Literature Review

The daily balancing act of value-based cancer care The American Journal of Managed Care (AJMC); by Laura Joszt, MA; 10/14/24 In value-based care, there’s a daily balancing act to achieve quality outcomes, cost reduction, and patient care improvements, explained Stuart Staggs, vice president of transformation, quality, and shared services for The US Oncology Network (Network). At the Institute for Value-Based Medicine event, cohosted by The American Journal of Managed Care (AJMC) and Minnesota Oncology, Staggs kicked it off with what he called a “practical look at value-based care.” He highlighted 4 main areas: quality, improvement, adoption, and cost. ... The area of improvement that the Network wanted to focus on was advanced care planning and better supporting and engaging patients and their families around hospice and life support. During the OCM, the Network better engaged patients and families around hospice care and encouraged practices to have difficult conversations. Not only does this improve patient experience by providing them the end-of-life care that they want, but there is also a cost factor. Patients who don’t receive hospice care spend significantly more in the last 30 to 60 days, Staggs said.

Millions of aging Americans are facing dementia by themselves California Healthline; by Judith Graham; 10/15/24 Sociologist Elena Portacolone was taken aback. Many of the older adults in San Francisco she visited at home for a research project were confused when she came to the door. They’d forgotten the appointment or couldn’t remember speaking to her. It seemed clear they had some type of cognitive impairment. Yet they were living alone. Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing? ... Portacolone got to work and now leads the Living Alone With Cognitive Impairment Project at UCSF. The project estimates that that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States. ... Imagine what this means. ...

Why recent outages are a wake-up call for healthcare and regulators Forbes; by Chris Bowen; 10/11/24 When the CrowdStrike outage first started to show itself in the early hours of that hazy July morning, it was hard to believe that this wasn’t a hack or cyberattack. I was driving in my car that morning and looked up to see a digital billboard glitch into the "blue screen of death" before my eyes. Flights were grounded, travel was delayed, and nearly every Windows machine in the world was unusable. It was total mayhem. Clearly, this was an outage of major proportions, as millions of Windows systems worldwide essentially cratered. Caused by a faulty misconfiguration, we saw firsthand how the very digital advancements that have helped transform and modernize our world also expose us to more vulnerabilities than ever. ... In healthcare, this event laid bare the vulnerabilities we cannot overlook—the gaps that directly threaten patient care and safety. It’s a clear reminder of our industry’s utmost responsibility to patient privacy and well-being. ...

Two Los Angeles-area residents arrested on indictment alleging scheme to fraudulently obtain and launder Medicare proceedsUnited States Attorney's Office - Central District of California; Press Release; 10/9/24 A Los Angeles woman and a San Fernando Valley man were arrested today on a 24-count federal grand jury indictment alleging a scheme to defraud Medicare out of more than $54 million via hospice and diagnostic testing services that were never provided and then laundered their illicit proceeds, including by buying millions of dollars’ worth of gold bars and coins. Sophia Shaklian, 36, of the Larchmont area of Los Angeles, and Alex Alexsanian, 47, of Burbank, were arrested early this morning. They are scheduled to be arraigned this afternoon in United States District Court in downtown Los Angeles. ... According to the indictment that a federal grand jury returned on October 2, Shaklian, often using aliases, managed and submitted claims for seven health care providers enrolled with Medicare and located in Los Angeles County. These businesses included a hospice company she owned – the Pasadena-based Chateau d’Lumina Hospice and Palliative Care – and several diagnostic testing companies: Saint Gorge Radiology in Sylmar; Hope Diagnostics in North Hollywood; Direct Imaging & Diagnostics and Lab One – both located in Hollywood; and Labtech and Lifescan Diagnostics in Claremont.

The best bets for palliative care reimbursement post-VBID Hospice News; by Jim Parker; 10/8/24 The hospice component of the value-based insurance design model (VBID) will sunset at the end of this year, but opportunities for payment through Medicare Advantage and other models remain. The hospice component is part of the larger VBID program, which will continue through 2030. The component was designed to test coverage of hospice through Medicare Advantage. It also contained elements intended to expand access to palliative care, for which reimbursement in general is scarce. Hospice News spoke with Dr. Bob Parker, chief clinical officer and chief compliance officer for the Texas-based hospice provider Kindful Health, about the opportunities in place for palliative care providers. [Click on the title's link for this interview.]

Hosparus Health ranked fourth in nation for overall quality The News-Enterprise; 10/5/24 Hosparus Health has been ranked fourth in the nation for Overall Quality among the 50 largest hospices, according to a study published in the American Journal of Hospice & Palliative Medicine. This ranking was determined based on key metrics: Consumer Assessment of Healthcare Providers and Systems caregiver survey scores, employee satisfaction ratings from Glassdoor and sentiment scores from Google reviews. David W. Cook, president and CEO of Hosparus Health, expressed his pride in the organization’s staff. “Your care, your compassion, it’s those on the front line of our care,” Cook said. “It’s thrilling to see the recognition of what you do here celebrated nationally.” Since 1978, Hosparus Health has been at the forefront of hospice and palliative care services, caring for thousands of patients across Kentucky and Indiana, the release said. Today, the nonprofit organization, which has offices in Elizabethtown, continues to provide expert care and holistic support to more than 14,000 patients and families annually, ensuring that each individual receives compassionate, high-quality care during life’s most challenging times.

