Tag: Reimbursement

To avoid penalties, know the rules for quality reporting

Keeping up with Medicare’s regulatory and reporting requirements for ambulatory surgery centers (ASCs) can be as difficult as ensuring physicians arrive to start their cases on time. “Regulations can change frequently,” says Gina Throneberry, MBA, RN, CASC, CNOR, director of education and clinical affairs for the Ambulatory Surgery Center Association…

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By: OR Manager
December 17, 2019
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Hospital-based care coordination strategies linked to CMS star ratings

Editor's Note Care coordination strategies were found to be associated with high overall hospital quality star ratings from the Centers for Medicare & Medicaid Services (CMS) in this study. A total of 710 general acute care noncritical access hospitals that received star ratings and responded to the 2015 American Hospital…

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By: Judy Mathias
November 21, 2019
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2020 OR Business Management Conference around the corner

Anyone seeking a break from the winter weather and a stimulating educational experience will find both at the 2020 OR Business Management Conference (ORBMC), which takes place January 27-30 in Weston, Florida. The highly relevant and timely presentations, along with networking events that connect OR business professionals with colleagues and…

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By: Elizabeth Wood
November 18, 2019
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CMS releases 2020 final payment rule for ASCs, HOPDs

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on November 1 released its final payment rule for ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). CMS added eight codes to the ASC-payable list, including total knee arthroplasty. CMS also removed total hip arthroplasty and seven spine codes from…

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By: Judy Mathias
November 4, 2019
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Waste in US healthcare spending, potential for savings

Editor's Note This study finds that the estimated cost of waste in the US health care system ranges from $760 billion to $935 billion and accounts for some 25% of healthcare spending. Projected potential savings from interventions to reduce waste, excluding savings from administrative complexity, range from $191 billion to…

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By: Judy Mathias
October 9, 2019
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Association between social risk factors and SSIs after colectomy, abdominal hysterectomy

Editor's Note Social risk factors were inconsistently associated with surgical site infection (SSI) rates after colectomy or abdominal hysterectomy in this study. In this analysis of 149,741 patients, Medicaid status (a marker for poverty) and living in a low-income zip code were linked to higher SSI rates after colectomy. For…

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By: Judy Mathias
October 3, 2019
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CMS: New round of readmission penalties affects 2,583 hospitals

Editor's Note Data from the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) shows that Medicare cut payments to 2,583 hospitals on October 1 because of the number of patients readmitted within a month, the October 1 Kaiser Health News reports. The Centers for Medicare & Medicaid Services (CMS) estimates…

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By: Judy Mathias
October 2, 2019
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CMS considering reimbursement for coronary interventions at ASCs

Editor's Note In a proposed rule, the Centers for Medicare & Medicaid Services (CMS) is considering whether to reimburse for percutaneous coronary interventions (PCIs) at ambulatory surgical centers (ASCs), the September 20 tctMD reports. As of May 1, 2019, approximately 22 states allowed for coronary interventions to be done outside…

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By: Judy Mathias
September 24, 2019
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Effect of ‘regression to the mean’ on excess readmissions

Editor's Note Strong evidence suggests that most declines in excess readmissions--after implementation of Medicare’s Hospital Readmission Reduction Program (HRRP)--at poorly performing hospitals can be explained by a statistical phenomenon called “regression to the mean [RTM],” this study finds. In RTM, entities farther away from the mean in one period are…

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By: Judy Mathias
September 4, 2019
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Machine learning identifies preop risks linked to postop Medicare super-users

Editor's Note In this study of more than 1 million Medicare patients, 4.8% were super-users of healthcare and incurred 31.7% of Medicare expenditures after surgery. A machine learning approach identified the following as the most significant risk factors linked to super-utilization of healthcare in the year following surgery: hemiplegia/paraplegia weight…

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By: Judy Mathias
August 20, 2019
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