Access to COVID-19 testing by individuals with housing insecurity during the early days of the COVID-19 pandemic in the United States: a scoping review.

Introduction: The COVID-19 pandemic focused attention on healthcare disparities and inequities faced by individuals within marginalized and structurally disadvantaged groups in the United States. These individuals bore the heaviest burden across this pandemic as they faced increased risk of infection and difficulty in accessing testing and medical care. Individuals experiencing housing insecurity are a particularly vulnerable population given the additional barriers they face.

Strategies to expand the distribution of nursing talent in the United States.

This panel paper is the third installment in a six-part Nursing Outlook special edition based on the 2022 Emory Business Case for Nursing Summit. The 2022 summit was led by Emory School of Nursing in partnership with Emory School of Business. It convened national nursing, health care, and business leaders to explore possible solutions to nursing workforce crises, including the nursing shortage.

Cost-Effectiveness of a Homeless Care Transition Program: Durham Homeless Care Transitions.

Transitional care and medical respite programs provide assistance to people experiencing homelessness as they move from acute care into community settings. These programs can address issues that may fall outside the reach of traditional medical care yet have a profound impact on the health of vulnerable populations. This article focuses on the cost-effectiveness of the Durham Homeless Care Transitions (DHCT) program.

The Cost-Effectiveness of Palliative Care: Insights from the PAL-HF Trial.

Background: In a randomized control trial, Palliative Care in Heart Failure (PAL-HF) improved heart failure-related quality of life, though cost-effectiveness remains unknown. The aim of this study was to evaluate the cost-effectiveness of the PAL-HF trial, which provided outpatient palliative care to patients with advanced heart failure.

Methods And Results: Outcomes for usual care and PAL-HF strategies were compared using a Markov cohort model over 36 months from a payer perspective.

Selection Bias in Observational Studies of Palliative Care: Lessons Learned.

Context: Palliative care (PC) programs are typically evaluated using observational data, raising concerns about selection bias.

Objectives: To quantify selection bias because of observed and unobserved characteristics in a PC demonstration program.

Methods: Program administrative data and 100% Medicare claims data in two states and a 20% sample in eight states (2013-2017).

Associations of Patient Characteristics and Care Setting with Complexity of Specialty Palliative Care Visits.

Information routinely collected during a palliative care consultation request may help predict the level of complexity of that patient encounter. We examined whether patient and consultation characteristics, as captured in consultation requests, are associated with the number of unmet palliative care needs that emerge during consultation, as an indicator of complexity. We performed a retrospective cohort analysis of palliative care consultations.

Use of Hospital Referral Regions in Evaluating End-of-Life Care.

Hospital referral regions (HRRs) are often used to characterize inpatient referral patterns, but it is unknown how well these geographic regions are aligned with variation in Medicare-financed hospice care, which is largely provided at home. Our objective was to characterize the variability in hospice use rates among elderly Medicare decedents by HRR and county. Using 2014 Master Beneficiary File for decedents 65 and older from North and South Carolina, we applied Bayesian mixed models to quantify variation in hospice use rates explained by HRR fixed effects, county random effects, and residual error among Medicare decedents.

Paying for Palliative Care in Medicare: Evidence From the Four Seasons/Duke CMMI Demonstration.

Context: Palliative care improves patient and family outcomes and may reduce the cost of care, but this service is underutilized among Medicare beneficiaries.

Objectives: To describe enrollment patterns and outcomes associated with the Center for Medicare and Medicaid Innovation expansion of a multisetting community palliative care program in North and South Carolina.

Methods: This observational study characterizes the Center for Medicare and Medicaid Innovation cohort's care and cost trajectories after enrollment.

Hospice Use Among Patients with Heart Failure.

Despite its many benefits, hospice care is underused for patients with heart failure. This paper discusses the factors contributing to this underuse and offers recommendations to optimise use for patients with heart failure and proposes metrics to optimise quality of hospice care for this patient group.

Medicare Shared Savings ACOs and Hospice Care for Ischemic Stroke Patients.

Objectives: Palliative care services have the potential to improve the quality of end-of-life care and reduce cost. Services such as the Medicare hospice benefit, however, are often underutilized among stroke patients with a poor prognosis. We tested the hypothesis that the Medicare Shared Savings Program (MSSP) is associated with increased hospice enrollment and inpatient comfort measures only among incident ischemic stroke patients with a high mortality risk.

