Deadline looms for CMS orthopedic bundled care program
Only a few months remain before the Comprehensive Care for Joint Replacement (CCJR) goes into effect on January 1, 2016. This orthopedic bundled program, mandated by the Centers for Medicare & Medicaid Services (CMS), is expected to save $153 million as part of the goal to convert 50% of Medicare…
Variation in bariatric surgery costs may impact bundled payments
Editor's Note In this analysis of nearly 25,000 Medicare patients, mean total payments for bariatric surgical procedures varied from $11,000 to $13,000 per episode of care. The index hospitalization was responsible for 75% of total payments, followed by physician services (21%), and postacute care services (2.8%). As hospitals enter Medicare…
Hospitals with high readmission rates penalized for the patients they serve
Editor's Note Hospitals with high readmission rates are being penalized largely because of the patients they serve, this study finds. The results showed that Medicare patients admitted to hospitals with higher readmission rates were more likely to have characteristics associated with a higher probability of readmission, such as more chronic conditions,…
ASCs face Medicare reimbursement challenges
Editor's Note The gap in Medicare reimbursement rates between ASCs and hospital outpatient departments continues to grow, the Wisconsin Health News reports. Reimbursement rates for hospital outpatient departments are updated using the hospital market basket, but rates for ASCs are updated with the consumer price index. The result is that…
Most Medicare ACOs received no bonuses in 2014
Editor's Note Only 97 of 353 Medicare accountable care organizations (ACOs) met targets for quality and slowed spending enough to earn bonuses in 2014, Modern Healthcare reports. This is a continuation of mixed results for the ACO initiative that the Obama administration has targeted for rapid expansion through 2018. The…
CMS announces additional participants for bundled payment initiative
Editor's Note The Centers for Medicare & Medicaid Services announced on August 13 that 360 more organizations have entered into agreements to assume financial risk for an episode of care during the second phase of the Bundled Payments for Care Improvement Initiative. The initiative is testing four bundled payment models…
Editorial
The French proverb, “the more things change, the more they stay the same,” is one way to view the readmission penalties imposed by the Centers for Medicare & Medicaid Services (CMS). About a year ago, a Kaiser Health News report said more than 2,600 hospitals in fiscal year 2015 were…
Quality reports to determine pay rise or fall
Ambulatory surgery centers (ASCs) that have yet to register and report compliance with quality measures can expect a decrease of 0.9% in 2016 from this year’s Medicare reimbursement rates. Those in compliance, however, may see an increase of approximately 1.1%, depending on specialties. As in the past, the Centers for…
CMS extends “Two-Midnight” rule partial enforcement delay to end of year
Editor's Note The Centers for Medicare & Medicaid Services on August 12 extended the partial enforcement delay of the “Two-Midnight” rule from September 30 to December 31, AHA News reports. The extension prohibits Recovery Audit Contractors from conducing post-payment patient status reviews for claims with admission dates October 1 to…
Variation in surgical readmissions mostly patient related
Editor's Note Postoperative readmissions occurred in more than 1 in 10 patients, in this study, with considerable variation across specialties. The majority of variation was attributable to patient-related factors (82.8%); surgical specialty accounted for 14.5% of the variability, and individual surgeon factors accounted for 2.8%. After adjusting for patient and…
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