Literature Review

The iatrogenic consequences of medicalising grief: Resetting the research agenda Sociology of Health & Illness: by Sarah Gurley-Green, Lisa Cosgrove, Milutin Kostic, Lauren Koa, and Susan McPherson; published 11/28/25, distributed via Evermore 1/28/25When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, there was a firestorm of controversy about the elimination of the bereavement exclusion. Proponents of this change and of the proposed “complicated grief” designation believed that this change would help clinicians recognise major depression in the context of recent bereavement. Other researchers and clinicians have raised concerns about medicalising grief. In 2022 “prolonged grief disorder” (PGD) was officially included in the DSM-5-TR in the trauma- and stressor-related disorders section. ... As human rights activists have argued, bereavement support is an inalienable human right, one that is centered on the right to health and well-being, for “bereavement health is as intrinsic to our humanity as any other aspect of health and citizenship” (Macaskill 2022). That is why there are increasing calls for investing in bereavement as a public good and for “cultivat[ing] a bereavement-conscious workforce.” (Lichtenthal et al. 2024, e273). As Lichtenthal notes, it is not only clinicians but also institutions and systems that must “shift bereavement care from an afterthought to a public health priority.”Editor's note: "Iatrogenic" refers to unintentional consequences/condition from a medical intervention. In the hospice context, this means bereavement/grief from the hospice death. How many patients do you serve? The CMS Hospice Conditions of Participation identify "bereavement" and/or "grief" 155 times. What priority do you give to bereavement care before, at and after your patients' deaths?

AHHC joins other state hospice advocates in legal challenge to Special Focus Program The Association for Home and Hospice Care of North Carolina (AHHCNC); Press Release; 1/23/25The Association for Home and Hospice Care of North Carolina (AHHCNC) has joined a multi-state coalition of hospices and hospice associations in challenging the federal government's implementation of the Hospice Special Focus Program (SFP), deeming it unlawful and arbitrary. The challengers are seeking a preliminary injunction to halt the SFP, citing patient safety concerns, misrepresentation of compliance records, and jeopardized access to high-quality end-of-life care. Congress directed CMS to establish the SFP to enhance enforcement for noncompliance hospices, but the Final Rule includes unrelated measures, heavily relying on survey data and other information not related to hospices’ compliance with Medicare requirements. Tim Rogers, President and CEO of AHHCNC, states:  "The approach CMS uses disadvantages well-established hospices and ignores Congress’s intent." [Click on the title's link to continue reading.] 

Healthcare Industry Team 2024 Year in Review JD Supra; by Claire Bass, S. Derek Bauer, Kevin Bradberry, Ernessa Brawley, Sarah Browning, Charlotte Combre, Payal Cramer, Emily Crosby, Vimala Devassy, Shareef Farag, Amy Fouts, Winston Kirton, Caroline Landt, Charlene McGinty, Justin Murphy, Lynn Sessions, Gregory Tanner; 1/22/25As we begin a year that will once again be transformative for the industry, we are excited to present our comprehensive 2024 year-in-review, highlighting all that has happened and the trends that will shape 2025. [Downloadable PDF from BakerHostetler, bakerlaw.com. Large categories include the following:]

Trump freezes HHS communications: report Modern Healthcare Alert; by Bridget Early; 1/22/25 The Health and Human Services Department and its agencies are going silent for now, according to the Washington Post. On Tuesday, the day after President Donald Trump's inauguration, HHS received an order to halt all outbound communications, including health advisories, weekly reports, research, website updates and social media posts, the newspaper reported. The Washington Post reports that the pause has no definitive end date and that the decree does not specify whether exceptions will be made for disease outbreaks or other urgent situations. The directive applies to agencies such as the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, the National Institutes of Health and the Substance Abuse and Mental Health Services Administration.

Medicare spending, insurance claim denials top concerns: KFF poll Modern Healthcare; by Hayley Desilva; 1/17/25 A majority of individuals, regardless of their political leanings, say the federal government needs to spend more on healthcare programs, according to a KFF Health Tracking Poll released Friday. The survey of 1,310 people earlier this month highlights several areas in healthcare where the public would like to see things done differently. The results were published three days before a new administration is set to take over in Washington, D.C. 

Medicare to Veterans Affairs cost shifting—A challenging conundrumJAMA Health Forum; Kenneth W. Kizer, MD, MPH, DCM; Said Ibrahim, MD, MPH, MBA; 12/24In this issue, Burke et al highlight how costs previously paid by Medicare for VA-Medicare dual eligible enrollees are now being paid by the VA under the VCCP [Veterans Community Care Program]. Today, there is reason to be concerned whether VA health care will be adequately funded because of the rapidly rising VCCP expenditures (driven in part by Medicare to VA cost shifting) and the impact of caring for an additional 740,000 enrollees who have entered the system in the past 2 years. This has created a $12 billion medical care budget shortfall for FY 2024. The substantial budgetary tumult that has resulted from these dynamics is adversely impacting the front lines of care delivery at individual VA facilities, leading to delays in hiring caregivers and impeding access to VA care and timely care delivery, as well as greatly straining the traditional roles of VA staff and clinicians trying to manage the challenging cross-system referral processes. The intertwined issues of Medicare to VA cost shifting and the rising costs of the VCCP present a challenging policy and programmatic conundrum.

