Literature Review

More nonprofit hospices consolidating amid economic, regulatory pressures Hospice News; by Jim Parker; 9/12/24 As M&A in the for-profit space continues its two-year slump, nonprofits are consolidating in rising numbers. Recent years have seen an uptick in consolidation activity among nonprofits in the hospice space. Increasingly, nonprofits are pursuing acquisitions and affiliations, as well as forming regional collaboratives. In addition, some nonprofits have also been acquired by for-profit companies. Driving this trend are reimbursement and regulatory pressures, as well as a need to compete with larger, well-capitalized for-profit entities, according to Mark Kulik, senior managing director for the M&A advisory firm The Braff Group. [Click on the title's link to continue reading this significant article.] 

2024 NHPCO Facts and Figures Report now available National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 9/10/242022 Data Show First Increase in Hospice Utilization Rates Since COVID The National Alliance for Care at Home (the Alliance) published the 2024 edition of National Hospice and Palliative Care Organization (NHPCO) Facts and Figures, an annual report on key data points related to the delivery of hospice care, including information on patient characteristics, location and level of care, Medicare hospice spending, and hospice providers. Facts and Figures – the leading resource for hospice providers and others interested in understanding the work of the community – has been published annually for over two decades by NHPCO. ... The findings in this report reflect patients who received care in Calendar Year (CY) 2022, or Fiscal Year (FY) 2022, provided by hospices certified by the Centers for Medicare and Medicaid Services (CMS) and reimbursed under the Medicare Hospice Benefit. This year COVID-19 continued to impact patient care as COVID-19 waivers were still in place through May 2023. These waivers included increased telehealth services. With 49.1% of all Medicare decedents in 2022 choosing hospice care, utilization of hospice increased in 2022 for the first time since 2019. The increase hints at a normalization of the utilization rates back to pre-COVID data. Hospice utilization rates increased across all race and ethnicity groups, with the largest increase among Hispanic Medicare beneficiaries seeing. The total number of beneficiaries enrolled in hospice care in 2022 was 1.72 million. Due to the unique impact of COVID-19 on 2020 data, those data are not included in many of the charts this year.

Prepping for the hospice HOPE tool: Starting the journeyCHAP email; by Jennifer Kennedy; 9/6/24The Centers for Medicare and Medicaid Services (CMS) recently finalized the implementation date of the hospice HOPE assessment tool in the FY 2025 Hospice Payment Update final rule. This quality requirement signals a new beginning for hospice providers related to quality measurement and future payment reform. Implementation is scheduled for October 1, 2025, so the clock is ticking, and the interval is short for provider and software vendor preparation for compliance.Publisher's note: Excellent article with helpful resource links.

Modeling nursing home harms from COVID-19 staff furlough policiesJAMA Open Network; by Sarah M Bartsch, Colleen Weatherwax, Bruce Leff, Michael R Wasserman, Raveena D Singh, Kavya Velmurugan, Danielle C John, Kevin L Chin, Kelly J O'Shea, Gabrielle M Gussin, Marie F Martinez, Jessie L Heneghan, Sheryl A Scannell, Tej D Shah, Susan S Huang, Bruce Y Lee; 8/24What is the tradeoff between COVID-19–related harms and non–COVID-19–related harms when allowing nursing home staff with mild COVID-19 to work while masked? The findings of this study suggest that allowing nursing home staff who were mildly ill with COVID-19 to work while masked was associated with less harm from alleviated missed tasks, outweighing increasing harm from COVID-19 transmission.

Trends in post-acute care use in Medicare Advantage versus Traditional Medicare: A retrospective cohort analysisJournal of the American Medical Directors Association; by Robert E Burke, Indrakshi Roy, Franya Hutchins, Song Zhong, Syama Patel, Liam Rose, Amit Kumar, Rachel M Werner; 8/24We sought to describe national trends in hospitalization and post-acute care utilization rates in skilled nursing facilities (SNFs) and home health (HH) for both Medicare Advantage (MA) and Traditional Medicare (TM) beneficiaries, reaching up to the COVID-19 pandemic (2015-2019). We found hospitalizations, SNF stays, and HH stays were all decreasing over time in both populations. Although similar proportions of MA and TM beneficiaries received SNF or HH care, MA beneficiaries received fewer days. The largest difference we found was in the number of post-acute care providers used in TM and MA, with MA using far fewer; however, quality ratings were similar among post-acute care providers used in each program.

OhioHealth and Compassus finalize partnership for home health and hospice PR Newswire, Columbus, OH and Brentwood, TN; by Compassus / OhioHealth; 9/4/24 Compassus, a leading national provider of integrated home-based care services, and OhioHealth, a nationally recognized, not-for-profit, charitable healthcare outreach of the United Methodist Church, are pleased to announce the finalization of their partnership for home health and hospice services to be called OhioHealth at Home in partnership with Compassus. Under this partnership, Compassus has acquired ownership interest in three hospice locations and four home health locations that were formerly led by OhioHealth. Compassus will manage the operations of these agencies, leveraging its extensive experience in home-based care, while OhioHealth will continue to play a key role in delivering high-quality care in Ohio. OhioHealth's Athens hospice services and the Kobacker House in Columbus, Ohio, are excluded from the partnership. Editor's note: This finalizes the announcement we posted on 6/12/24: Compassus announces new partnership for home care and hospice.