BREAKING NEWS 10/1/2024, 12:30pm - Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements; Correction Federal Register - The Daily Journal of the United States Government; Centers for Medicare & Medicaid Services  (CMS), Department of Health and Human Services (HHS); 10/1/24 This document corrects technical and typographical errors in the final rule that appeared in the August 6, 2024 Federal Register titled “Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements”.I. Background: In FR Doc. 2024-16910 of August 6, 2024 (89 FR 64202), there were a number of technical and typographical errors that are identified and corrected in this correcting document. The provisions in this correction document are effective as if they had been included in the final rule that appeared in the August 6, 2024 Federal Register . Accordingly, the corrections are effective October 1, 2024.II. Summary of Errors: ...Given these errors, we are republishing the FY 2025 Hospice Wage Index file accordingly on the CMS website at: https://www.cms.gov/​medicare/​payment/​fee-for-service-providers/​hospice/​hospice-wage-index effective October 1, 2024.

BREAKING NEWS 10/1/2024, 12:30pm - Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements; Correction Federal Register - The Daily Journal of the United States Government; Centers for Medicare & Medicaid Services  (CMS), Department of Health and Human Services (HHS); 10/1/24 This document corrects technical and typographical errors in the final rule that appeared in the August 6, 2024 Federal Register titled “Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements”.I. Background: In FR Doc. 2024-16910 of August 6, 2024 (89 FR 64202), there were a number of technical and typographical errors that are identified and corrected in this correcting document. The provisions in this correction document are effective as if they had been included in the final rule that appeared in the August 6, 2024 Federal Register . Accordingly, the corrections are effective October 1, 2024.II. Summary of Errors: ...Given these errors, we are republishing the FY 2025 Hospice Wage Index file accordingly on the CMS website at: https://www.cms.gov/​medicare/​payment/​fee-for-service-providers/​hospice/​hospice-wage-index effective October 1, 2024.

Alliance sees Hospice CARE Act as opportunity to advance hospice benefit discussionNHCPO / National Alliance for Care at Home; Press Release; 9/26/24 The National Alliance for Care at Home (the Alliance), a new national organization formed by the integration of the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) recognizes the introduction of the Hospice Care Accountability, Reform, and Enforcement (CARE) Act, by Congressman Earl Blumenauer (OR-3).  The Alliance shares Rep. Blumenauer’s desire to update the Medicare hospice benefit to address the evolving needs of our country’s aging population while ensuring the sustainability and integrity of the hospice program. As a long-standing champion of hospice care, Rep. Blumenauer has consistently demonstrated a commitment to ensuring that hospice services remain accessible, compassionate, and of the highest quality for patients and their families. The Alliance appreciates Rep. Blumenauer’s commitment to involving a diverse group of stakeholders in developing this legislation and will continue to work closely with congressional leaders on the finer points of the proposed bill to ensure that the final legislation supports the needs of patients, families, and providers alike. 

Blumenauer proposes overhaul to Hospice Benefit: If enacted, the legislation would be the single most significant update to the hospice benefit and payment structure since its inception in 1982.U.S. Congressman Earl Blumenauer, Washington, DC; Press Release; 9/26/24Today, Congressman Earl Blumenauer (D-OR), a senior member of the Ways and Means Committee, introduced the Hospice Care Accountability, Reform and Enforcement Act (Hospice CARE Act) to modernize Medicare’s hospice benefit, which has remained largely unchanged since its inception in 1982. The proposal comes as egregious reportsof fraud and abuse within the benefit persist, despite action from Centers for Medicare & Medicaid Services (CMS). The legislation is the product of years of collaboration between stakeholders, lawmakers, and industry leaders. It builds on Blumenauer’s decades-long commitment to ensure the federal government supports families at a time of great stress and vulnerability: the end of life. 

‘Think like a reviewer’: How hospices can use communication, documentation to boost quality McKnights Home Care; by Adam Healy; 9/24/24 Regulators are tightening their scrutiny of the hospice industry, so providers must prioritize the documentation and communication practices that help them obtain higher quality scores. That’s according to hospice industry experts who spoke during an educational session at the National Hospice and Palliative Care Organization’s annual meeting in Denver. “They’re looking closely at the hospice industry,” Angela Huff, senior managing consultant at Forvis Mazars, said last week during the conference. “They have increasing concerns about fraud, waste and abuse in this space. … Don’t think this is going to stop.” ... A key part of hospice quality assurance is communication, Gallarneau said. Providers should support open, friendly channels of communication. This helps staff and clients feel comfortable raising concerns, making quality issues easier to tackle quickly and effectively. Also, prioritizing accuracy in documentation will help providers stay ready for any surveys or audits, Gallarneau noted. Hospices should ensure patient consent and election of benefit forms are properly filled out, signed and dated, and staff should all be trained to do so accordingly. 

Cigna to cut Medicare Advantage plans in several statesModern Healthcare; by Lauren Berryman; 9/19/24Cigna Group's health insurance unit is scaling back Medicare Advantage offerings in eight states next year, according to a notice to third-party marketers published by the insurance brokerage Pinnacle Financial Services. Members in 36 health plans will be affected by Cigna Healthcare’s cuts and service area reductions in Colorado, Florida, Illinois, Missouri, North Carolina, Tennessee, Texas and Utah. Most people will have another Cigna Medicare Advantage plan available in their counties. The company's Medicare Advantage business is fully exiting at least three counties: two in Missouri and one in North Carolina, the notice said.