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A proposal to remove hospice providers from a state review poses a threat to patient care

A proposal to remove hospice providers from a state review poses a threat to patient care

Boston Globe16-05-2025
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The CON process isn't one of the flashier, public-facing functions of state government, but it has a direct impact on the quality of health and hospice care that Rhode Islanders receive throughout their lives.
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The CON process is used to determine the need for a particular health care service and to ensure that providers entering Rhode Island are prepared and equipped to provide the highest quality, most ethical care before receiving a license.
Exempting hospice from meeting the rigorous standards that a CON requires poses an immediate threat to the quality of patient care.
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In fact, extensive
In the last decade, profit-driven private equity firms have spent more than
Recently, based on increased reports of hospice fraud, waste and abuse, the Centers for Medicare and Medicaid Services (CMS) announced
All of this is a warning for Rhode Island. To roll back Certificate of Need requirements for hospice providers exposes vulnerable Rhode Islanders to the whims of anonymous, for-profit operators who put profit first, and patient care a distant second. Research has demonstrated that states with CON requirements have much higher quality of hospice care.
When we opened in 1976, HopeHealth was only the second hospice in the United States. As the leader of this nonprofit organization, I can tell you that this work is not about maximizing profits. It's a calling.
On behalf of our patients, their families, and our employees, we strongly urge the General Assembly not to weaken Rhode Island's Certificate of Need process. Instead, we should recommit to maintaining the high-quality hospice system that provides a level of care that Rhode Islanders have come to expect — and deserve — from their hospice providers by keeping hospice in CON.
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Diana Franchitto is the president and CEO of HopeHealth Hospice & Palliative Care.
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Care Without Distance: Rural Health's Leap Into The Digital Age
Care Without Distance: Rural Health's Leap Into The Digital Age

