Literature Review

U.S. health care spending reaches $4.9 trillion Hospice News; by Jim Parker; 12/20/24 The nation’s total health expenditures rose 7.5% to $4.9 trillion in 2023, a new analysis by the U.S. Centers for Medicare & Medicaid Services (CMS) found. This growth took place at a faster pace in 2023 than prior years. In 2022, health care spending rose at a rate of 4.6%. Total Medicare hospice spending accounted for $25.7 billion last year, according to a separate report from the Medicare Payment Advisory Commission (MedPAC). ... About 21% of U.S. health care spending in 2023 was via Medicare, with private insurance representing a 30% share. Medicaid accounted for 21%, and the remaining 10% were out-of-pocket costs. “Hospital care, physician and clinical services, and nursing care facilities and continuing care retirement communities, which collectively accounted for 33% of all out-of-pocket spending in 2023, were the main contributors to the faster growth in 2023,” CMS indicated.

CMS names first Hospice Special Focus Program Cohort, delays list of future candidates Hospice News; by Jim Parker; 12/23/24 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. For this reason, they have argued that the list of operators should not be made public. Though CMS published the list, it delayed the release of a second that would point to future candidates for the program. “CMS has also generated a list of future SFP candidates. We are not publishing the candidate list at this time, but we are sharing the underlying data used to create both lists to allow for external review, thereby ensuring transparency in the process by which low-performing hospices are identified,” the agency indicated on its website. “We will continue to work with providers, patients and their families, and industry, to improve hospice care across the nation.” Stakeholders applauded the delay, including the National Alliance for Care at Home. [Click on the title's link to continue reading.]

Convicted trio jailed for elder abuse Inland News Today, Riverside, CA; 12/18/24 A 7-year prison sentence has been meted out for the neglect and abuse of six severely disabled residents at an unlicensed Riverside care facility. Ronnel Tiburcio was convicted of six counts of elder abuse likely to produce great bodily harm. Earlier, co-defendants Joel Ombao and registered nurse Nimfa Molina were handed jail sentences. Ombao owned several hospice companies, including the unlicensed Secure Hands board and care facility where the victims were housed. Ombao, his assistant Tiburcio, and registered nurse Molina, were responsible for operating the facility and caring for the residents. When investigators first checked out the care facility, residents were being housed in squalor. Many of them were emaciated and dehydrated.

States ranked by nurse communication Becker's Hospital Review; by Mackenzie Bean; updated 12/13/24 Hospitals in Louisiana, Minnesota, North Dakota, Nebraska and South Dakota have the highest nurse communication scores, while hospitals in the District of Columbia have the lowest, CMS data shows. CMS collects and publicly reports data on nurse communication as part of its HCAHPS survey data. The nurse communication measure assesses the percentage of patients who reported that their nurses "always" communicated well. The data was collected in 2023 and published in CMS' Provider Data Catalog Oct. 30. Nationwide, 80% of patients reported nurses always communicated well, up one percentage point from the year prior, according to CMS data. [Click on the title's link for this ranked list.]

Hospice utilization rebounds to pre-pandemic levels, but fraud casts a shadow Hospice News; by Jim Parker; 12/17/24 The nation’s hospice utilization rate among Medicare decedents has once again surpassed 50%, for the first time since the pandemic. However, fraud issues in the space create questions around the quality of care patients are receiving. Hospice utilization reached 51.7% in 2023, up more than two percentage points from the prior year, according to recent data from the Medicare Payment Advisory Commission (MedPAC). This is the highest rate since 2019. MedPAC observed increases in utilization across the board, even when stratified into subgroups by age, sex, race and rural or urban location. ... Despite these positive trends, an influx of new hospices continued in states considered hotbeds for Medicare fraud, including Arizona, California, Nevada and Texas. Many of these new additions came in areas where additional hospices were likely not necessary based on the needs of the patient population. Georgia also saw a large spate of new providers emerge in 2023.

MedPAC advises cutting home health payments by 7 percent, freezing hospice payments in ’26 McKnights Home Care; by Liza Berger; 12/16/24 The Medicare Payment Advisory Commission (MedPAC) on Friday issued draft recommendations that entail cutting payments to home health agencies by 7% and freezing hospice payments in 2026. The body, which advises Congress on Medicare payment issues, issued the same recommendations last year. Providers, once again, were not pleased. “The recent recommendations by MedPAC regarding Medicare home health and hospice policy are misguided and deeply troubling,” Steve Landers, MD, CEO of the National Alliance for Care at Home, said in a statement to McKnight’s Home Care Daily Pulse. “Medicare hospice spending has not kept up with labor inflation in the past five years and the typical length of stay and proportion of beneficiaries accessing hospice has stagnated. With respect to home health, the recommendation for drastic cuts is based on a flawed analysis of agency margins that fails to account for all payers and the true financial health of the home health system.”

What's new for Medicare in 2025? Fidelity; by Kate Ashford, Nerdwallet; 11/25/24, updated 12/11/24Each year, Medicare comes with a new set of prices, new plan ratings and sometimes new regulations. What you’ll pay may be different from last year, and your network and prescription drug coverage may change, depending on your plan. Here’s how Medicare looks in 2025. ...

