Literature Review

Humana selects Thyme Care for oncology services MociHealthNews and HIMSS Media; by Anthony Vecchione; 3/3/25 Humana has unveiled an agreement with value-based cancer care platform Thyme Care with the aim of providing oncology support for its Medicare Advantage (MA) members. The agreement impacts MA members who reside in Michigan, New York, Illinois, Indiana, Tennessee, Pennsylvania and New Jersey. Eligible Humana members will have access to Thyme Care’s services, which include 24/7 virtual care navigation. Additionally, patients will be connected to a care team made up of oncology nurses, nurse practitioners, social workers and resource specialists. Thyme Care's team will provide medication guidance, urgent care support, chronic condition management and palliative care support.

House sets up potential Medicaid cuts with budget bill passage Modern Healthcare; by Michael McAliff; 2/25/25 Republicans in the House took the first step Tuesday [2/25] toward steep potential healthcare cuts, passing a budget resolution that aims to trim spending by at least $1.5 trillion while also adding trillions to the debt to fund tax cuts. The House voted 217-215 on nearly party lines to begin what is known as budget reconciliation, passing a budget resolution that instructs committees to come up with cuts or extend tax cuts that largely benefit the wealthy. The bill mandates the House Energy and Commerce Committee, which oversees Medicaid and Medicare, come up with the majority of the savings, and cut $880 billion.

DOJ launches probe into UnitedHealth’s Medicare billing practices after investigative reports MSN; by Taylor Herzlich; 3/22/25 The Department of Justice has reportedly launched an investigation into UnitedHealth Group’s Medicare billing practices as scrutiny over the health insurance industry intensifies — sending the company’s stock plummeting.The probe is analyzing the company’s practice of frequently logging diagnoses that trigger larger payments to its Medicare Advantage plans, according to The Wall Street Journal. UnitedHealth shares plunged nearly 9% Friday. A series of Wall Street Journal reports last year found that Medicare paid UnitedHealth billions of dollars for questionable diagnoses.

Study shows end-of-life cancer care lacking for Medicare patients Vanderbilt University Medical Center (VUMC) News; by Tom Wilemon; 2/21/25 The study involved patients of diverse ethnic backgrounds age 66 or older who died from breast, prostate, pancreatic or lung cancers. Many Medicare patients with advanced cancer receive potentially aggressive treatment at the expense of supportive care, according to a study that analyzed Medicare records. The study, published Feb. 21 in JAMA Health Forum, examined the quality of end-of-life care among 33,744 Medicare decedents. ... Overall, claims records showed that 45% of the patients experienced potentially aggressive care (such as multiple acute care visits within days of death), while there was a low receipt of supportive care, such as palliative, hospice and advanced care planning in the last six months of life. While hospice care spiked to more than 70% during the month that death occurred, over 16% of patients spent less than 3 days in hospices. Moreover, receipt of advanced care planning and palliative care remained below 25%. Editor's note: Click here for the research article, "Contemporary Patterns of End-of-Life Care Among Medicare Beneficiaries With Advanced Cancer." Though this research was published just this past Friday February 21, 2025, multiple newsletters are posting it, highlighting different elements. 

Judge sets trial date for DOJ’s challenge to UnitedHealth takeover of Amedisys McKnights Home Care; by Adam Healy; 2/20/25 A judge reportedly has set a date for the Department of Justice’s challenge of UnitedHealth Group’s (UHG’s) acquisition of home health and hospice provider Amedisys. US District Judge James K. Bredar set the trial for Oct. 27. However, the trial may have to be rescheduled to Feb. 9, 2026, Bredar said in an order, according to MLex, which provides news and analysis on legal developments.

Hospices traverse the ‘new twists’ in increasingly complex auditing processes Hospice News; by Holly Vossel; 2/20/25 Auditors are raising new questions around two common issues in hospices’ Medicare claims — documentation supporting patient eligibility and the physician narrative. Program integrity issues and quality concerns have raised the bar of regulatory oversight in recent years, with auditing activity ramping up as more providers undergo multiple audits simultaneously each year. ... Claim denials most frequently occur due to insufficiently documented evidence that demonstrates a patient’s eligibility within the physician narrative explanation, Nowicki stated. Auditors have increasingly required more details to support a patient’s six month terminal illness prognosis, potentially stretching the boundaries of hospice requirements stipulated by the U.S. Centers for Medicare & Medicaid Services (CMS), he indicated. [Click on the title's link to continue reading.]

[Updated] Trump administration suspends hospice Special Focus Program Hospice News; by Jim Parker; 2/14/25 The Trump Administration has suspended implementation of the hospice Special Focus Program. Finalized in the 2024 home health payment rule, the program is designed to identify poor performing hospices, mandate quality improvement and in some cases impose additional penalties. However, stakeholders in the hospice space have contended that the agency’s methodology for selecting hospices for the program is deeply flawed. Notice of the suspension appeared [Friday, 2/14] on the U.S. Centers for Medicare & Medicaid Services (CMS) website.

What's keeping CFOs up at night? Becker's Hospital CFO Report; by Alan Condon; 2/14/25 As health system CFOs chart their course for 2025, they face an increasingly complex financial landscape marked by mounting labor costs, tightening margins, shifting payer dynamics and an evolving regulatory environment. ... [Several] CFOs recently joined the “Becker's CFO and Revenue Cycle Podcast” to discuss the trends they're watching most closely — and the strategies they're deploying to stay ahead. [Key items include the following: labor shortages (key theme); major investments in ambulatory care facilities; AI to support operations and service; physician partnerships; shift from fee for service to value-based care; clinical labor; malpractice litigation; growth of Medicare Advantage programs; staffing shortages; inflation; reimbursements; providing care to undersinsured patients; Medicaid supplemental funding programs; "disruptors' by private equity and "other nontraditional players"; uncertainty of federal and state regulation changes.]

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.

Medicare's 2025 physician pay cut, explainedBecker's Hospital CFO Report; by Stefanie Asin; 2/5/25 As of Jan. 1, Medicare is paying physicians almost 3% less than last year for services provided to the country's 66 million Medicare patients. The decreased payments aren't a surprise or anything new, as CMS, by law, must keep physician payments budget neutral (cannot raise total Medicare spending by more than $20 million in a year). As a result, since 2020, Medicare has cut physician pay each year ... [Click on the title's link to continue reading these items.]

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.