Forbes

time7 hours ago

  • Forbes

Care Without Distance: Rural Health's Leap Into The Digital Age

The rising cost of delivering care to rural Americans is only one part of the story. What matters most to patients, and to those of us who have spent our careers caring for them, is getting care when and where it's needed, in the most convenient (and yes, affordable) way possible. When I was practicing surgery as a heart specialist, many of my patients came from small towns. They were referred from rural clinics that were doing their best, often without resources or specialist support. I saw firsthand how delays in diagnosis or distance from care could change the course of an illness. These experiences stay with me. They are part of why I believe so strongly that we can and must build a better, more connected system for rural America. This moment in time, I believe, brings both hope and genuine opportunity. With the right strategy and newly available technologies, we can deliver care that is closer to home, more consistent, and more personal. Daily advances in artificial intelligence (AI), digital health, and virtual care are opening the doors to revolutionary new ways to connect patients to care. These methods are already transforming delivery in other parts of the country and the world. In July 2025, Congress passed the One Big Beautiful Bill Act which includes the Rural Health Transformation Program, an innovative $50 billion federal initiative to support rural communities to be disproportionately impacted by the Act's Medicaid spending cuts and other reimbursement reductions. Beginning in 2026, the Centers for Medicare & Medicaid Services (CMS) will allocate $10 billion annually through 2030 to states that submit qualifying transformation plans. These funds will support high-priority initiatives such as broadband expansion, digital infrastructure, chronic disease management, and training for the adoption of technologies such as AI and remote patient monitoring. Though limited in size and scope, the Transformation Program represents a meaningful down payment on a more modern and equitable rural health sector. It's more than a funding package; it reflects a growing recognition in Washington that transformative technology, especially AI, must play a central role in the future of rural health. In Part Two of this series, we documented the impact of rural hospital closures. But we don't need to rebuild what was lost brick by brick. We can build something better: care that moves to and with the patient, not just inside a building. And rural communities, with their strong culture of self-reliance, adaptability, resilience, and strong local ties, are uniquely positioned to benefit from and potentially lead this transformation. Barriers to Access—and Why They Must Be Overcome Rural America is home to 60 million people, nearly one in five Americans. Yet these communities experience some of the worst health outcomes in the country. Chronic illnesses are more common. Life expectancy is shorter. And getting timely, high-quality care is harder than ever. On average, rural Americans live twice as far from the nearest hospital as their urban or suburban peers. That distance is growing as more rural hospitals and clinics close, many operating on razor-thin margins with aging infrastructure and too few clinicians to sustain services. As discussed in Part One, these facilities are more than care sites. They are employers, civic institutions, and sources of community trust. When one closes, the effects ripple out. A single hospital closure can lead to a 14% decline in employment in the county it served. Fewer young doctors are choosing to practice in rural communities. Medical specialists are nearly nine times more concentrated in urban areas than rural ones. The provider shortage is worsening just as demand for care, especially for chronic conditions and behavioral health, is growing. 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It will require new commitments to public-private partnerships with policy alignment and sustained investment. That's what makes the Rural Health Transformation Program so interesting. With $10 billion in federal funding each year between 2026 and 2030, the program gives states the opportunity and the incentive to build the appropriate infrastructure that rural health requires to thrive in the digital age. From Potential to Practice: How AI Is Already Advancing Rural Health Advancements in multi-modal language models, reasoning models, and voice agents are central to this innovation. Investments in frontier models and technical ingenuity of engineers are producing tools that are changing care delivery for the better. These are the building blocks for the hospitals and clinics of the future. Once the foundation is laid, rural communities are positioned to move from planning to action. Across the country AI tools are already being deployed to support patients, reduce administrative burdens, and enhance how clinicians deliver care. These tools are not theoretical. We know they work, and they are especially well-suited to the needs of rural populations, where distance and access are larger barriers to health. At Frist Cressey Ventures, we sit at the front line of technology innovation in healthcare. Through deep relationships with founders, health systems, medical groups, and independent physicians, we see the impact that AI applications are having on patient outcomes, clinician satisfaction, and operational efficiency at sites of care. For illustration purposes, here are some of what we are seeing in rural health today: AI-enabled platforms are enhancing how patients understand and manage their own health. 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In Kenya, OpenAI's partnership with primary care provider Penda Health, though in a different setting, has shown what's possible: a 16% reduction in diagnostic errors over 40,000 patient visits. This kind of augmentation won't replace local physicians. It will support and extend their reach, ensuring that rural patients, who by geography are typically more physically distant from their providers, receive the same standard of care as those in more urban centers. Governance and Guardrails: Making AI Safe, Trusted, and Transparent While the promise of AI in rural health is real, we must proceed thoughtfully. The speed of innovation cannot come at the expense of safety, patient trust, or clinical integrity. And in rural settings, where resources are stretched and IT support may be more limited, clear guardrails are essential. AI tools must be explainable. They must be tested for bias. They must work consistently across diverse populations and care settings. 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With the right technology in place, rural providers can leapfrog outdated systems and become national leaders in delivering smarter, earlier, and more personal care. Rural America has always led in farming, in military service, in faith and family. It can lead in health care, too. That's what this moment offers. Not a return to the past, but a chance to shape the future. A future defined by innovation, partnerships, connection, and Cressey Ventures, of which the author is a partner, has a minority investment in the companies marked with an asterisk above. They are for illustrative purposes only.

Dr. Oz on the future of US healthcare: 'There is a new sheriff in town'
Dr. Oz on the future of US healthcare: 'There is a new sheriff in town'

Yahoo

time9 hours ago

  • Yahoo

Dr. Oz on the future of US healthcare: 'There is a new sheriff in town'

