Palliative Care News’ Post

Insightful read on the necessity for hospices to leverage palliative care. Value demonstration and relevancy depend on it.

Susan Ponder-Stansel spoke at the Elevate Conference earlier this year about how the Medicare fee-for-service models can lead to inadequate support interdisciplinary palliative care. However. programs like Medicare Advantage are focused on integrating palliative care into their models, offering better reimbursement options and shared savings components. You can read the full article below. #AliviaCare #PalliativeCare #Medicare #HospiceNews

Hospice and #palliativecare providers are increasingly customizing care models to align with patient needs and value-based payment priorities, aiming to improve quality and reduce hospitalizations, especially in partnerships with ACOs and Medicare Advantage plans. https://bit.ly/4hnrL1A

U.S. health care is moving steadily towards value-based reimbursement, and having a robust palliative care program can help hospices ensure they are not left behind. With insight from Confidis Consulting https://bit.ly/3AyBOjA

We are excited to share an insightful article from Hospice News, highlighting the growing significance of palliative care in the value-based healthcare model. As the healthcare landscape shifts towards outcomes-based payment systems, palliative care is set to play a crucial role in improving patient outcomes and reducing costs. 🔍 Key Takeaways: -Medicare Reimbursement: While traditional fee-for-service models present challenges, the transition to value-based care promises better support for interdisciplinary approaches. -Growing Investment: A diverse range of healthcare providers, including hospices and home health agencies, are increasingly investing in palliative care services. -Value-Based Models: Accountable Care Organizations (ACOs) and Medicare Advantage plans are creating new opportunities for palliative care through customized payment arrangements and supplemental benefits. -Cost Savings: Programs like the Medicare Care Choices Model (MCCM) have demonstrated significant cost savings and improved patient care outcomes by integrating palliative care with curative services. What this means for Tuesday Health: As we continue to adapt and innovate within this evolving healthcare landscape, we remain committed to delivering exceptional, value-based supportive care to seriously ill patients. Our efforts are focused on improving patient experiences, enhancing their quality of life, and reducing overall healthcare costs. Read the full article here: https://hubs.ly/Q02CG2060 #PalliativeCare #ValueBasedCare #HealthcareInnovation #PatientCare #TuesdayHealth

American healthcare has come a long way since the 1940s, with significant improvements in access and affordability. The introduction of Medicare, Medicaid, and the Affordable Care Act has helped millions of Americans gain access to healthcare. However, ongoing debates on universal coverage, Medicaid expansion, prescription drug costs, cost transparency, and telemedicine continue to challenge policymakers and stakeholders. As we look to the future, managing an aging population, rising costs, technological integration, workforce shortages, health disparities, chronic disease management, and public health preparedness will be key challenges. Balancing access, cost, and quality remains a top priority for the American healthcare system. #healthcare #medicare #medicaid #medicine #AMA #americanmedicalassociation #Affordablecareact #obamacare

Medicare Advantage Policies Strain Critical Access Hospitals A recent U.S. Senate report reveals that Medicare Advantage (MA) insurers—UnitedHealthcare, CVS, and Humana—are increasingly using prior authorization to limit post-acute care, placing an undue burden on Critical Access Hospitals (CAHs). Swing-bed programs, a cornerstone of rural healthcare, are facing reduced utilization as insurers deny necessary post-acute care stays. These practices push patients into less costly but often less effective care settings, such as home health, undermining CAHs’ ability to meet the recovery needs of their communities. The report highlights troubling practices that prioritize cost savings over patient care. Post-acute care denial rates are significantly higher than for other services, with UnitedHealthcare increasing skilled nursing facility denials ninefold between 2019 and 2022. CVS and Humana use algorithms to identify cases likely to be denied, focusing on financial savings while forcing patients into premature discharges. These discharges often compromise recovery, increase caregiver burdens, and lead to worsened outcomes. For CAHs, these policies reduce swing-bed utilization, threatening a vital service line essential for post-acute recovery in rural areas. They also lead to increased emergency department visits as patients denied care often return with complications. Additionally, insurers’ denials place financial strain on CAHs, which frequently provide unreimbursed care to patients unable to safely transition to home health. Navigating appeals for denied care adds further administrative burden, straining already limited resources. Swing-bed programs are lifelines for rural communities with limited healthcare options. Denials of post-acute care jeopardize health outcomes, increase hospital readmissions, and erode community trust in local healthcare systems. Policymakers must address these practices to ensure rural hospitals can continue providing the recovery care their communities need. Together, we can advocate for fairer policies and protect access to care for rural patients. #RuralHealth #CriticalAccessHospitals #SwingBedAdvocacy

Prior authorization improvements will be motivated by CMS mandated improvements and ONC information sharing requirements on providers and payers and there is no time to lose in improving the collaboration of providers and payers. Better collaboration among providers and payers can reduce unneeded denials and appeals resulting from inadequate and delayed sharing of payer requirements and provider documentation. Better information sharing earlier in patient episodes will also improve transitions in care, outcomes, and unneeded denials. Actual improvements sought by measuring approvals, denials, appeals beginning next year (to report in 2026) will only happen by motivation to collaborate more than comply. Patients depend on this today, no time to lose! https://lnkd.in/e4Z-jfPQ

While the hospice carve-in from VBID is coming to an end, hospice and value-based care's (VBC) relationship is not ending at all. Hospices will still need to understand their data to prove their value to VBC entities such as Medicare Advantage (MA) plans, MSSP ACO groups, and ACO REACH groups. Check out this article on what hospices can do to make themselves valuable partners in VBC! https://okt.to/8zL2S9

CMS has defined a Universal Foundation of quality measures to ensure ongoing alignment across multiple healthcare quality programs and to advance the National Quality Strategy. The Universal Foundation is prominently mentioned in the 2025 CMS Call Letter for Medicare Advantage Plans. Approximately 70% of the preliminary measures are Healthcare Effectiveness Data and Information Set (HEDIS) measures. Amy Salls explains the program and implications for healthcare plans in her blog: https://lnkd.in/e-rGEky3