“Rehabbed to Death” in oncology: Where do we go from here?JCO Oncology Practice; by Daniel E. Lage, Craig D. Blinderman, Corita R. Grudzen; 9/3/24You can go to rehab to see if you get stronger for chemo. These are words that every clinician caring for hospitalized patients with cancer has heard or said countless times. And yet, especially when it comes to older adults with advanced solid tumors, less than a third of these patients will ever receive systemic therapy again. Furthermore, their symptom profile is more similar to those discharged to hospice than to those discharged home, and they face debilitating functional decline and early mortality—leading some to coin the term “rehabbed to death” to describe this phenomenon. We suggest a few keys area of focus: (1) reframing hospital discharge conversations, including incorporating practices of disclosing prognoses using validated tools or other algorithms; (2) empowering team-based care and inclusion of palliative care clinicians in the SNF setting; and (3) identifying patients failing to make functional progress early. [Also see accompanying article: Respect for the patient-oncologist relationship may limit serious illness communication by acute and postacute care clinicians after discharge to a skilled nursing facility by Sarguni Singh, Ashley Dafoe, John Cagle, Elizabeth R. Kessler, Hillary D. Lum, Brooke Dorsey Holliman, Stacy Fischer.]

Hospice leaders: Culture the key to sustaining the workforceHospice News; by Jim Parker; 8/30/24In a time of workforce shortages, hospices are seeking the “secret sauce” that will help keep employees on board and bring new people into their fold. To find the right mix, hospice providers that have achieved national recognition for employer best practices point to a particular secret ingredient — a supportive culture with open lines of communication, a career path with room to grow and competitive compensation. For the California-based YoloCares, culture is critical, according to the nonprofit’s CEO Craig Dresang.Notable mentions: YoloCares, Vitas, Jennifer Blades of Haven Hospice.

Matters of life and death: Our health (and lack thereof) is worth talking aboutPsychology Today; by Samantha Stein; 8/29/24In his book Being Mortal, Dr. Atul Gawande, a practicing surgeon, discusses how having the hard conversations about end-of-life medical interventions (or not) may lead to a shorter life but a more fulfilling one. In his book Telltale Hearts, Dr. Dean-David Schillinger, a physician and public health advocate, discusses how accurate diagnosis, treatment, and true healing come from listening deeply to patients and their stories. Medical advances in the past century have been astounding. We live significantly longer and are able to survive repeated health crises that once would have killed us. Nearly everyone would agree that in many, if not most, cases that’s a positive thing. However, many would argue that our hyperfocus on prolonging life at all costs, along with our tendency to treat symptoms rather than looking for underlying causes, has caused us to lose sight of the importance of quality of life and true health.

NAHC and NHPCO unveil name, logo, and website for newly formed organizationPress Release; 9/5/24The National Alliance for Care at Home will Combine the Strengths of the Two Largest National Organizations Representing Healthcare Providers Delivering Care Primarily in Homes. The Alliance Will Provide Unparalleled Resources and Representation to Support the Care-at-Home Community.

Healthcare faces deficit of 100,000 workers by 2028Becker's Hospital Review; by Molly Gamble; 8/29/24A nationwide shortage of 100,000 healthcare workers is anticipated by 2028, with some states facing projected surpluses or severe deficits between future supply and demand. The finding comes from Mercer, which examined projected changes to the U.S. healthcare labor market by 2028 for states and metro and micro statistical areas. If current U.S. workforce trends continue, the healthcare workforce is projected to reach 18.6 million by 2028, an increase of over 1.5 million from 2023. However, with demand expected to rise to 18.7 million, this still leaves a shortfall of more than 100,000 workers within five years. While this gap may not seem critical in absolute terms, it adds significant strain to a healthcare system already burdened by geographic and demographic disparities in access to care.Publisher's note: This finding is particularly important for hospices already facing workforce shortages and challenges finding staff committed to the hospice philosophy of care.

Editorial: Palliative care can drive change via new payment models Hospice News; by Jim Parker; 8/27/24 A range of emerging payment model demonstrations are integrating principles traditionally associated with “palliative care” into their structures, but without using that term. The Center for Medicare & Medicaid Innovation’s (CMMI) has unveiled a series of models that incorporate elements designed to provide patient-centered care to improve seriously ill patients’ quality of life. Examples include the Guiding an Improved Dementia Experience (GUIDE), the Kidney Care Choices and Enhancing Oncology models. The GUIDE model, for example, includes language requiring “person-centered care meant to improve quality of life, delivered by interdisciplinary teams.” Thus, one could argue that palliative care principles are becoming more integrated into the larger system, even if stakeholders are not using the same terminology. ...

Executive Personnel Changes - 8/16/24