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…
Editorial
The inaugural Bundled Payment Bootcamp on June 20 in Nashville, Tennessee, was a timely opportunity for healthcare providers to learn how reimbursement is changing the way they do business. Though the uncertain direction of US healthcare legislation continues to cause consternation, this workshop—which will be presented again in fall 2017—clarifies…
Do Medicare's latest code changes help or hurt ASCs?
Medicare is increasing approval of higher-acuity procedures performed in the ambulatory surgery center (ASC) setting, creating meaningful opportunities for ASCs. At the same time, however, a number of outpatient procedure codes have been deleted, reduced, or are packaged and considered all-inclusive in a case, without additional payment. “Key changes occurred…
Study identifies high-risk groups for readmissions
Editor's Note Comparing rates, characteristics, and costs of hospital readmissions across all ages and insurance types, researchers from Beth Israel Deaconess Medical Center, Boston, found that of more than 12.5 million patients discharged in 2013, approximately 1.8 million were readmitted within 30 days. Medicare patients accounted for 56% of readmissions,…
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