Tag: Reimbursement

CMS releases alert on new ICD-9, ICD-10 exclusions

Editor's Note The Centers for Medicare & Medicaid Services (CMS) released an alert May 23 on newly excluded ICD diagnosis codes that will no longer be accepted starting January 7, 2017. The codes include: T88.8XXA (Other specified complications of surgical and medical care, not elsewhere classified, initial encounter) T88.8XXD (Other…

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By: Judy Mathias
June 2, 2016
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NYC hospital downsizing in response to changes in care models

Editor's Note New York City’s (NYC’s) 825-bed Mount Sinai Beth Israel hospital will close in 4 years and be replaced by a much smaller 70-bed facility while expanding outpatient surgery, primary care, and behavioral health services, the May 25 New York Times reports. Officials blame the high cost of health…

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By: Judy Mathias
June 1, 2016
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Vulnerable hospitals and unintended consequences of the Affordable Care Act

Editor's Note Vulnerable status of hospitals is linked to higher readmission rates after major cancer surgery, this study finds. Of 355 hospitals analyzed, safety net hospitals and high Medicaid hospitals had higher 30-day, 90-day, and repeated readmissions. The findings reinforce the need to account for socioeconomic variables in risk adjustments…

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By: Judy Mathias
May 31, 2016
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Effects of Medicare bundled payments for colectomy

Editor's Note In this study from Johns Hopkins, Baltimore, payments for colectomy under Medicare’s Bundled Payments for Care Improvement Initiative were lower than a fee-for-service payment model, and the proportion of patients contributing to a net negative margin increased. Net negative margins were calculated as the difference between total hospital…

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By: Judy Mathias
May 19, 2016
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Surgery at critical access hospitals safe, less expensive

Editor's Note In this study, Medicare patients having common surgical procedures at critical access hospitals had no significant difference in 30-day mortality than those at noncritical access hospitals (5.4% vs 5.6%), and they had lower rates of serious complications (6% vs 14%) and lower expenditures ($14,450 vs $15, 845). The…

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By: Judy Mathias
May 18, 2016
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Make it your business to grow a healthy bottom line

In this challenging healthcare environment, OR leaders have a fiscal responsibility to help hospitals meet financial goals that contribute to a healthy bottom line. There is no more expensive procedure you can have in the hospital than to spend time in the OR,” says Keith Siddel, PhDc, JD, MBA, CHC.…

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By: OR Manager
May 16, 2016
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PSH Learning Collaborative gains participants in phase two

The perioperative surgical home (PSH) has been gaining momentum, with early results linking it to lower costs, better quality, fewer emergency department (ED) visits and readmissions, and shorter stays in skilled nursing facilities or none at all. In February, the PSH Learning Collaborative, a partnership between the American Society of…

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By: OR Manager
May 16, 2016
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PSH provides affordable, reliable care for adult and pediatric patients

Affordable, reliable care for adult and pediatric patients alike is the hallmark of the perioperative surgical home (PSH), as demonstrated by two organizations that are using PSH programs: a community health system and a children’s hospital. Leaders from both organizations shared their PSH journeys with OR Manager. Lower costs, shorter…

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By: OR Manager
May 16, 2016
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Public reporting measures don’t indicate hospital safety

Editor's Note Common measures used to rate hospital safety, such as the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators and the Centers for Medicare & Medicaid Services (CMS) Hospital-acquired Conditions, do not accurately capture the quality of care provided, this study finds. Only one measure out of…

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By: Judy Mathias
May 12, 2016
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VBP program rewards 231 low-quality hospitals

Editor's Note Through its Value Based Purchasing (VBP) program, the  Centers for Medicare and Medicaid Services (CMS) paid bonuses to 231 hospitals with lower quality because their patients were less expensive, this study finds. CMS began measuring both spending and quality in FY 2015 to encourage hospitals to provide more…

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By: Judy Mathias
May 5, 2016
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