Listen and subscribe to Decoding Retirement on Apple Podcasts, Spotify, or wherever you find your favorite podcasts. In an exclusive interview on Yahoo Finance's Decoding Retirement podcast, Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services (CMS), discussed the financial and operational challenges facing the US healthcare system. Ultimately responsible for the healthcare of 66 million Medicare beneficiaries, 78 million people enrolled in Medicaid and the Children's Health Insurance Program (CHIP), and millions more in Affordable Care Act health plans, Oz weighed in on issues ranging from new Medicaid work requirements to Medicare Advantage fraud. This embedded content is not available in your region. Medicaid work requirements The Congressional Budget Office (CBO) estimates that the One Big Beautiful Bill Act (OBBBA) could reduce federal Medicaid spending by $793 billion over the next decade and lead to 10.9 million fewer enrollees by 2034. This is partially attributed to the Medicaid work requirements the OBBA will make states enforce for certain adult enrollees by Jan. 1, 2027, which generally involves 80 hours per month of work, community service, education, or work programs. The CBO estimates the requirement will decrease coverage by 5.2 million enrollees by 2034. Concerns about red tape are not hypothetical: In Georgia, where work requirements are already in place, reports show that otherwise eligible workers are losing coverage simply because of paperwork hurdles. However, Oz said that technology and digital solutions could help beneficiaries comply with the rules without losing coverage. 'We've already launched two pilots in Louisiana and Arizona with good results so far,' Oz said. The new digital process, he explained, uses a smartphone app to verify work automatically through payroll providers. "The people running it are the same folks who fixed the passport system in America,' he said. 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Medicare Advantage allows enrollees to receive Part A (hospital), Part B (medical), and, when bundled, Part D (prescription drug) coverage in one plan. The program has been under a harsh spotlight. Earlier this month, UnitedHealth confirmed it is under federal investigation. And a Wall Street Journal story detailed how some Medicare Advantage providers allegedly exploited the system through questionable or outright fraudulent billing practices. 'The whole point of launching Medicare Advantage was to give seniors options," Oz said. "But in the middle of all this, if it turns out that Medicare Advantage is costing us a lot more than fee-for-service, you're violating the whole premise.' The big problem is 'upcoding," the practice of inflating the severity of patients' conditions to trigger higher government payments. 'In Medicare Advantage, I do think that there's been an ability for the private companies to game the coding system,' Oz said. 'Instead of just saying, 'I got what I got, I'm going to take care of them and be honest about how sick they are,' they expertly devised tactics to upcode to pretend the patients were sicker than they really were. That got them more money.' Oz said CMS is now taking aggressive steps to recover funds and send a message: 'We have a process called RADV that allows us to go back to the late teens and, for the first time, audit Medicare Advantage companies,' he said. 'Based on what we find, we're going to pull money back from them. We expect it will be billions and billions of dollars. But more importantly, we're sending a message to the industry: Listen, I want you to succeed. I want you to thrive, but not at the expense of the American taxpayer.' Concern about Medicare's financial future According to the 2025 OASDI Trustees Report, Medicare Part B premiums are expected to rise 11.6% in 2026 to $206.50 a month — the steepest single-year increase in nearly a decade. At the same time, the Medicare Hospital Insurance Trust Fund, which finances Part A, is projected to run dry in 2033. If Congress doesn't intervene, that insolvency would trigger an automatic 11% cut in covered hospital services. Oz called the looming Part B increase a 'major concern,' citing the surge in prescription drug prices as the primary culprit. 'But there are other things,' Oz said, 'that are in Part B as well that we believe we have control over and we could get to be more efficient.' Rather than promising immediate regulatory fixes, Oz said his agency should work directly with industry. 'A lot of this is hearing the stakeholders and then pushing back on what you've heard and then letting them actually come up with some ideas themselves,' he said. 'We've gone back to all of them and said, we need better answers. What you're doing now is making you a lot of money, and you can do that for another year or two — and then the bottom's going to fall out.' 'The … Trustees Report predicts that [Part A] is bankrupt in 2033,' Oz added. 'That's three years shorter than we thought a month ago. And in their worst-case scenario, it goes bankrupt in [2029].' For context, Medicare Part A is primarily funded through a dedicated payroll tax under the Federal Insurance Contributions Act, or FICA. The total Medicare tax rate is 2.9% of wages — typically split evenly between employee and employer. That means 1.45% is withheld from your paycheck, and your employer contributes the other 1.45% on your behalf. Navigating Medicare open enrollment As Medicare's annual open enrollment period approaches — beginning Oct. 15 for 2026 coverage — millions of beneficiaries will face one of the biggest financial decisions of the year: whether to stick with their current plan or make a change. Most Medicare beneficiaries never switch plans, even though premiums, provider networks, and drug formularies can change from year to year. 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'It's run by criminal syndicates — not small-time operators. They take advantage of people at their most vulnerable time.' Hospice fraud is insidious because it targets people making some of the most difficult decisions of their lives. Oz said, 'We are hearing horror stories about people who thought they were entering legitimate hospice and there's nothing there for them. And even worse — because you're not really sick — people are on these hospice programs for years. We're going after them in a big way.' 'There is a new sheriff in town' Oz promised a tougher stance against healthcare fraud, both foreign and domestic. 'We already have actions in several states,' he said. 'The Department of Justice is pursuing a lot of these leads. We will leave no stone unturned. There is a new sheriff in town. I promise you, if you're cheating the American people, we will come after you. And if you're doing it to hurt folks who are most vulnerable — we'll be doubly vigilant.' Beyond enforcement, Oz emphasized that better technology and patient identification are key to preventing fraud before it happens. 'You're talking about an agency with a $1.7 trillion budget,' Oz said. 'One policy memo can affect [tens of millions of Americans.] We have to get it right.' One key will be distilling the complexity of the system into actionable information for both the public and his team. 'The goal is the same as it was" on his TV show, Oz said. "Explain it so people understand it and can act on it,' he said. 'If we simplify the rules, give people clear guidance, and enforce the protections already in place, we can change outcomes for millions of Americans." Got questions about retirement? Email Robert Powell at yfpodcast@ and we'll do our best to answer it in a future episode of Decoding Retirement. Each Tuesday, retirement expert and financial educator Robert Powell gives you the tools to plan for your future on Decoding Retirement. You can find more episodes on our video hub or watch on your preferred streaming service. Sign up for the Mind Your Money newsletter Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data

