CMO of Hospice of the Western Reserve. Associate Professor of Medicine @CWRU. Previously @ClevelandClinic & @ClevelandVAMC. Opinions here are my own.
Cleveland, Ohio
Joined January 2009
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1/ The rules that govern hospice care haven't had a major rewrite in 20 years. CMS is starting now, and it wants to hear from families and frontline staff first. #HospiceCare hospicenews.com/2026/09/25/c…
2/ Listening sessions: Oct 6 (hospice leaders), Oct 7 (nurses, aides, social workers, chaplains), Oct 14 (caregivers and families).
3/ If you've walked this road with someone you love, your voice matters most. Good rules protect patients and reward hospices that truly show up. Register and speak up. #PalliativeCare
1/ No doctor can tell you exactly when someone will die. We can tell you a lot, but a six-month prognosis is a judgment made under real uncertainty. A federal appeals court just acknowledged that out loud. mcknightshomecare.com/news/h…
3/ But read the whole opinion. The court still upheld the underlying denials. Documentation matters. Oversight matters. This is not cover for bad actors, it's protection for honest clinical judgment. Those aren't in tension.
4/ About 1 in 5 hospice patients is discharged alive. That's not failure, that's what uncertainty looks like. The real cost of second-guessing is families who get referred too late, or never. #HospiceCare #PalliativeCare
1/ CMS finalized the FY 2027 hospice rule. The rule publishes a Service and Spending Variation Index score for every Medicare-certified hospice in the country. I support measurement and oversight. The question is how this index is constructed.
2/ Part of the score reflects Medicare spending outside the hospice benefit — care hospices often can't see or direct. If that's scored on total spending rather than adjusted for patient days, size alone moves the number.
3/ That's a measurement problem, not a quality signal. Worth getting right before families rely on it. Accountability and accurate measurement are compatible goals. #HospiceCare #HealthPolicy
No one in their final months of life should have to log 80 work hours to keep their health coverage. But Medicaid's new work rules (Jan 2027) exempt caregivers and some conditions — not hospice or palliative patients by name. A fixable gap. Let's fix it! #HospiceCare
hospicenews.com/2026/07/24/h…
A California hospice fraud case in the news today: patients were signed up for care they never knew about — then denied hospice when they truly needed it. That's not a billing story. It's a betrayal of trust. Accountability doesn't threaten hospice — it protects it. #HospiceCare hospicenews.com/2026/07/17/c…
250 years ago, this country was founded on an idea: that every person is owed dignity. I’ve seen that promise kept at the bedside — Veterans and families honored with comfort in their final chapter. Grateful today for the teams who make it real. Happy #July4th #HospiceCare
1/ A nurse practitioner has been charged with billing Medicare $900M+ for wound treatments terminally ill hospice patients never needed. If proven, it's a betrayal of people who came to us for comfort at the end of life.
msn.com/en-us/crime/general/…
2/ I don't read stories like this and get defensive. I get clear. The vast majority of hospice clinicians would be sickened by it — because it's the opposite of why they do this work.
3/ Fraud steals public dollars and something harder to rebuild: a family's trust to call hospice at all. Strong oversight isn't a threat to good providers. It protects them. #HospiceCare #PalliativeCare
1/ Today we opened the doors of our new Reserve Care East Care Center — and moved every patient safely into it. New rooms, new space, same promise to the families who count on us. 🤍
2/ Here’s what made today matter to me: most hospices right now aren’t opening new units. This is a statement about who we want to be for this community😊
Expert, compassionate care close to home is something every community deserves. We are endlessly proud of our team for this huge and important undertaking and grateful to be able to serve our community #HospiceCare #PalliativeCare
1/ A new government report has reopened the debate on how Medicare pays for hospice. Modernizing the benefit is overdue — but we have to get it right.
2/ The risk: treating hospice as a list of individual billable visits. That's not how this care works. Families in their hardest days are held by a team — nurse, chaplain, social worker, physician — moving together.
3/ Real reform should lower the cap on bad actors and reward the mission-driven providers caring for the sickest patients. Modernize the benefit. Don't dismantle what makes hospice work. #HospiceCare #PalliativeCare nphihealth.org/nphi-calls-fo…
