Literature Review

Oz does not rule out Medicaid cuts during Senate confirmation hearing McKnights Home Care; by Adam Healy; 3/14/25 Mehmet Oz, MD, President Donald Trump’s pick to lead the Centers for Medicare & Medicaid Services, did not give a direct answer when asked whether he was for or against Medicaid cuts Friday during a Senate Finance Committee hearing. “I cherish Medicaid and I’ve worked within the Medicaid environment quite extensively practicing at Columbia University,” Oz said when asked by Sen. Ron Wyden (D-OR) if he would oppose cuts to Medicaid. “I want to make sure that patients today and in the future have resources to protect them if they get ill. The way you protect Medicaid is by making sure it’s viable at every level, which includes having enough practitioners to afford the services, paying them enough to do what you request of them, and making sure that patients are able to actually use Medicaid.”

CMS pulls plug on projects aimed at improving care, saving on costs KFF Health News - Morning Briefing; 3/13/25 One initiative that has been scrapped would have offered some generic drugs to Medicare enrollees for $2. Meanwhile, the Trump administration has backed off hospice oversight.

OIG Nursing Facility Compliance Program Guidance: Renewed focus on fraud and abuse McDermott Will & Emery, Chicago, IL; by Gregory E. Fosheim, Monica Wallace, Dexter Golinghorst, and Brigit Dunne; 3/11/25 The US Department of Health and Human Services Office of Inspector General’s (OIG’s) release of Nursing Facility Industry Segment-Specific Compliance Program Guidance (ICPG) for the first time since 2008 reemphasizes the importance of billing and coding and fraud and abuse compliance for nursing facilities and skilled nursing facilities (SNFs). This On the Subject is the second in a two-part series summarizing highlights of the Nursing Facility ICPG. This installment focuses on OIG’s recommendation that nursing facilities comply with existing billing rules and analyze referral source arrangements for compliance with fraud and abuse laws. [Click on the title's link for this significant information.]

Research brief: Medicare Advantage Special Needs Plans linked to use of inferior hospice carePenn LDI - Leonard Davis Institute of Health Economics; 3/11/25 Beneficiaries of Medicare Advantage special needs plans are significantly more likely to use lower-quality hospices than beneficiaries of other Medicare plans. These disparities may result from the geographic availability of high-quality hospices or the referrals that beneficiaries receive from their plans’ contracted hospitals and nursing homes. The results support incentivizing referrals to high-quality hospices and improving consumer information about hospice quality.

The rising importance of social workers on the home health team Home Health Care News; by Audrie Martin; 3/10/25 Addressing social determinants of health (SDoH) is becoming increasingly important due to new regulations from the Centers for Medicare & Medicaid Services (CMS) and the shift toward value-based care payment models. With ongoing staffing shortages and a growing demand for home-based care services, social workers are taking on greater responsibilities to support the health care system. ... Individuals requiring home health care often need complex support that addresses both their medical and psychosocial needs, especially if they are isolated from typical social interactions and services. Some home care teams are now integrating home health social workers (HHCSWs) to provide a comprehensive approach to care that considers these SDoHs.Ediotor's note: March is National Social Work Month. Click here for National Association of Social Worker's (NASW) Social Media Toolkit for Social Work 2025.

How much does end-of-life care generally cost? 50 Plus Finance; by David Leto; 3/3/25 [For the public] ... Knowing how much end-of-life care generally costs can help you manage and prepare your finances appropriately to ease the burden on you and loved ones when the time comes. ... The cost of end-of-life care can vary widely depending on the services required. On average, however, Americans spend between $10,000 and $70,000 on such care, with the majority of expenses often occurring in the last year or month of life. These costs can stem from hospital stays, at-home care, or nursing facility care. Hospice, which focuses on comfort and pain management, typically costs less than intensive medical treatments but still averages several thousand dollars each month, or around $150 a day with insurance. Understanding these figures helps you set realistic financial expectations and prepare for them. ...

House budget resolution draft includes massive cuts to Medicaid spending McKnights Home Care; by Foster Stubbs and Liza Berger; 2/12/25As Republicans on Wednesday put forth a draft House budget resolution that includes reductions of at least $880 billion over 10 years to Medicaid, healthcare providers and advocates cried foul.  “This budget resolution is a five-alarm fire alert for our healthcare,” Families USA said in a statement. ... Katie Smith Sloan, the CEO and president of LeadingAge, issued in a statement earlier in the day about the need to protect services for older adults in maneuvering over budget reconciliation. She warned about the effects of trimming the federal government’s Medicaid share.  

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.]

Medicaid unwinding experiences in dual-eligible older adultsJAMA Health Forum; Renuka Tipirneni, MD, MSc; Wendy Furst, MA; Dominic A. Ruggiero, MPH; Dianne C. Singer, MPH; Erica Solway, PhD, MSW, MPH; Erin Beathard, MPH, MSW; Syama R. Patel, MPH; Andrei R. Stefanescu, PhD, MS; Jeffrey T. Kullgren, MD, MS, MPH; John Z. Ayanian, MD, MPP; Eric T. Roberts, PhD; 1/25This US national survey of low-income older adults found varying awareness of and experiences with the Medicaid unwinding process and identified cost-related access barriers among those who recently lost Medicaid. By 9 to 10 months into the unwinding process, few older adults reported hearing a lot about Medicaid unwinding and many reported not receiving any communication about needing to renew Medicaid eligibility. By the time of our survey, slightly less than half of respondents had completed a Medicaid renewal. Although the proportion of respondents who said they lost Medicaid in the last 6 months was relatively low, those who lost Medicaid were more likely to report cost-related difficulty getting care. These findings highlight the importance of addressing informational and navigational barriers among dual-eligible older adults to avoid disruptions in Medicaid coverage that may contribute to difficulties accessing care. 

Up to $212,500 funding now available to researchers investigating health disparities CMS.gov - Health Equity - Grants & awards; Minority Research Grant Program; via email 1/21/25, retrieved from the internet 1/21/25 The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) is pleased to release the Minority Research Grant Program (MRGP) 2025 Notice of Funding Opportunity (NOFO). This grant awards funding to health equity researchers at minority-serving institutions (MSIs) investigating health disparities and improving the health outcomes of minority populations.As a grantee, you will enhance your impact and visibility in the research community, support our mission to advance health equity, and join a prestigious group of awardees whose collective MRGP-funded research has been cited in more than 190 publications. CMS will award up to six grants, totaling up to $1,275,000, in 2025. Review the notice of funding opportunity CMS-1W1-25-001 and submit your application on grants.gov by April 1, 2025.

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. 

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. 

Increasing Medicaid rates: A critical step to support home-based care Association Press, North Salt Lake, UT; by Business Wire; 1/14/25To address the growing challenges facing the healthcare system, the Homecare and Hospice Association of Utah (HHAU) calls for an urgent increase in Medicaid reimbursement rates for Home and Community-Based Services (HCBS) waivers, Private Duty Nursing (PDN), and Home Health. These critical services form the backbone of home-based care, enabling individuals to receive the medical attention and support they need in their homes, while saving tax dollars and alleviating strain on hospitals and long-term care facilities.