Study: Hospital readmissions sometimes save lives
Editor's Note Analyzing data on nearly 4,500 acute-care facilities, Johns Hopkins researchers found that the hospitals with the highest rates of readmissions were more likely to show better mortality scores. Data on mortality and hospital readmissions used by the Centers for Medicare & Medicaid Services (CMS) sometime fail to tell…
Factors linked to pediatric surgical readmissions
Editor's Note Patient and hospital factors were associated with readmissions after pediatric surgical procedures in this study. Factors associated with readmissions included: patients with an emergency department visit within about 1 year before surgery American Society of Anesthesiologists Class IV or greater Hispanic ethnicity late-day or holiday/weekend discharges. Most factors…
FDA expands indication for two transcatheter aortic valves
Editor's Note The Food and Drug Administration (FDA) on August 18 approved an expanded indication for the Sapien XT and Sapien 3 transcatheter heart valves for patients with aortic stenosis. The new indication is for patients who are at intermediate risk for death or complications associated with open-heart surgery. Previously,…
Advisory panel recommends CMS remove total knees from inpatient-only list
Editor's Note The Advisory Panel on Hospital Outpatient Payment (HOP) on August 22 unanimously recommended that the Centers for Medicare & Medicaid Services (CMS) remove total knees from its inpatient-only list, the Ambulatory Surgery Center Association (ASCA) reports. CMS is requesting information on the feasibility of removing total knees from…
CMS: ICD-10 grace period ends October 1
Editor's Note The Centers for Medicare and Medicaid Services (CMS) on August 18 announced in its FAQ guidelines that the 1-year grace period for claims using the ICD-10 code set will end October 1. Healthcare organizations will be required to use the correct degree of specificity when coding claims. Unspecified…
Impact of race/ethnicity, socioeconomic status on readmission rates after total joints
Editor's Note The addition of race/ethnicity and socioeconomic status to the risk-adjusted algorithm for readmissions after total hips and knees used by the Centers for Medicare & Medicaid Services led to a relative-performance change in readmission rates of <3% of 1,194 hospitals in this study. Policy makers and payers should…
Hospital cost of surgery-related pressure ulcers
Editor's Note This study found that hospital-acquired pressure ulcers add 44% to the cost of major surgical hospital stays, but the amount varies depending on length of stay. Using data from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011…
Medicare Advantage pays hospitals 8% less than traditional Medicare
Editor's Note Medicare Advantage plans paid hospitals 8% less for hospital services than fee-for-service Medicare in 2009 and 2012, finds this study. Researchers also found that commercial insurers paid hospitals much higher than Medicare Advantage or fee-for-service Medicare. Some of this difference is because of higher prices commercial plans pay…
Help decode ICD-10 for prompt reimbursement
Despite warnings of calamities, implementation of the International Classification of Diseases (ICD)-10 on October 1, 2015, proceeded smoothly, with minimal impact on denied claims. In the fourth quarter of 2015, the percentage of Medicare claims denied was 10%, comparable to the preimplementation figure of 9.9%. But that doesn’t mean OR…
CMS issues final PPS rule for 2017
Editor's Note The Centers for Medicare & Medicaid Services on August 2 issued its final rule for the FY 2017 hospital inpatient prospective payment system (PPS), which increases rates by 0.95%. The 0.95% increase reflects the projected hospital market basket update of 2.7% for those hospitals that were meaningful users…
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