What to Know About 5-Star Medicare Advantage Plans
What to Know About 5-Star Medicare Advantage Plans

Health Line

time3 days ago

  • Health Line

What to Know About 5-Star Medicare Advantage Plans

Star ratings can offer useful insight into how Medicare Advantage plans perform across various metrics. Earning an overall rating of 5 stars is rare and indicates superior quality, according to the Medicare rating system. Medicare Advantage (Part C) plans are coverage options offered by Medicare-approved private insurance companies. These plans are alternatives to Original Medicare that include additional benefits, such as vision, dental, and hearing care, and prescription drug coverage. Since there are many different plan options from a range of insurance carriers, the Centers for Medicare & Medicaid Services (CMS) developed a rating system that aims to help buyers understand the quality of a potential plan before they enroll. Five stars is the highest score a plan can earn. In this article, we list the 5-star plans for 2025 and discuss how the rating system works. 5-star Medicare Advantage plans in 2025 If a plan earns 5 stars, the CMS considers it to be 'excellent.' The list below includes the health plans (and their parent organizations) that earned overall ratings of 5 stars in 2025: Highmark Choice Company (Highmark Health) Leon Health, Inc. (LMC Family Holdings, LLC) Network Health Insurance Corporation (Network Health, Inc.) Alignment Health Plan of North Carolina, Inc. (Alignment Healthcare USA, LLC) HealthSun Health Plans, Inc. (Elevance Health, Inc.) MCS Advantage, Inc. (MHH Healthcare, L.P.) Optimum Healthcare, Inc. (Elevance Health, Inc.) These seven health plans represent roughly 1% of all Medicare Advantage plans offered across the United States. Medicare Advantage plans are offered regionally and typically have area-based networks of healthcare professionals, hospitals, and care facilities. Thus, not everyone will have access to a 5-star Medicare Advantage plan. The plans previously mentioned are only available in the following states: Florida North Carolina Nevada Pennsylvania Wisconsin How the ratings work Every October, prior to the start of the Medicare open enrollment period, the CMS releases its star ratings for Medicare Advantage and Part D drug plans for the coming year. Medicare open enrollment runs from October 15 through December 7. The CMS assesses plans on 30 or 42 independent quality and performance measures, depending on whether the plan includes drug coverage. It bases its ratings on data it collects from the health plans themselves, CMS contractors, CMS administrators, and member surveys. Measures include elements such as: health screening and vaccination rates management of conditions such as diabetes and heart disease member satisfaction efficiency of appeals processing These measures are grouped into five categories, with each plan receiving its own star rating in each category: Staying Healthy: Screening, Tests, and Vaccines Managing Chronic (Long-Term) Conditions Member Experience with Health Plan Member Complaints and Changes in the Health Plan's Performance Health Plan Customer Service The CMS has a coverage finder tool that you can use to compare Medicare Advantage plans in your area. The initial search results page will show the overall rating of every plan listed. When you click through to see further details on an individual plan, you can view a breakdown of the plan's star ratings across the various metrics that contribute to the overall rating. How to use star ratings If a Medicare Advantage plan has a 5-star rating, you can expect it to deliver superior quality service. However, the most important thing to consider when shopping for a Medicare Advantage plan is defining your personal needs. While a plan's star rating can be a useful point of data to consider during your search, it shouldn't be the sole factor you use when making your final decision. Also, do not judge a plan solely on its overall rating. The overall rating reflects an average of the plan's performance on various unique measures. The result is a comprehensive picture of where a plan excels and where it might fall short. This granular look at plan performance can be useful for narrowing your search. For example, if a plan has low marks in an area of care or performance that you find valuable, it may suggest looking for alternatives. Summary In 2025, seven Medicare Advantage health plans received an overall rating of 5 stars. This indicates that they deliver excellent quality care and perform well in key measures assessed by the CMS. Five-star plans are rare and limited to certain geographic areas. Thus, they won't be available to all individuals. Medicare's star ratings can be a useful consideration when shopping for health insurance. However, a person should prioritize finding a plan that meets their personal needs. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

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