Literature Review

Elevating quality, outcomes, and patient experience through Value-Based Care: CMS Innovation Center’s Quality PathwayNEJM Catalyst; by Susannah M. Bernheim, MD, MHS; Noemi Rudolph, MPH; Jacob K. Quinton, MD, MPH; Julia Driessen, PhD; Purva Rawal, PhD; and Elizabeth Fowler, PhD, JD; 4/3/24The U.S. Center for Medicare and Medicaid Innovation is launching a new Quality Pathway to elevate patient-centered quality goals in the design and evaluation of alternative payment models. The Quality Pathway will align model design around quality goals; elevate outcomes and experience measures, particularly patient-reported outcomes; and ensure that evaluations have the ability to assess the impact of models on primary quality goals. These determinations will help the Innovation Center make critical decisions about which models to scale or expand in the pursuit of improving the quality of care for people with Medicare and Medicaid.

Glendale, California men sentenced for role in $9M hospice fraud scheme – owner of San Gabriel Hospice and Palliative Care Inc. and Broadway Hospice Inc.Sierra Sun Times; 3/31/24The owner of two California-based hospice companies, along with his biller and consultant, were sentenced last Thursday for their respective roles in a scheme that resulted in stealing over $9 million from Medicare in false and fraudulent claims for hospice services. ... According to court documents, ...  [Gayk] Akhsharumov concealed his ownership and control over the hospice entities from Medicare, inserted nominee owners, paid kickbacks to patient recruiters, and profited from the scheme. In April 2020, after San Gabriel had ceased operations, Akhsharumov used the company to fraudulently obtain COVID-19 relief funds.

New Federal Health IT Strategy sets sights on a heathier, more innovative, and more equitable health care experienceU.S. Department of Health and Human Services; 3/28/24The U.S. Department of Health and Human Services (HHS) through the Office of the National Coordinator for Health Information Technology (ONC), today released the draft 2024–2030 Federal Health IT Strategic Plan (the draft Plan) for public comment. The draft Plan: 

Enhancing interoperability in home health and hospice careMcKnights Home Care, by Tim Smokoff; 3/26/24In the dynamic realm of home health and hospice care, the seamless flow of information across care settings stands as a crucial element for ensuring quality patient outcomes and efficient workflows. Recent advancements in electronic health record (EHR) solutions within this sector have not only fostered enhanced care-team collaboration, but have also addressed challenges posed by evolving reimbursement models and workforce shortages.

Hospice & Palliative Care Handbook: Quality, Compliance, and Reimbursement, 4th Edition McGraw Hill - Access APN; textbook by Tina M. Marrelli and Jennifer Kennedy; 3/28/24 “Hospice & Palliative Care Handbook, Fourth Edition, is an invaluable resource for timely hospice regulatory and compliance information, documentation, care planning, and case management. It provides clear guidance for hospice managers, clinicians, and interdisciplinary group members. I have utilized Tina Marrelli’s home health and hospice handbooks to support training new clinical staff and students for decades and consider these resources to be the gold standard.” – Kimberly Skehan, MSN, RN, HCS-D, COS-C, Vice President of Accreditation - Community Health Accreditation Partner

M&A volume may shift from hospice to home health Hospice News, by Jim Parker, 3/26/24 Though many expect a hospice M&A rebound in 2024, the scales are tipping in favor of home health companies among buyers. Generally, signs point to heightened buyer activity this year, particularly among private equity as interest rates start to come down. 

[Pediatrics] North Dakota Health and Human Services announces new pilot program CBS KX News, by Nathaniel House; 3/26/24 North Dakota Health and Human Services (HHS) has announced that family members who provide extraordinary care to either a child or adult enrolled in an eligible North Dakota (ND) Medicaid 1915(c) waiver may receive payments from the state through the new Family Paid Caregiver pilot program. State funding for the pilot program was approved from the passage of Senate Bill 2276 during the 2023 legislative session. Eligible ND Medicaid 1915(c) waivers include the Autism Spectrum Disorder Birth Through 17 Waiver, Children with Medically Fragile Needs Home and Community-Based Services Waiver, Children’s Hospice Home and Community-Based Services Waiver and the Traditional Individual with Intellectual Disabilities and Developmental Disabilities Home and Community-Based Services Waiver. 

The Hospice Special Focus Program: What it is & why it is importantFORV/S, by Angela Huff; 3/25/24 The CMS Hospice Special Focus Program (SFP) aims to shed light on poorly performing hospices. CMS has publicly stated it is looking closely at the hospice industry due to increasing concerns regarding fraud, waste, and abuse. The Hospice Special Focus Program (SFP) is a new CMS program that identifies poor-performing hospices, takes action to inform the public, and engages those hospices to either improve their performance or terminate the hospice from the Medicare program. 

Regulatory reference links for home health care, hospice and durable medical equipment National Association for Home Care & Hospice; per email 3/25/24 Includes reference descriptions and links to the following:

New legislation proposes national expansion of integrated care modelsHealth Affairs, by Laura M. Keohane; 3/20, 24 This article is the latest in the Health Affairs Forefront major series, Medicare and Medicaid Integration. The series features analysis, proposals, and commentary that will inform policies on the state and federal levels to advance integrated care for those dually eligible for Medicare and Medicaid.  ... On March 14, a bipartisan group of senators—members of the Senate Duals Working Group—released legislation (The DUALS Act: Delivering Unified Access to Lifesaving Services Act of 2024) that commits to ambitious goals for aligning Medicare and Medicaid coverage ... Would the integration measures proposed in this bill be more successful [than previous programs] in achieving these goals? This Forefront article highlights the key components of the legislation and assesses its ability to advance better outcomes for dual-eligible beneficiaries.

Lawmakers threaten harsher penalties for negligent providers, CEOs in wake of crippling cyberattack McKnights Home Care; by Adam Healy; 3/20/24 Roughly a month after Change Healthcare fell victim to a cyberattack that debilitated a large section of the healthcare system, Sen. Ron Wyden (D-OR) and Xavier Becerra, secretary of the Department of Health and Human Services, devised a plan to penalize providers that fail to protect their patients’ data. 

New ACO model paves way for innovative home-based primary care services: CMS McKnights Home Care, by Adam Healy; 3/20/24 The Centers for Medicare & Medicaid Services on Tuesday unveiled a new person-centered care payment model that expands how and where beneficiaries can receive primary care. “People whose primary care provider participates in the ACO PC Flex Model may get care in more convenient ways, like care based at home or through virtual means, extra help managing chronic diseases, and more preventive health services to keep them healthy,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Not only will people with Medicare receive more coordinated, seamless care that addresses their unique needs, but CMS is supporting primary care clinicians and giving them more flexibility to provide person-centered care.”

CAHPS Hospice Survey - Quality Assurance Guidelines V10.0: Technical Corrections and Clarifications, March 2024