Bundled payments with copay waivers reduce surgery costs for patients, payers
Editor's Note A RAND Corporation study published in the March Health Affairs finds that health insurers and patients can achieve significant savings when they participate in a bundled payment program that waives cost-sharing for patients. Researchers examined a bundled payment program developed by a private insurer that ran from 2016…
Total hospital admissions down 8.5%
Editor's Note An electronic medical record (EMR) data analysis by Epic Health Research Network for the Kaiser Family Foundation finds that from March through December 2020, hospital admissions were 8.5% below predictions because of COVID-19. The analysis, which is based on Epic’s EMR data on all inpatient admissions from December…
More states report telehealth reimbursement laws
Editor's Note A Foley & Lardner survey finds that state telehealth reimbursement laws have significantly increased during the COVID-10 pandemic, but more can be done to address telehealth adoption barriers, the February 15 Revcycle Intelligence reports. More than 43 states and Washington, DC, have some telehealth statute for commercial payers,…
COVID-19 has hastened outpatient surgery migration
The latest surge of COVID-19 cases has put many hospitals in a precarious position, with shortages of staff, space, and supplies. Lessons learned earlier in the pandemic cannot necessarily shore up systems that have been overwhelmed with patients. Throughout most of 2020, some patients postponed medical or surgical care. When…
CMS releases final 2021 Medicare payment rule for ASCs, HOPDs
Editor's Note The Centers for Medicare & Medicaid Services (CMS) on December 2 released its 2021 final payment rule for ASCs and hospital outpatient departments (HOPDs). CMS has finalized the addition of 11 procedures to the ASC covered procedures list, including total hip arthroplasty, autochondrocyte knee implant, and open complex…
CMS releases final PFS for 2021, surgeons say rule jeopardizes care
Editor's Note The Centers for Medicare and Medicaid Services (CMS) on December 1 released its 2021 final rule for the Medicare physician fee schedule (PFS), which expands telehealth services and increases payments for primary care and chronic disease management. The rule also reduces payments for surgeons, emergency physicians, and other…
Shifts in case mix bode well for future of outpatient surgery
Before COVID-19 emerged as the biggest disruptor of 2020, many ambulatory surgery centers (ASCs) had been growing volume and receiving Medicare reimbursements for an increasing number of procedures. Stopping elective procedures in the spring was a significant setback, especially for smaller, independent facilities, notes a Global Healthcare Advisors (GHA) brief,…
CMS: How to prepare for COVID-19 vaccine
Editor's Note The Centers for Medicare and Medicaid Services (CMS) on November 5 released a set of toolkits and enrollment actions to take to administer the COVID-19 vaccine when it’s available. Many Medicare-enrolled providers don’t have to take any actions until the vaccine is available. Some Medicare-enrolled providers must also…
CMS penalizes 2,545 hospitals for high readmissions
Editor's Note The Centers for Medicare and Medicaid Services (CMS) will penalize and reduce a year’s worth of payments to nearly half of the nation’s hospitals because of 30-day readmission rates, the November 2 Kaiser Health News reports. The penalties are part of the ninth year of the Hospital Readmissions…
Think 'outside the blocks' to shore up balance sheets
Editor’s Note: This article from Whitman Partners addresses some ways OR nurse leaders can help their health systems recover from the financial fallout and disruption in normal processes caused by the COVID-19 pandemic. Whitman Partners is a Portland, Oregon-based specialty search firm dedicated to placing directors of surgical services at…
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