Literature Review

Medicare and Medicaid: 60 years of health care reform Medicare Rights Center; by Jisoo Choi; 7/30/25 On this day 60 years ago, Medicare and Medicaid were signed into law, creating a national health insurance program for older adults, people with disabilities, and people with limited incomes. In the first three years, Medicare and Medicaid enrolled nearly 20 million beneficiaries; today, Medicare has an enrollment of over 68 million and Medicaid, over 71 million. The programs, established amidst sustained public pressure and organizing by labor unions and older adults, have been and remain very popular: recent polling shows 82% of American adults hold a generally favorable view of Medicare, and 97% consider Medicaid to be important to people in their local communities.

Hospital decision-making and adoption of health-related social needs programs in US hospitalsJAMA Network Open; by Dina Zein, Cory E. Cronin, Neeraj Puro, Berkeley Franz, Elizabeth McNeill, Ji E. Chang; 6/25In response to health disparities in the US, the Centers for Medicare & Medicaid Services (CMS) released a Framework for Health Equity recommending increased hospital commitment and leadership engagement around screening for health-related social needs (HRSNs). This cross-sectional study found that hospitals with multiple layers of management engagement tended to adopt multifaceted strategies that address patients’ social needs, which are critical components of health equity frameworks. Interestingly, hospitals where only senior management was involved were more likely to offer specific programs like food insecurity and transportation services, although these associations were generally smaller compared with when both senior and other management were engaged.

How Compliance Management Systems help ensure business efficiency Enterprise Talk; by Apoorva Kasam; 7/22/25 With changing rules and regulations, businesses can’t afford to leave compliance to chance. A robust compliance management system (CMS) helps meet regulatory, legal, and internal policy requirements.

51 healthcare leaders’ takes on doing more with less Becker's Hospital Review; by Allie Woldenberg, Kelly Gooch, Mariah Taylor, Giles Bruce, Kristin Kuchno, and  Andrew Cass; 7/17/25 It’s a directive that hospitals and health systems of every size know well — whether sprawling academic medical centers, multistate nonprofit systems or rural, independent 25-bed hospitals. While the phrase isn’t new, the urgency behind it is intensifying. The nation’s healthcare workforce remains fragile, forcing leaders to distinguish between staffing gaps that are temporary hurdles or structural limitations. Revenue projections for health systems have shifted dramatically ... Against this backdrop, Becker’s set out to understand how health system leaders across the U.S. are interpreting and enacting the mandate to “do more with less” today. From June 9 to July 15, we spoke with executives across the country, in every type of market, hospital, and health system, to hear how they are navigating this evolving landscape. ...Editor's Note: Scan through these with a sharp eye toward improving the quality of patient care while "doing more with less." I applaud many of these leaders for not just focusing on cutting costs, but for using these crucial changes as a vehicle to improve patient care.

AAPA asks CMS to remove regulatory restrictions on PAs providing hospice care American Academy of Physician Associates (AAPA); by Trevor Simon; 7/9/25 In June 2025, AAPA submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the topics of hospice, skilled nursing facilities, inpatient rehabilitation facilities, and inpatient psychiatric facilities. These comments, in response to annually released proposed rules that make adjustments to the hospice wage index and respective fee schedules, responded directly to inquiries made within the rules, as well as identified policy obstacles faced by PAs in these settings. [Continue reading for] a brief summary of the topics AAPA discussed in each, with links to the full letters.

DOJ & HHS announce reinvigoration of False Claims Act Working Group and Healthcare Fraud Enforcement Priorities Dorsey & Whitney LLP; Press Release; 7/9/25 The Department of Justice and the Department of Health and Human Services announced the reinvigoration of a False Claims Act (“FCA”) Working Group, a joint effort between the two agencies.  The announcement was made on July 2 during remarks at the American Health Law Association (“AHLA”) Annual Meeting by Brenna Jenny, the new Deputy Assistant Attorney General of DOJ’s Commercial Litigation Branch, and in a press release that same day. This working group underscores that healthcare fraud is a priority for the Administration, despite recent staff changes and recent policy announcements about enforcement priorities in civil rights and DEI. It also underscores that robust compliance programs should continue to be a priority for healthcare-industry stakeholders.

Medicaid provisions threaten home and community-based services for millions of vulnerable Americans National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 7/3/25The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the House’s passage of the “One Big Beautiful Bill Act,” also known as the Reconciliation bill, which now heads to President Trump’s desk for his signature. “The Alliance is deeply troubled by the Medicaid provisions within the One Big Beautiful Bill Act, which has passed both chambers of Congress and now awaits President Trump’s signature,” said Alliance CEO Dr. Steve Landers. “These provisions—including work requirements, reduced provider taxes, and new cost-sharing mandates—prioritize short-sighted budget savings over the health and wellbeing of our most vulnerable citizens who rely on home and community-based services (HCBS).” The home care community advocated throughout the legislative process for Congress to mitigate these harmful Medicaid provisions.

