Payment variation in CABG episodes of care can affect bundled payments
Editor's Note Wide variation was found in 90-day coronary artery bypass grafting (CABG) episode payments for Medicare and private payer patients in this study. The differences were driven by increased use of evaluation and management services, higher utilization of inpatient rehabilitation, and patients with multiple readmissions. In the analysis of…
More than 800 ICD-10 code changes coming
Editor's Note ChartLogic (Salt Lake City) is reporting that as of August 9, 2017, a total of 419 ICD-10 codes were added, 273 codes were revised, and 123 codes were being deleted, according to the August 15 Becker’s Hospital CFO Report. The changes are slated for implementation on October 1,…
CMS proposes canceling two bundled payment models, scaling back a third
Editor's Note The Centers for Medicare & Medicaid Services (CMS) on August 15 announced a proposed rule that would cancel two bundled-payment models and reduce the number of providers required to participate in a third. The proposed rule would cancel the Episode Payment Models and the Cardiac Rehabilitation incentive payment…
Purpose of CMS readmission program questioned
Editor's Note The Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program has only seen a drop in readmissions by 0.1% from 2013 to mid-2016, which has industry experts and hospital leaders questioning its purpose, the August 12 Modern Healthcare reports. The Affordable Care Act mandated program, which…
Hospitals partnering with ASCs to perform outpatient total joints
Editor's Note With the growth of ambulatory surgeries and the shift to Medicare reimbursement for outpatient hip and knee replacements, hospitals are acquiring and forming joint ventures with ambulatory surgery centers (ASCs), the August 5 Modern Healthcare reports. This allows hospitals to keep part of the revenue and better aligns…
CMS push to value-based care leading to more burnout
Editor's Note The push by the Centers for Medicare & Medicaid Services (CMS) to transform healthcare delivery at community health centers to value-based care is increasing staff dissatisfaction and burnout, this study finds. From 2013 to 2014, clinicians and staff at 296 centers reported statistically significant declines in multiple measures…
CMS releases FY 2018 inpatient PPS final rule
Editor's Note The Centers for Medicare and Medicaid Services (CMS) on August 2 issued the FY 2018 Medicare Inpatient Prospective Payment System final rule, which updates Medicare payment and policies when patients are discharged from hospitals. The rule increases rates by 1.2%. This includes an initial market-basket update of 2.7%…
AHRQ: Cost trends for inpatient stays
Editor's Note From 2005 to 2014, the average inflation-adjusted cost of a hospital inpatient stay increased by 12.7%, from $9,500 to $10,900, according to new statistics from the Agency for Healthcare Research and Quality (AHRQ). Average costs for stays increased: 16% for Medicaid 18% for private insurance 8% for Medicare…
CMS issues 2018 OPPS/ASC proposed payment rule
Editor's Note The Centers for Medicare & Medicaid Services (CMS) on July 13 issued the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. CMS is proposing an update of 1.9% for ASCs, which is a combination of a 2.3% inflation update…
CMS proposes paying for outpatient total joints
Editor's Note The Centers for Medicare & Medicaid Services on July 13 issued a proposed rule that updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System. Among the proposals are that Medicare pay for knee replacement procedures performed in outpatient…
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