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,…
Survey: Physicians unprepared for MACRA
Editor's Note A survey of 1,000 physicians by the American Medical Association and KPMG finds that fewer than one in four believe they are well prepared to meet the 2017 requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), KPMG.com reported on June 28. MACRA reshapes how…
Study characterizes ED visits after total joint procedures
Editor's Note Emergency department (ED) visits after total joint procedures were numerous and mostly for pain-related diagnoses, and Medicaid patients had almost double the risk of an ED or pain-related ED visit, this study finds. Of 152,783 patients analyzed, 3.42% returned to the inpatient setting and 5.81% visited the ED…
Value-based purchasing not linked to improvements in quality
Editor's Note In this study, Medicare’s Hospital Value-Based Purchasing (HVBP) program was not associated with improvements in quality measures of clinical process or patient experience. HVBP also was not associated with a significant reduction in two of three mortality measures (ie, acute myocardial infarction or heart failure). It was associated…
Half million providers to get 2% cut in Medicare payments
Editor's Note More than 500,000 physicians and other providers will get a 2% cut in their Medicare payments because of poor performance in the Physician Quality Reporting System (PQRS), the June 13 Modern Healthcare reports. The penalties are based on 2015 claims data. Though Medicare is phasing out PQRS and…
Relationship between bariatric surgery outcomes and Medicare expenditures
Editor's Note Medicare payments for bariatric surgery are significantly lower at hospitals with low complication rates, and cost savings are most prominent in patients at highest risk for complications, this study finds. The analysis of 38,374 bariatric surgery patients found a strong correlation between complication rates and episode payments−hospitals in…
Racial disparities in surgical mortality narrowing
Editor's Note Despite concerns that quality improvement efforts may widen disparities, national racial disparities in surgical mortality are narrowing, this study finds. Using Medicare claims data from 2005 to 2014, Harvard researchers found that, overall, national mortality trends improved for both black and white patients by 0.10% and 0.07% per…
US Representatives ask Secretary Price’s assistance with ASC inflationary update measure
Editor's Note A bipartisan group of 24 US Representatives sent a letter to Department of Health and Human Services Secretary Tom Price, MD, on May 26 asking him to use his statutory authority to move ambulatory surgery centers (ASCs) from the Consumer Price Index for All Urban Consumers (CPI-U) to…
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