Hospitals still using chargemaster markups to improve revenue
Editor's Note Since Medicare adopted its prospective payment system in 1985, many hospital executives and economists have suggested that the hospital chargemaster (list of prices for all hospital procedures and supplies) is irrelevant. However, in this study, researchers found that hospitals are systematically adjusting their charge-to-cost ratios (ie, chargemaster price…
CJR bundled payments may penalize hospitals that treat elderly, sickest patients
Editor's Note Hospitals that care for the oldest, sickest, and most complicated patients could suffer financially under Medicare’s Comprehensive Care for Joint Replacement (CJR) bundled payment program, this study finds. The study analyzed data from more than 23,000 Michigan patients who had hip or knee replacements at 60 hospitals in a…
CMS releases payment adjustments for 2017 EHR incentives
Editor's Note The Centers for Medicare & Medicaid Services (CMS) has announced that starting October 1, 2016, hospitals that are still not meaningful users of electronic health records (EHRs) will be subjected to a reduced increase in their Inpatient Prospective Payment System rate, the September 2 Healthcare IT News reports.…
Advisory panel recommends CMS remove total knees from inpatient-only list
Editor's Note The Advisory Panel on Hospital Outpatient Payment (HOP) on August 22 unanimously recommended that the Centers for Medicare & Medicaid Services (CMS) remove total knees from its inpatient-only list, the Ambulatory Surgery Center Association (ASCA) reports. CMS is requesting information on the feasibility of removing total knees from…
CMS: ICD-10 grace period ends October 1
Editor's Note The Centers for Medicare and Medicaid Services (CMS) on August 18 announced in its FAQ guidelines that the 1-year grace period for claims using the ICD-10 code set will end October 1. Healthcare organizations will be required to use the correct degree of specificity when coding claims. Unspecified…
Impact of race/ethnicity, socioeconomic status on readmission rates after total joints
Editor's Note The addition of race/ethnicity and socioeconomic status to the risk-adjusted algorithm for readmissions after total hips and knees used by the Centers for Medicare & Medicaid Services led to a relative-performance change in readmission rates of <3% of 1,194 hospitals in this study. Policy makers and payers should…
Hospital cost of surgery-related pressure ulcers
Editor's Note This study found that hospital-acquired pressure ulcers add 44% to the cost of major surgical hospital stays, but the amount varies depending on length of stay. Using data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011…
Medicare Advantage pays hospitals 8% less than traditional Medicare
Editor's Note Medicare Advantage plans paid hospitals 8% less for hospital services than fee-for-service Medicare in 2009 and 2012, finds this study. Researchers also found that commercial insurers paid hospitals much higher than Medicare Advantage or fee-for-service Medicare. Some of this difference is because of higher prices commercial plans pay…
Physician-owned surgical hospitals performed better in VBP program
Editor's Note Medicare’s value-based purchasing (VBP) program revealed superior performance associated with physician owned surgical hospitals in this study. Researchers analyzed 3,089 hospitals that included physician-owned surgical, University HealthSystem Consortium, US News & World Report Honor Roll, Kaiser Permanente, and Accountable Care Organization hospitals. Estimated mean total performance scores were…
Help decode ICD-10 for prompt reimbursement
Despite warnings of calamities, implementation of the International Classification of Diseases (ICD)-10 on October 1, 2015, proceeded smoothly, with minimal impact on denied claims. In the fourth quarter of 2015, the percentage of Medicare claims denied was 10%, comparable to the preimplementation figure of 9.9%. But that doesn’t mean OR…
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