HHS lowers maximum penalties for HIPAA violations
Editor's Note The Department of Health and Human Services (HHS) on April 26 announced it is lowering the maximum civil penalty for healthcare providers, health plans, and business associates who violate the Health Insurance Portability and Accountability Act (HIPPA), based on the level of culpability. A 2013 rule created four…
Study: CMS policy changes cut readmission fines
Editor's Note The Centers for Medicare & Medicaid Services (CMS) recent changes to its Hospital Readmission Reduction Program resulted in a drop in readmission fines for academic, safety-net, and rural hospitals, this study finds. This analysis of 3,049 hospitals found that because of policy changes that now separate hospitals into…
Accuracy of surgical procedure valuations in Medicare’s Fee Schedule
Editor's Note The Center’s for Medicare and Medicaid Services (CMS) is legally responsible for setting and updating the work element of its relative value units (RVUs), which form the Medicare Physician Fee Schedule used to determine physician payments. In practice, however, updating what is known as the “work RVU” is…
Non-opioid pain management gaining favor in ASCs
Pressure to contain opioid overuse in the United States is at a boiling point. The Centers for Disease Control and Prevention reports that overdose deaths linked to opioid prescriptions have increased fivefold over the last two decades. To reduce reliance on opioid prescriptions, the Centers for Medicare & Medicaid Services…
ASCs react to 2019 regulatory changes
Each year, ambulatory surgery centers (ASCs) adapt to numerous federal regulatory policy reforms. As an example, since 2012, when the Centers for Medicare & Medicaid Services (CMS) launched the Ambulatory Surgery Center Quality Reporting (ASCQR) Program ASCs had been asking for, ASCs have reported data for a changing set of…
Government payment policies linked to hospital performance fail to improve CAUTI rates
Editor's Note This study found no evidence that value-based incentive programs (VBIPs), which link financial incentives or penalties to hospital performance, had any measurable association with changes in catheter-associated urinary tract infection (CAUTI) rates. Researchers at Boston University School of Medicine analyzed 592 hospitals across the country, and found that…
Use of ‘hot spotting’ to identify high-cost surgery patients
Editor's Note Because a subset of patients are responsible for a disproportionate share of Medicare spending, targeting high-cost patients (ie, “hot spotting”) for cost containment efforts would be an effective strategy to reduce costs in surgical patients, this study finds. Using Medicare claims data from 2010 to 2013, University of…
Effect of Medicare ACOs on spending for inpatient surgery
Editor's Note Though Medicare Accountable Care Organizations (ACOs) have had some success in reducing spending for medical care, they have not had similar success with surgical spending, this study finds. Of 341,675 patients at 427 ACO hospitals and 1,024,090 patients at 1,531 non-ACO hospitals analyzed, average baseline payments were similar…
Editorial
Early in a new year, there’s a tendency to reflect on how past events might inform the future. The January issue of OR Manager looked at 2018 legislative changes and their potential impact on healthcare. In just the past few weeks, several legal and financial actions have already changed the…
2019 Medicare final payment rule brings big wins for ASCs
The holiday spirit got off to a good start at ambulatory surgery centers (ASCs) across the country with the November 2, 2018, announcement of the Centers for Medicare & Medicaid Services’ (CMS) 2019 Ambulatory Surgical Center Payment System and Quality Reporting (ASCQR) Program Final Rule. Several significant changes ASCs had…
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