Researchers pinpoint factor that predicts unplanned readmissions
Editor's Note The widely used “LACE index,” which assesses a patient’s risk of hospital readmission, has a “blindspot” because it fails to consider whether patients are on Medicaid, West Virginia University researchers say. LACE stands for length of stay, acuity, comorbidity, and emergency department. To assess the predictive value of…
Editorial
Early in a new year, there’s a tendency to reflect on how past events might inform the future. The January issue of OR Manager looked at 2018 legislative changes and their potential impact on healthcare. In just the past few weeks, several legal and financial actions have already changed the…
Medicare’s bundled payments for joint replacements show moderate savings
Editor's Note In the first 2 years of Medicare’s Comprehensive Care for Joint Replacement (CJR) program, there was a modest reduction in spending per procedure without an increase in complication rates, this study finds. Comparing costs associated with 280,161 joint replacement procedures in 803 hospitals required to participate in the…
Editorial
A greater focus on cost cutting and improving quality of care, a rise in outpatient procedures, and increased demand for cost and quality transparency were among the major healthcare trends projected for 2018. It’s safe to say these will continue to dominate in 2019 and beyond. A year ago, all…
Advise and collect: Helping patients pay for surgery
Long gone are the days when employer-based health insurance covered most, if not all, of patients’ healthcare bills. Insurance companies and employers expect individuals to pay a larger chunk of healthcare costs themselves. The 2018 benchmark Kaiser Family Foundation (KFF) Employer Health Benefits Survey found that “a quarter (26%) of…
CMS gives states more Medicaid waiver power, and flexibility to lower premiums
Editor's Note The Centers for Medicare & Medicaid Services (CMS) on October 22 issued guidance that gives state governors more power and flexibility in overhauling the rules and regulations of their Medicaid programs imposed by the Affordable Care Act and changes the way waivers are evaluated. Under the new policy,…
Orthopedic bundled payment models on the fast track--Part 2
According to a 2016 McKesson report, payers expect value-based reimbursement, including bundled payments, to grow from a third of their business to a majority of it in 5 years. And as noted in Part 1 of this two-part series (OR Manager, September 2018, 1, 13-17), bundles are advancing on multiple…
Value-based payment models moving forward
Editor's Note Accountable care organizations (ACOs) and other value-based payment (VBP) models are increasing in the US, and there is no longer any question of whether private payers and the Centers for Medicare and Medicaid Services (CMS) will continue to support value-based payments, according to the August 14 Health Affairs…
Editorial
The Centers for Medicare & Medicaid Services (CMS) on July 12 issued a proposed rule with potential changes to the Medicare Physician Fee Schedule on or after January 1, 2019. According to CMS, the changes would increase the time available for physicians and other clinicians to spend with their patients…
US House votes to kill medical device tax
Editor's Note A bill that would repeal the medical device tax cleared the House of Representatives on July 24 in a 283-132 vote. the July 24 The Hill reports. The tax provided part of the funding for the Affordable Care Act. Rep Erik Paulsen (R-Minn), the bill sponsor, says the…
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