to voice their collective concerns to legislators. This is according to Scott Levy, chief government affairs officer at National Alliance for Care at Home (the Alliance). Levy stepped into the role earlier this year after holding a similar position at Amedisys. He has been involved in government relations, public policy, advocacy and law for more than 20 years. Levy recently sat down with Hospice News to discuss the array of regulatory and legislative evolutions on the horizon in hospice care delivery.  .[Continue reading ...]

Hospice Medical Review Top Denial Reason Codes: Q4 2024 [Palmetto GBA]Palmetto GBA press release; 3/17/25We encourage all providers to review this information when filing claims to prevent denials and to ensure their claims are processed timely. The following information affects providers billing 81X bill types.  1 5CF36 Not Hospice Appropriate  2 56900 Auto Denial — Requested Records not Submitted  3 5CNER The Notice of Election Is Invalid Because It Doesn't Meet Statutory/Regulatory RequirementsSee the article for Top Ten.

Disparities in end-of-life symptom burden linked to complex interplay among wealth, health, and social supportJAMA Network Open; Peter A. Boling, MD; 3/25On average, US health care spending in the last year of life alone was $80,000, with 12% ($9,500) being out of pocket and mostly incurred before the final 6 months. This problem worsened in the past decade when the nonspecific diagnosis of failure to thrive was removed as a condition eligible for hospice care and more stringent definitions were applied for dementia, which became the next bubble as the hospice balloon was squeezed. Hospice care is a means of reducing symptom burden, but the Medicare payment model discourages prolonged enrollment during slowly progressing advanced chronic illness and effectively limits funding of social support during hospice care, which is particularly problematic for patients with cognitive and functional impairment and for their friends and families. Considering suffering as a medical condition warranting treatment rather than a social problem requiring support services might help with the evolution of a Medicare policy that might provide a more graduated approach to end-of-life care.

MedPAC recommends Congress tie physician pay to inflation for 2026 Healthcare Dive; by Susanna Vogel; 3/17/25 Dive Brief:

What Trump has done with Medicare so far Kiplinger; by Kathryn Pomroy; 3/17/25 Since President Trump was sworn into office on January 20, he has proposed or initiated changes impacting Medicare. Here's a roundup. ...

2010 to 2019 saw early palliative care billing up for advanced cancer HealthDay News; by Elana Gotkine; 3/17/25 For patients with distant-stage cancers, there was an increase in early palliative care (PC) billing from 2010 to 2019, but the level remained low, according to a study published online March 7 in the Journal of Clinical Oncology. ... The researchers found that in 2010 to 2019, there was an increase in the percentage with early PC billing among 102,032 patients treated by 18,908 unique physicians, from 1.44 to 10.36 percent. The likelihood of early PC billing was increased in association with treating physician's early PC referrals in the previous year and organizations' employment of any HPM specialist (3.01 and 4.54 percentage points, respectively). 

Hospice use among Medicare beneficiaries with Parkinson Disease and Dementia with Lewy bodiesJAMA Network Open; Meredith Bock, MD; Siqi Gan, MPH; Melissa Aldridge, PhD; Krista L. Harrison, PhD; Kristine Yaffe, MD; Alexander K. Smith, MD; John Boscardin, PhD; Lauren J. Hunt, PhD; 3/25Lewy body disease (LBD)—an umbrella term that includes Parkinson disease (PD) and dementia with Lewy bodies (DLB)—describes progressive, incurable neurodegenerative disorders. Parkinson disease is the second most common neurodegenerative disorder after Alzheimer disease (AD) and is the fastest growing neurologic disorder in the world.In this cohort study of ... Medicare beneficiaries enrolled in hospice between 2010 and 2020, hospice enrollees with both PD and DLB were less likely to be disenrolled due to extended prognosis than those with AD. Enrollees with PD—but not DLB–were more likely to have longer lengths of stay and revoke hospice. The findings of this study suggest a higher likelihood of revocation of hospice care in PD, raise important questions about their unmet needs in hospice, and highlight the need to disaggregate dementia subtypes for policy analysis. 

CMS pulls plug on projects aimed at improving care, saving on costs KFF Health News - Morning Briefing; 3/13/25 One initiative that has been scrapped would have offered some generic drugs to Medicare enrollees for $2. Meanwhile, the Trump administration has backed off hospice oversight.

Empath Health CEO to Congress: Invest in home-based care Hospice News; by Jim Parker; 3/11/25The federal government must invest further in home-based care, Empath Health CEO Jonathan Fleece told lawmakers at a hearing with the U.S. House of Representatives Ways & Means Health Subcommittee. leece was among several post-acute care leaders who appeared at the hearing, representing home health, hospice, skilled nursing facilities, rehabilitation hospitals and other stakeholders. In opening remarks, Fleece pointed to the benefits of home-based care for patients and families, as well as the sector’s ability to reduce health care costs. 

How Houston Methodist’s ACO reduced its end-of-life spending by nearly 20% MedCity News - Hospitals; by Katie Adams; March 10, 2025 Houston Methodist Coordinate Care is reducing costs through a partnership with Koda Health, a digital platform that guides patients through their end-of-life choices. Preliminary findings show the technology resulted in a 19% reduction in the total cost of care for patients at the end of their life, which equals nearly $9,000 in savings per patient. ... The ACO has been working with Koda Health for more than three years — and it is saving money by getting patients more involved in their end-of-life care plan.

CMS deletes Medicare Advantage vision statement, signaling another shift from health equity Fierce Healthcare - Regulatory; by Noah Tong; 3/10/25 The Centers for Medicare & Medicaid Services (CMS) wiped away the agency’s stated intentions for the future of Medicare Advantage (MA), underlining new uncertainty for the future of health-related social needs, CMS Innovation Center models and the federal health program. ... A frequently asked questions page gave further explanation, as did an executive summary of a report to be released in early 2025. The page included a section with the question, “What is CMS’ vision for the future of the MA program?” as of Feb. 22, archived versions of the web page shows. But that question and answer was quietly deleted, and the page was last modified Feb. 26. It previously described how the VBID model helped health plans address health-related social needs and stressed health equity as an important cornerstone of its mission. ... The CMS did not immediately respond to a request for comment.

The rising importance of social workers on the home health team Home Health Care News; by Audrie Martin; 3/10/25 Addressing social determinants of health (SDoH) is becoming increasingly important due to new regulations from the Centers for Medicare & Medicaid Services (CMS) and the shift toward value-based care payment models. With ongoing staffing shortages and a growing demand for home-based care services, social workers are taking on greater responsibilities to support the health care system. ... Individuals requiring home health care often need complex support that addresses both their medical and psychosocial needs, especially if they are isolated from typical social interactions and services. Some home care teams are now integrating home health social workers (HHCSWs) to provide a comprehensive approach to care that considers these SDoHs.Ediotor's note: March is National Social Work Month. Click here for National Association of Social Worker's (NASW) Social Media Toolkit for Social Work 2025.

How much does end-of-life care generally cost? 50 Plus Finance; by David Leto; 3/3/25 [For the public] ... Knowing how much end-of-life care generally costs can help you manage and prepare your finances appropriately to ease the burden on you and loved ones when the time comes. ... The cost of end-of-life care can vary widely depending on the services required. On average, however, Americans spend between $10,000 and $70,000 on such care, with the majority of expenses often occurring in the last year or month of life. These costs can stem from hospital stays, at-home care, or nursing facility care. Hospice, which focuses on comfort and pain management, typically costs less than intensive medical treatments but still averages several thousand dollars each month, or around $150 a day with insurance. Understanding these figures helps you set realistic financial expectations and prepare for them. ...