Effect of Medicare ACOs on spending for inpatient surgery
Editor's Note Though Medicare Accountable Care Organizations (ACOs) have had some success in reducing spending for medical care, they have not had similar success with surgical spending, this study finds. Of 341,675 patients at 427 ACO hospitals and 1,024,090 patients at 1,531 non-ACO hospitals analyzed, average baseline payments were similar…
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…
2019 Medicare final payment rule brings big wins for ASCs
The holiday spirit got off to a good start at ambulatory surgery centers (ASCs) across the country with the November 2, 2018, announcement of the Centers for Medicare & Medicaid Services’ (CMS) 2019 Ambulatory Surgical Center Payment System and Quality Reporting (ASCQR) Program Final Rule. Several significant changes ASCs had…
Reduced readmissions credited to HRRP overstated
Editor's Note Medicare’s Hospital Readmissions Reduction Program (HRRP), which penalizes readmissions for several targeted conditions, has been credited with lowering readmission rates; however, these reductions now appear to be overstated, this study finds. A concurrent change in electronic transaction standards that increased diagnostic coding allowed hospitals to document a larger…
CMS underpaid hospitals by $76.8 billion in 2017
Editor's Note The Centers for Medicare & Medicaid Services (CMS) underpaid hospitals by $76.8 billion in 2017, according to data from the American Hospital Association’s Annual Survey of Hospitals. Medicare underpayments totaled $53.9 billion, and Medicaid underpayments were $22.9 billion. Hospitals also provided $38.4 billion in uncompensated care, the January…
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…
Most hospitals will get increased Medicare payments in 2019
Editor's Note The Centers for Medicare & Medicaid Services announced December 3 that more than 1,550 hospitals will share $1.9 billion in bonus payments under the Hospital Value-Based Purchasing Program for FY 2019. Though it is a slight decline from FY 2018, average performance scores were higher at 38.1%, compared…
CMS: New online tool compares cost differences for outpatient procedures
Editor's Note The Centers for Medicare & Medicaid Services (CMS) on November 27 launched a new online tool that compares Medicare payments and co-payments for certain outpatient surgical procedures performed in hospitals and ambulatory surgery centers. The “Procedure Price Lookup” tool will help Medicare patients consider potential cost differences when…
Reliability of measuring surgeon spending for MIPS
Editor's Note The Centers for Medicare & Medicaid Services should measure surgeon spending at a group level or incorporate multiple years of data to reduce misclassification of surgeon performance in its Merit-based Incentive Payment System (MIPS) program, this study finds. University of Michigan researchers found that annual cost-profiles of individual…
93% of eligible clinicians received MIPS payment under QPP last year
Editor's Note New data from the Centers for Medicare & Medicaid Services (CMS) shows that 93% of eligible clinicians who participated in the Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP) received positive payment adjustments for their performance last year, the November 9 EHR Intelligence reports. Only…
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