Tag: Reimbursement

CMS to bundle payments for CABG, expand orthopedic program

Editor's Note The Centers for Medicare & Medicaid Services (CMS) will select 98 hospitals in metropolitan areas to take part in a 5-year mandatory program to test a bundled-payment model for myocardial infarction and coronary artery bypass graft (CABG) procedures, the July 25 Modern Healthcare reports. CMS will also expand…

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By: aadeleke
July 26, 2016
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Survey reveals challenges in implementing eCQMs

Editor's Note A survey by the Joint Commission, American Hospital Association, and Federation of American Hospitals, finds that Medicare's new Hospital Inpatient Quality Reporting program requirements for electronic clinical quality measures (eCQMs) are achievable, but organizations will need to address education, process, and technology hurdles to meet the deadline of…

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By: Judy Mathias
July 20, 2016
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CMS releases OPPS, ASC proposed rule for 2017

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on July 14 published the 2017 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates proposed rule.  Among the proposals:  an increase in OPPS payment rates by 1.55%--a combination…

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By: Judy Mathias
July 13, 2016
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Study: Complexity of quality measures impeding adoption

Editor's Note Nearly three-quarters of physicians and health plan executives say quality measures are too complex, making it difficult for physicians to achieve them in a survey by Quest Diagnostics and Inovalon. Other findings include: 65% of physicians don’t have all the patient information they need 64% of physicians don’t…

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By: Judy Mathias
June 16, 2016
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Healthcare providers struggling to transition to VBP

Editor's Note Moving to information systems and data requirements of the new value-based payment (VBP) reimbursement system is proving to be a daunting challenge for healthcare providers, the June 13 Health Data Management reports. A survey of healthcare executives from 190 hospitals shows that only 3% of respondents provide more…

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By: Judy Mathias
June 14, 2016
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Reminder: July 1 is deadline to apply for 'meaningful use' hardship exception

Editor's Note Eligible hospitals, critical access hospitals, and professionals who did not achieve "meaningful use" in the Medicare Electronic Health Record Incentive Program for the 2015 reporting period have until July 1 to apply for a hardship exception from the 2017 payment adjustment.   The streamlined hardship applications reduce the…

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By: Judy Mathias
June 13, 2016
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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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