NPHI supports lawsuit to ensure proper implementation of Hospice Special Focus Program National Partnership for Healthcare and Hospice Innovation, Washington, DC; Press Release; 1/16/25Today, a lawsuit was filed by the Texas Association for Home Care & Hospice; Indiana Association for Home & Hospice Care; Association for Home & Hospice Care of North Carolina; South Carolina Home Care & Hospice Association; and Houston Hospice. The lawsuit challenges CMS’s implementation of the hospice Special Focus Program (SFP) as unlawful and arbitrary. We acknowledge that Houston Hospice, an NPHI member, is one of the plaintiffs in this legal action, and we are committed to supporting them and others impacted by the SFP or the accompanying excel files. The hospice Special Focus Program (SFP), conceived and passed on a bipartisan basis as a part of the HOSPICE Act in 2021, was designed to address poor-quality hospice providers by offering them additional support and technical assistance to ensure compliance with the Medicare Hospice Conditions of Participation. NPHI is extremely disappointed that CMS has departed from that Congressional intent, transforming the hospice SFP into a burden for many well-meaning hospices, with an algorithm for identifying providers based on inaccurate data and including elements that are not referenced in the statutory language. ... NPHI fully supports the litigation filed today, which aims to direct CMS to comply with the spirit and intent of the statute and regulations. [Click on the title's link to continue reading.]

CMS Call for Nominations: 2025 CMS Health Equity Award U.S. Centers for Medicare and Medicaid Services; by CMS Health Equity; via CMS email 1/13/25Nominations for the 2025 CMS Health Equity Award are now open to organizations working to advance health equity, showing others how to reduce disparities in health care access, quality, and outcomes. Nominations are due February 18 at 11:59 pm PT.  ... Health equity is defined by CMS as the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, and other factors that affect access to care and health outcomes. 

CMS Gives Notice of 4.3% Pay Hike for Medicare Advantage Plans Hospice News; by Jim Parker; 1/13/25 The U.S. Centers for Medicare & Medicaid Services (CMS) plans to increase payments to Medicare Advantage plans for 4.3% in 2026, but implementation will depend on what happens with the new presidential administration. CMS has issued an advance notice of policy changes for Medicare Advantage and Part D that would install technical updates, including to the ways the agency calculates payments to health plans. ... Though Medicare Advantage does not cover hospice care, many providers depend on MA payments for other programs like palliative care, among others. The changes are intended to continue CMS’s three-year phase-in of updates to the MA risk adjustment model and growth-rate calculation related to medical education costs. However, it will be up to the incoming Trump administration to bring these changes to fruition — if they so choose. 

Hospice Coalition Questions and Answers: October 30, 2024Palmetto GBA; 12/12/2024Meeting Q&A and these attachments: Attachment A1: Hospice Appeals Report Q2; Attachment A2: Hospice Appeals Report Q3; Attachment B: Hospice CAP Updates.

MA Special Needs Beneficiaries more likely to receive lower quality hospice care Hospice News; by Jim Parker; 1/2/25 Medicare Advantage special needs plan (SNP) beneficiaries were more likely to use lower-quality hospices than those enrolled in fee-for-service Medicare. Researchers from the Perelman School of Medicine at University of Pennsylvania in Philadelphia examined Medicare enrollment and claims data for 4.2 million decedents and 2.2 million hospice enrollees from Jan 1, 2018 to Dec. 31, 2019. Among other findings, results indicated that MA SNP beneficiaries were more likely to receive care from hospices with lower Hospice Quality Reporting Program (HQRP) scores. “These results suggest that policymakers should consider incentivizing referrals to high-quality hospices and approaches to educating beneficiaries on identifying high-quality hospice care,” researchers wrote in the study, published in JAMA Network Open. Editor's note: Click here for the CMS.gov Special Needs Plans webpage.

Accountable Health Communities (AHC) Model: Third evaluation report (2018-2023)CMS press release; 12/27/24The Accountable Health Communities (AHC) Model tested whether connecting beneficiaries to community resources for their health-related social needs (HRSNs) improved health care utilization outcomes and reduced costs. [The five core HRNS's include housing instability, food insecurity, transportation problems, utility difficulties, and interpersonal violence.] Collectively, these findings provide evidence that navigation can transform the delivery of care in ways that address major HRSN barriers to health and promote health equity for underserved populations.

Inside the CMS plan to streamline quality measurement Modern Healthcare; by Bridget Early; 12/23/24 Quality measurement is burdensome and complicated. The government and the private sector are struggling to figure out a good fix. The Centers for Medicare and Medicaid Services uses quality data to inform its reimbursement rates, so it's a high-stakes matter for providers and health insurance companies. CMS has proposed an overarching framework meant to streamline the process: the Universal Foundation. ... The Universal Foundation consists of two dozen quality measures across several categories that track wellness and prevention, chronic conditions, behavioral health, and "person-centered" care. Those include measures of breast and colorectal cancer screenings, blood pressure, blood sugar levels, vaccinations, and hospital readmissions. ... CMS has incorporated this framework into recent regulations such as the Medicare Advantage final rule for 2024 and the Physician Fee Schedule final rule for 2025.