by editor | Dec 8, 2024 | Blog, Keys to Compassionate Care
Reopening of prior year CAP calculations is always difficult to manage and is one of the dreaded letters that you may receive any year. It’s difficult enough to manage CAP during a given CAP year, but you also need to efficiently estimate CAP for patients who move between hospice providers so that you can estimate your risk of CAP overage and associated estimated overpayments.
The OIG released an audit of CGS’ cap calculation process for the 805 hospices that operated in CGS’s jurisdiction. Of these, 61 had net cap overpayments totaling $9.1 million for cap year 2020.
As part of the audit, the OIG reviewed the templates used to calculate aggregate cap amounts and selected 45 hospices to determine whether CGS followed its processes and whether the calculations in the templates were accurate.
The audit identified that CGS accurately calculated the initial 2020 cap amounts for all 805 hospices and collected or attempted to collect the $9.1 million in cap overpayments in accordance with CMS requirements.
For the the 45 selected hospices, the audit revealed that CGS did not reopen and recalculate most hospice caps for prior cap years (i.e., 2017, 2018, and 2019) resulting in lost collections of overpayment for these prior years. (CAP calculations may be reopened for up to three years.)
As a result, the OIG recommended actions that would increase CGS’ compliance with the policy of reopening prior year CAP calculations.
Hospice agencies operating in the CGS jurisdiction should take note of the results of this audit as it will likely result in increased identification of CAP overpayment demands in upcoming years.
For Additional Information
Link to full OIG report: https://tinyurl.com/ym3vu3ez
Video: Hospice CAP and key indicators for hospice CAP risk
by editor | Dec 8, 2024 | Hospice Research Articles
Abstract
Dame Cicely Saunders was a pioneer in palliative care and the founder of the modern hospice movement. Her visionary work, particularly in establishing St. Christopher’s Hospice in 1967, reshaped the way healthcare professionals approach the care of patients with life-limiting illnesses. She emphasized a holistic approach that addresses not only physical pain but also the emotional, social, and spiritual needs of patients. Her contributions have left an indelible mark on the medical field, leading to the global expansion of palliative care services and their integration into various medical specialties. Today, palliative care and hospice services are recognized for enhancing the quality of life for patients and their families, focusing on quality over quantity of life, promoting dignity in dying, respecting patient autonomy, and supporting patients in creating a meaningful legacy.
Link to Full Article
Link to article: https://tinyurl.com/76kny69m
by editor | Dec 8, 2024 | Hospice Research Articles
Abstract
Objectives:
Published research in disparities in advance care planning, palliative, and end-of-life care is limited. However, available data points to significant barriers to palliative and end-of-life care among minority adults. The main objective of this scoping review was to summarize the current published research and literature on disparities in palliative and hospice care and completion of advance care planning and directives among non-Hispanc Blacks.
Methods:
The scoping review method was used because currently published research in disparities in palliative and hospice cares as well as advance care planning are limited. Nine electronic databases and websites were searched to identify English-language peer-reviewed publications published within last 20 years. A total of 147 studies that addressed palliative care, hospice care, and advance care planning and included non-Hispanic Blacks were incorporated in this study. The literature review include manuscripts that discuss the intersection of social determinants of health and end-of-life care for non-Hispanic Blacks. We examined the potential role and impact of several factors, including knowledge regarding palliative and hospice care; healthcare literacy; communication with providers and family; perceived or experienced discrimination with healthcare systems; mistrust in healthcare providers; health care coverage, religious-related activities and beliefs on palliative and hospice care utilization and completion of advance directives among non-Hispanic Blacks.
Discussion:
Cross-sectional and longitudinal national surveys, as well as local community- and clinic-based data, unequivocally point to major disparities in palliative and hospice care in the United States. Results suggest that national and community-based, multi-faceted, multi-disciplinary, theoretical-based, resourceful, culturally-sensitive interventions are urgently needed. A number of practical investigational interventions are offered. Additionally, we identify several research questions which need to be addressed in future research.
Keywords: palliative care, hospice care, advance care planning, advance directives, non-Hispanic blacks, disparity, mistrust, discrimination, religion and religiosity
Link to Full Article
Link to Article: https://tinyurl.com/bd85zaf4
by editor | Dec 8, 2024 | Hospice Research Articles
Abstract
The Medicare hospice program is intended to provide palliative care to terminal patients, but
patients with long stays in hospice are highly profitable, motivating concerns about overuse
among the Alzheimer’s and Dementia (ADRD) population in the rapidly growing for-profit
sector. We provide the first causal estimates of the effect of for-profit hospice on patient spending
using the entry of for-profit hospices over twenty years. We find hospice has saved money for
Medicare by offsetting other expensive care among ADRD patients. As a result, policies limiting
hospice use including revenue caps and anti-fraud lawsuits are distortionary and deter cost-saving
admissions.
Read the Full Article
Link to full Article: https://tinyurl.com/43ffsufm
by editor | Dec 8, 2024 | Hospice Research Articles
Abstract
The US hospice industry has shifted from not-for-profit to for-profit ownership models,1,2 producing concerns about care quality. For-profit hospices may have higher rates of live discharges3 and hospitalizations4 and worse caregiver-reported experiences.1 Recently, hospices have been acquired by private equity firms (PEFs) and publicly traded companies (PTCs).5 Although all for-profit ownership models are oriented toward profit maximization, PEF and PTC ownership structures are distinct in being incentivized to generate short-term and above-market returns for investors,5 raising questions about the potential influence of financial objectives on quality. We compared differences in caregiver-reported hospice quality across categories of ownership.
Link to Full Article
Link to article: https://tinyurl.com/bdda96ej