Patient, Caregiver, and Taxpayer Knowledge of Palliative Care and Views on a Model of Community-Based Palliative Care.

Context: Palliative care (PC) model delivered by two large hospices and PC providers.

Objectives: To understand study participants' knowledge of PC and acceptability of a new community-based PC model.

Methods: Semistructured interview with patients and caregivers; focus groups with taxpayers.

Predicting Length of Hospice Stay: An Application of Quantile Regression.

Background: Use of the Medicare hospice benefit has been associated with high-quality care at the end of life, and hospice length of use in particular has been used as a proxy for appropriate timing of hospice enrollment. Quantile regression has been underutilized as an alternative tool to model distributional changes in hospice length of use and hospice payments outside of the mean.

Objective: To test for heterogeneity in the relationship between patient characteristics and hospice outcomes across the distribution of hospice days.

Will Changes to Medicare Payment Rates Alter Hospice's Cost-Saving Ability?

Background: On January 1, 2016, Medicare implemented a new "two-tiered" model for hospice services, with per diem rates increased for days 1 through 60, decreased for days 61 and greater, and service intensity add-on payments made retrospectively for the last seven days of life.

Objective: To estimate whether the Medicare hospice benefit's potential for cost savings will change as a result of the January 2016 change in payment structure.

Design: Analysis of decedents' claims records using propensity score matching, logistic regression, and sensitivity analysis.

Do Live Discharge Rates Increase as Hospices Approach Their Medicare Aggregate Payment Caps?

Context: The rate of live discharge from hospice and the proportion of hospices exceeding their aggregate caps have both increased for the last 15 years, becoming a source of federal scrutiny. The cap restricts aggregate payments hospices receive from Medicare during a 12-month period. The risk of repayment and the manner in which the cap is calculated may incentivize hospices coming close to their cap ceilings to discharge existing patients before the end of the cap year.

Standardization and Scaling of a Community-Based Palliative Care Model.

Background: Although limited, the descriptions of Community-Based Palliative Care (CBPC) demonstrates variability in team structures, eligibility, and standardization across care settings.

Objective: In 2014, Four Seasons Compassion for Life, a nonprofit hospice and palliative care (PC) organization in Western North Carolina (WNC), was awarded a Centers for Medicare and Medicaid Services Health Care Innovation (CMMI) Award to expand upon their existing innovative model to implement, evaluate, and demonstrate CBPC in the United States. The objective of this article is to describe the processes and challenges of scaling and standardizing the CBPC model.

One Size Does Not Fit All: Disease Profiles of Serious Illness Patients Receiving Specialty Palliative Care.

Introduction: Understanding the symptom profiles of seriously ill patients who receive palliative care, especially noncancer diagnoses where the data are sparse and are critical to better targeting our resources to the needs of patients.

Methods: We performed a retrospective, multicohort study of patients evaluated during their first consultative palliative care visit in a community-based palliative care registry. We placed into one of seven major disease categories based on clinician-reported primary diagnosis for consultation.

Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial.

Background: Advanced heart failure (HF) is characterized by high morbidity and mortality. Conventional therapy may not sufficiently reduce patient suffering and maximize quality of life.

Objectives: The authors investigated whether an interdisciplinary palliative care intervention in addition to evidence-based HF care improves certain outcomes.

A Positive Association Between Hospice Profit Margin And The Rate At Which Patients Are Discharged Before Death.

Hospice care is designed to support patients and families through the final phase of illness and death. Yet for more than a decade, hospices have steadily increased the rate at which they discharge patients before death-a practice known as "live discharge." Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices' desire to maximize profits drives them to inappropriately discharge patients.

Advance care planning in Medicare: an early look at the impact of new reimbursement on billing and clinical practice.

Objective: In this study, we examined the US Medicare programme's (government-funded social insurance for the elderly or disabled) new reimbursement for advance care planning (ACP) that began on 1 January 2016. This single-centre study addressed whether clinicians who have ACP conversations with patients will use the new reimbursement code and if the new reimbursement is successful at motivating clinicians to have more ACP conversations with patients.

Methods: This is a multimethod study.