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…
Success in efforts to prevent HAPUs may depend on data sources
Editor's Note Transitioning from administrative data to chart-based surveillance review to measure hospital-acquired pressure ulcers (HAPUs) and accounting for HAPU severity could improve the validity of measures for assessing the clinical and financial impact of value-based purchasing interventions, this study finds. Assessing HAPU incidence, severity, and trends using administrative data…
Early action advised to achieve better OAS CAHPS responses
Mandatory implementation of the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) originally scheduled for 2018 has been delayed, but that does not mean it should be ignored, say ambulatory surgery center (ASC) leaders. The earliest projected date when the survey could become mandatory…
CMS: 1,299 providers join new bundled payment initiative
Editor's Note The Centers for Medicare & Medicaid Services (CMS) on October 9 announced that 1,299 healthcare providers are participating in its new Bundled Payments for Care Improvement−Advanced model, which began October 1 and will continue until December 31, 2023. The program includes 32 bundled clinical episodes (29 inpatient, 3…
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