Older adults spending excess time in ED, putting hospitals at risk of failing to meet new guideline, analysis finds McKnights Long-Term Care News; by Donna Shryer; 7/1/25 A new national analysis of hospital data shows that older adults in the United States increasingly are spending more time in emergency departments (EDs) than federal guidelines recommend — delays that can be harmful to aging patients. The findings come as hospitals prepare to comply with new Medicare rules aimed at improving emergency care for older adults. ... Among patients who were admitted to the hospital, more than one-third (36%) waited more than three hours after the decision was made to admit them, a delay known as boarding. These benchmarks — eight hours in the ED and three hours to admission — are part of the new Age-Friendly Hospital Measure introduced by the Centers for Medicare & Medicaid Services (CMS). As of January 2025, hospitals are required to confirm they have procedures in place to meet these time goals.

Understanding hospice care: Eligibility, cost and purpose Emmanuel Hospice; 6/5/25 How do you want to live? It may be surprising to learn that’s the first question Emmanuel Hospice asks every new patient. Isn’t hospice about dying? While hospice is often associated with death, Melissa Wedberg will tell you it’s more about living, especially at Emmanuel Hospice, where she serves as vice president of community relations. With more than a decade in the hospice industry, Wedberg has spent years dispelling this and many other myths. Despite having roots in the U.S. dating back to the 70s, there remains a lot of mystery about hospice. Common questions Wedberg hears include: What is hospice and who’s eligible? How does hospice work? How is hospice paid for? Editor's note: This simple question jumps to the core of person-centered care, "How do you want to live?"

CMS budget puts complaint surveys over routine inspections as main nursing home oversight McKnights Long-Term Care; by Kimberly Marselas; 6/2/25 A proposed 2026 Trump administration budget request would shift nursing home survey priorities, further delaying the time between standard inspections at many facilities. The Centers for Medicare & Medicaid Services budget justification published late Friday calls for a $45 million increase in survey spending across multiple sectors next fiscal year. But it also prioritizes complaint surveys in a way that would reduce the availability of surveyors to conduct routine, annual inspections mandated by law. The document from the Department of Health and Human Services shows the percentage of nursing home standard surveys completed each year would fall from 74% in fiscal year 2024 to a projected 65% completion rate in fiscal year 2026. 

TCN/HPC Today: Storm clouds on the horizon for reimbursement - Top news stories, May 2025 Teleios Collaborative Network (TCN); podcast by Chris Comeaux with Cordt Kassner, 6/4/25 What happens when artificial intelligence meets end-of-life care?  How do we reconcile private equity's profit motives with hospice's mission-driven ethos?  These questions took center stage in this month's roundup of hospice news with host Chris Comeaux and guest Cordt Kassner. The May edition of TCNtalks' top news stories reveals a healthcare sector at a fascinating crossroads.  AI has emerged as both a tantalizing promise and a practical challenge for hospice providers.  ... In this episode of TCN Talks, hosts Chris Comeaux and Cord Kassner reflect on Memorial Day and discuss significant news stories from May, including the complexities of thanking veterans for their service, the role of artificial intelligence in hospice care, and the importance of honest conversations about racism in healthcare.Editor's note: This monthly podcast combines quantitative data and qualitative discussion from articles gleaned from the 400+ posts we provide each month. Do you seek to make sense of it all? Tune in and learn. We welcome your feedback via our newsletter's Contact page. 

Providers, advocates ask Senate to reject $700M in Medicaid cuts, Congress to save OAA programs McKnights Senior Living; by Kathleen Steele Gaivin; 5/27/25Providers and advocates for older adults are counting on the Senate to reject a portion of the proposed federal budget that would gut $700 million from the Medicaid program. Members of the House of Representatives passed their version of the bill late Wednesday. ... Home care advocates ANCOR and the National Alliance for Care at Home on Thursday also called on the Senate to reject the House-passed cuts to Medicaid.

‘We need you to work with us’: Home health providers renegotiate better Medicare Advantage deals Home Health Care News; by Joyce Famakinwa; 5/20/25 As Medicare Advantage (MA) enrollment continues to surge, home health providers have seen slim margins deteriorate further. Some providers have openly expressed their decision to reject financially unsustainable MA contracts. Abandoning unfavorable MA contracts may sometimes be necessary, industry executives told Home Health Care News. However, some providers have improved their MA standing by renegotiating rates or returning after walking away, leveraging data and understanding the needs of payer partners. “We have walked away, in specific states, from payers and Medicare Advantage groups because of rates and the inability to raise those rates, and pre-authorization terms,” G. Scott Herman, CEO of New Day Healthcare, told HHCN.