Killing of UnitedHealthcare CEO brings resentment of the health care system to the fore STAT Business, Boston, MA; by Bob Herman and Tara Bell; 12/6/24 The targeted killing of UnitedHealthcare CEO Brian Thompson has become a defining moment in the zeitgeist of American health care. The attack was a tragedy that adds to the country’s grim tally of gun deaths. But instead of eliciting sympathy, it opened the floodgates for an outpouring of rage, captured across social media and online forums, over the health care system — one that charges people the highest prices in the world, erects financial and bureaucratic barriers to getting care, and has plunged millions of people into debt. Social media posts have ranged from mournful to apathetic to joyful, including morbid celebrations of Thompson’s death. That deluge has forced people across the country to grapple with two heavy subjects at once: the callousness of a slaying, and an undercurrent of deep-seated anger at a health care industry that makes a lot of money by exploiting Americans. ... [Click on the title's link to continue reading.]

New alliance steps up as voice for providers & patients HomeCare; by Hannah Wolfson; 12/3/24 Stopping Medicare cuts, ensuring Medicare Advantage beneficiaries have good access to care, passing groundbreaking hospice legislation and bringing homecare into the forefront are all priorities for the newly-formed National Alliance for Care at Home, said CEO Steve Landers. “We’ve got to start improving access to home health care, and the way that we do that is we end this march of payment cuts that are being set forward by Medicare,” Landers said at the Alliance’s Homecare and Hospice Conference and Expo, which was held in October in Tampa, Florida. ... The alliance has automatically enrolled members of both legacy organizations, but Landers said that for renewals or new members, participants will be required to sign an attestation that says they have a program in place for quality and compliance, that they monitor the Office of Inspector General’s expulsion list and don’t take referrals or staff from organizations on that list and that they strive to participate in Medicare’s quality reporting programs.

Regulators extend some telemedicine flexibilities, gauge telehealth’s ‘new path forward’ in hospice Hospice News; by Holly Vossel; 12/4/24 Regulators recently extended certain temporary telemedicine waivers granted during the pandemic, with some flexibilities now sunsetting in 2025 rather than the end of this year. The U.S. Drug Enforcement Administration (DEA) and the U.S. Department of Health and Human Services (HHS) have announced the extension of telemedicine flexibilities for the prescribing of controlled medications until Dec. 31, 2025. ... The move was made in response to feedback the agencies received from more than 38,000 comments and two days of public listening sessions. The extension allows for more time to consider a “new path forward” for telemedicine, according to the DEA and HHS. “We continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations,” the agencies stated in an announcement. “With the end of 2024 quickly approaching, DEA, jointly with HHS, has extended current telemedicine flexibilities through December 31, 2025.” The temporary rule, entitled as the Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, was recently submitted to the Federal Register and will take effect/become effective Jan. 1, 2025.

Court Orders VitalCaring to place 43% of profits into trust for Encompass Health Hospice News; by Jim Parker; 12/3/24 A federal judge in Delaware has ordered home health and hospice provider VitalCaring Group and its private equity backers to share future profits with Encompass Health (NYSE: EHC). The case has a long circuitous history that dates back to 2022 when Encompass Health spinned off its home health and hospice business as a standalone company, now known as Enhabit Inc. (NYSE: EHAB) brand. At the time, VitalCaring CEO April Anthony was CEO of the Encompass home-based case segment. “Encompass is entitled to one recovery,” a court opinion indicated. “That recovery takes the form of an equitable payment stream of VitalCaring’s future profits to be administered via a constructive trust, certain mitigation damages, and attorneys’ fee.” The court ordered that 43% of VitalCaring’s future profits be placed in trust to benefit Encompass. The remaining 57% would go to VitalCaring’s private equity backers, the Vistria Group and Nautic Partners.

Hospice Oversight: 2024’s most impactful regulatory action Hospice News; by Jim Parker; 11/27/24 The past year has seen a slew of regulatory developments aimed at improving quality and combatting fraud in the hospice industry. The drive by regulators and members of Congress to strengthen oversight is fueled by two main factors. The first was two July 2019 reports on hospice quality from the Office of the Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS). These spurred passage of the Helping Our Senior Population in Comfort Environments (HOSPICE) Act, which mandated the establishment of a hospice Special Focus Program (SFP), among other actions. The second driving force was the emergence of fraudulent actors in the space in relatively large numbers, particularly concentrated in California, Nevada, Arizona and Texas. [Click on the title's link to continue reading this important information.]

Keeping referral partners happy after dropping contracts with Medicare Advantage plans Home Health News; by Audire Martin; 11/25/24 Home health providers may walk away from specific health plans due to financial feasibility, administrative burdens, or misalignment with their patient care values and priorities. However, this decision can create short-term challenges with referral partners and health systems, as they may have patients enrolled in those plans. “If a health plan consistently under-reimburses for services or requires excessive administrative hurdles, it may compromise the ability to deliver quality care efficiently,” Preston Lucas, chief financial officer at Interim HealthCare Great Lakes, told Home Health Care News. “Additionally, if the plan’s policies restrict access to necessary treatments or fail to support the level of care required for patients, it becomes difficult to sustain the partnership.” ... Maintaining open lines of communication and emphasizing the shared goal of providing high-quality care helps mitigate the short-term consequences of leaving a health system, according to Lucas.