According to a 2016 McKesson report, payers expect value-based reimbursement, including bundled payments, to grow from a third of their business to a majority of it in 5 years. And as noted in Part 1 of this two-part series (OR Manager, September 2018, 1, 13-17), bundles are advancing on multiple…
We asked some top ambulatory surgery center (ASC) leaders, including members of OR Manager’s Editorial Advisory Board, to identify the top challenges ASC leaders are facing. Here are their responses. We believe you will see some of your own challenges reflected in their comments. Mary Stewart, MSN, BSN, RN…
Editor's Note Accountable care organizations (ACOs) and other value-based payment (VBP) models are increasing in the US, and there is no longer any question of whether private payers and the Centers for Medicare and Medicaid Services (CMS) will continue to support value-based payments, according to the August 14 Health Affairs…
Editor's Note Hospital participation in Medicare’s Bundled Payments for Care Improvement (BPCI) program for lower extremity joint replacement (LEJR) was not associated with changes in overall procedural volume or the majority of patient case-mix factors, this study finds. The analysis of 1,717,243 Medicare patients found hospital participation in the BPCI…
Editor's Note This interim analysis of the first year of the Comprehensive Care for Joint Replacement (CJR) bundled payment model finds that CJR may reduce institutional postacute care. Of 75 metropolitan statistical areas (MSAs) that were assigned the bundled payment model and 121 control MSAs, the mean percentage of discharges…
The Centers for Medicare & Medicaid Services (CMS) is poised to launch Bundled Payments for Care Improvement (BPCI) Advanced on October 1, 2018, and is continuing its Comprehensive Care for Joint Replacement (CJR) bundled payment model for total hip and knee arthroplasty (THA, TKA). “Orthopedics is the most important service…
The Centers for Medicare & Medicaid Services (CMS) on July 12 issued a proposed rule with potential changes to the Medicare Physician Fee Schedule on or after January 1, 2019. According to CMS, the changes would increase the time available for physicians and other clinicians to spend with their patients…
Editor's Note A new study by consultancy firm Navigant found that academic medical centers are trailing community hospitals across cost and quality measures. Among the findings: Cost per case was 5.8% higher at medical centers, equating to $3.1 million added annual operating expense per center. Cost per case disparity between high…
Editor's Note Hospitals participating in Medicare’s Comprehensive Care for Joint Replacement model or its Bundled Payments for Care Improvement initiative for lower extremity joint replacement episodes report reducing skilled nursing facility (SNF) use and improving care coordination, in this survey. Interviews of executives or administrators in each of 22 hospitals…
Editor's Note On August 2, the Centers for Medicare & Medicaid Services (CMS) finalized its Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) rule for FY 2019. The rule will empower patients and advance the White House “MyHealthData” initiative and the CMS “Patients…