Quality indicators for anesthesia For the past several years, physicians have participated in the Physician Quality Reporting System (PQRS) established by Medicare as a way to assess the quality of patient care and tie that to reimbursement. Beginning in 2015, a negative payment adjustment hit individuals and group practices whose…

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Editor's Note The Centers for Medicare and Medicaid Services (CMS) has finalized the rule that will require hospitals in 67 geographic areas to participate in a test of bundled payments for hip and knee replacements, Modern Healthcare reports. Medicare's average bundled payment ranges from $16,500 to $33,000 for surgery, hospitalization,…

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Editor's Note Readmission after emergency general surgery procedures is common and varies widely according to patient factors and diagnosis, this study finds. Of more than 177,000 patients analyzed, nearly 6% were readmitted within 30 days. The most common reasons were surgical site infections (16.9%), gastrointestinal complications (11.3%), and pulmonary complications…

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Editor's Note The Nationwide Inpatient Sample (NIS) database underreports data on patients’ weight, body mass, alcohol use, and tobacco use, finds a study from the Johns Hopkins University School of Medicine, Baltimore. Medicare uses NIS data to set reimbursement rates based on a hospital’s risk for readmissions and surgical complications. The…

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Editor's Note A coalition of 111 medical societies on November 4 sent letters asking Senate and House leaders to take legislative action to pause Stage 3 of the electronic health records meaningful use program and revise Stage 2 so that it enables provider success, HealthData Management reports. Stage 3 requirements…

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Editor's Note On October 30, the Centers for Medicare & Medicaid Services (CMS) released the final 2016 payment rule for ambulatory surgery centers (ASCs). ASC payment rates will increase by 0.3%, which is based on a projected inflation rate of 0.8% minus a 0.5% productivity adjustment required by the Affordable…

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Editor's Note The Centers for Medicare & Medicaid Services (CMS) has issued its final rules detailing how it will pay for services provided by physicians and other healthcare professionals in 2016. Key policies finalized in the rules include: Updates to the “Two-Midnight” rule, which clarifies when inpatient admissions are appropriate…

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Clinical and social characteristics not included in Medicare’s current risk-adjustment methods explained much of the difference in readmission risk between patients admitted to hospitals with higher versus lower readmission rates, a study finds. The Medicare Hospital Readmissions Reduction Program penalizes hospitals with higher than expected 30-day readmission rates by reducing…

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Editor's Note Wider adoption of “dropless” cataract surgery could save Medicare more than $7.1 billion over the next 10 years, a new study finds. In addition, patients could save an additional $1.4 billion for out-of-pocket costs for pharmaceutical co-payments, and states could save $124 million in Medicaid payments. The dropless…

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Editor's Note Researchers found significant differences in the odds of 30-day readmissions after total hip arthroplasties on the basis of race, socioeconomic status, and payer. African American and Hispanic patients had a higher risk of readmissions than white patients. Lower socioeconomic status was linked to higher odds of readmission. Medicare…

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