Literature Review

Targeted palliative care may cut older adults’ risk of readmissions after elective surgeries: study McKnights Long-Term Care News; by Alicia Lasek; 7/27/25 Older adults with serious illness before elective surgery are at double the risk of extended hospital stays, readmissions, emergency department visits and costs, a new study has found. Targeting four key palliative care needs before surgery may help make the recovery period less burdensome for these patients and the healthcare system, the authors say. The study, published in the Journal of the American College of Surgeons, looked at seriously ill older surgical patients to see what palliative care interventions might help reduce the need for excess healthcare use post surgery. Among 2,499 older adults undergoing major elective surgery, [researchers reported] 63% were seriously ill, and 79% had four key palliative care needs:

Regional anesthesia for hip fracture surgery in older adults: A retrospective comparison of outcomes using ACS NSQIP dataGeriatric Orthopaedic Surgery & Rehabilitation; Arissa M. Torrie, MD, MHS; Gerard P. Slobogean, MD, MPH; Rachel Johnson, MD; Ron E. Samet, MD; Samuel M. Galvagno, DO, PhD; Robert V. O’Toole, MD; Nathan N. O’Hara, PhD, MHA; 6/25Surgical fixation of hip fractures in older adults is associated with significant morbidity and mortality. This study found that regional anesthesia, presumably using peripheral nerve block techniques, may offer advantages beyond pain control, with potential protective benefits in high-risk hip fracture patients. Future clinical trials should examine peripheral nerve block benefits beyond pain management, identify mechanisms of action, determine optimal techniques for different risk profiles, and assess long-term outcomes. By combining the insights from this study with carefully designed future research, researchers can work towards developing more effective, patient-centered approaches to anesthesia for older adults undergoing surgical fixation of hip fractures.

Simulating the overall hospital quality Star ratings with random measure weightsJAMA Network Open; Benjamin D. Pollock, PhD, MSPH; Daniel S. Ubl, MPH; Subashnie Devkaran, PhD; Sean C. Dowdy, MD; 7/25We found that only 244 US hospitals achieved reliable excellence in hospital quality in 2024 when defined as 90th percentile performance or better in at least 50.0% of 100,000 simulations using random weights for each measure in the CMS Overall Star Ratings. Our analysis highlights that there is meaningful variation in hospital quality performance across the spectrum of quality measures, even among 5-star hospitals. Future efforts to assess this variation may allow for better identification of reliably excellent hospitals, which could in turn lead to solicitation of evidence regarding the processes or cultures that separate reliable excellence from inconsistent greatness in hospital quality. 

Where UnitedHealthcare, Humana rule the Medicare Advantage market Modern Healthcare; by Tim Broderick; 7/22/25 Medicare Advantage competition was meager in 97% of counties last year, where beneficiaries could choose among just a handful of dominant insurers. The health policy research institution KFF analyzed Centers for Medicare and Medicaid Services data on the plans available across the U.S. and Puerto Rico in 2024. The findings indicate that Medicare enrollees have few options in most areas. Market share was “highly concentrated” in 79% of counties and “very highly concentrated” in another 18%, KFF found, using metrics similar to those the Federal Trade Commission and the Justice Department employ to measure competitiveness. ... Ninety-three percent of Medicare-eligible people lived in “highly concentrated” or “very highly concentrated” counties. ... [Click here and scroll down for the national map with] the level of Medicare Advantage market concentration for each county and the market share for each county's top insurer.

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.

100 great community hospitals | 2025 Becker's Hospital Review; by Anna Falvey; 7/11/25 Becker’s is pleased to release the 2025 edition of its “Great community hospitals” list. Community hospitals play a vital role in the fabric of the U.S. healthcare system, delivering accessible, affordable care to patients beyond major metropolitan areas. Whether serving rural regions or suburban neighborhoods, these hospitals are essential to keeping communities healthy and connected to quality care. The community hospitals recognized on this list are dedicated to clinical excellence, academic advancement and personalized, whole-person care delivery. Their mission is to elevate health outcomes within the communities they serve. 

When a fall becomes a death sentence for nursing home residents Justice News Flash; by Harve J.; 7/8/25 For nursing home residents, a trip to the hospital can be far more than a temporary setback it often marks the beginning of the end. According to data reviewed in a national nursing home longevity study by Gruber Law Offices, nearly 30% of older adults die within a month of hospital discharge. These figures suggest that transitions in care, rather than stabilizing vulnerable patients, may be accelerating their decline. ... Each year, nursing homes report between 100 and 200 falls, with the average resident experiencing 2.6 falls. These aren’t isolated accidents they’re indicators of systemic risk. Many residents already face mobility challenges, and understaffing makes close monitoring difficult. The result is a cycle: a fall leads to hospitalization, hospitalization increases frailty, and frailty increases the chance of further injury or death.

What might the past suggest about rural emergency services amidst critical access hospitals’ decline? AMA Journal of Ethics, American Medical Association; by Siân Lewis-Bevan, MD, MPH, EMT-B and Stephen Powell, MD; July 2025Critical access and other rural hospitals have struggled to remain open, which exacerbates inequity in rural residents’ access to routine and emergency health services and strains already-taxed rural emergency medical services (EMS). This article discusses the recent history of rural hospital closures and their effects on rural emergency care. This article also suggests modifications to EMS policy and practice that could improve rural community members’ access to health services and bolster EMS services in rural areas.

Palliative care knowledge, attitudes, and self-competence of nurses working in hospital settingsJournal of Palliative Care; Mona Ibrahim Hebeshy, PhD, RN; Darcy Copeland, PhD, RN; 6/25With the growing need to integrate palliative care into healthcare systems, nurses in hospital settings often provide care for patients with life-limiting conditions, many of whom lack formal education in palliative care. [Conclusions:] Nurses generally feel competent; however, they often lack confidence in addressing patients’ social and spiritual needs. They experienced unease when discussing death and exhibited paternalistic attitudes. Significant differences were found in educational background, nursing experience, personal caregiving experience, and practice setting. Positive correlations exist between attitudes, knowledge, and self-competence, indicating that greater knowledge and competence were associated with better attitudes toward end-of-life care.

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.

The greatest financial threat to hospitals, per revenue cycle leaders  Becker's Hospital Review; by Andrew Cass; 7/1/25Nearly half of hospital revenue cycle leaders view payer denials as the single greatest threat to their organization’s financial performance, according to a report from RCM company Knowtion Health, featuring joint research with Healthcare Financial Management Association. The report is based on a nationwide survey of 147 revenue cycle leaders, according to a June 26 Knowtion news release. 

209 women hospital and health system presidents and CEOs to know | 2025 Becker's Hospital Review - Leadership & Management; by Anna Falvey and Allie Woldenberg; 6/16/25 Becker’s is proud to recognize 209+ women presidents and CEOs leading hospitals and health systems across the nation. These inspiring leaders are champions of expanding care access, advancing equity and inclusion, and driving meaningful improvements in how healthcare is delivered. Their vision and leadership are shaping a stronger, more inclusive future for healthcare. ... This list was compiled based on nominations and editorial research. This list is not exhaustive, nor is it an endorsement of included presidents, CEOs, hospitals, health systems or associated healthcare providers. [The following persons have "hospice" in their profile.]