When Medicare and Medicaid legislation was passed and signed into law in 1965, the US Congress formed the precursor federal agency to the Centers for Medicare & Medicaid Services (CMS) to write the rules and regulations spelling out the “Conditions of Participation” (CoPs) required to obtain federal funding under these…
Healthcare providers are straddling a variety of payment models while many regulatory changes remain in flux under the Trump Administration. Although the shift from fee-for-service to value-based payment began some years ago, not everyone is on board. Opinions about bundled payments also remain mixed, despite reports of improved outcomes and…
On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released its final rule for the 2018 Medicare Hospital Outpatient Prospective Payment System/ASC Payment System and Quality Reporting Programs. In summary, several ambulatory surgery center (ASC) measures (ASC-1 to ASC-14) are unaffected, except that three measures (ASC-5, -6,…
Editor's Note Hospitals with the largest reductions in serious complications after bariatric surgery had the greatest decrease in per-patient Medicare payments, this study finds. Analyzing 37,329 Medicare patients undergoing bariatric surgery from 2005 to 2006 and 2013 to 2014, researchers found a strong association between reductions in complications and decreased…
Editor's Note The Joint Commission on December 6 announced that revisions are continuing to be made to the Life Safety (LS) and Environment of Care (EC) chapters of its accreditation manuals. The revisions are a result of the Centers for Medicare & Medicaid Services’ adoption of the 2012 editions of…
Editor's Note The Centers for Medicare & Medicaid Services (CMS) on November 30 announced a final rule that cancels the mandatory hip fracture and cardiac bundled-payment models, which were to begin on January 1, 2018, and implements changes to the Comprehensive Care for Joint Replacement (CJR) Model. In the final…
Editor's Note The Joint Commission on November 29 announced a new software tool, “Tracers with AMPTM plus CMS,” to help hospitals and critical access hospitals manage their Joint Commission accreditation and Centers for Medicare & Medicaid Services (CMS) compliance efforts. The tool is a web-based platform that stores a hospital’s…
Editor's Note The Centers for Medicare & Medicaid Services (CMS) has issued a new requirement, effective immediately, that a hospital must have at least two active inpatients at the time of survey, or the survey/resurvey will not be allowed to continue, the Joint Commission reported November 15. The new requirement…
Peer review is a hot topic in the quality arena as many ambulatory surgery centers (ASCs) strive to create meaningful and sustainable evaluation of their providers. “As a surveyor, I can tell you peer review trips everybody up,” says Ann Geier, MS, RN, CNOR, CASC, chief nursing officer of Surgical…
Editor's Note Despite the expansion of requirements for electronic clinical quality measure (eCQM) reporting to the Centers for Medicare & Medicaid Services, an increased number of Joint Commission accredited hospitals are adopting and reporting eCQMs to drive quality improvement, the Joint Commission reports. In 2016, 470 accredited hospitals submitted eCQM…