Medicare

Latest Issue of OR Manager
December 2017

Hospitals partnering with ASCs to perform outpatient total joints

Editor's Note With the growth of ambulatory surgeries and the shift to Medicare reimbursement for outpatient hip and knee replacements, hospitals are acquiring and forming joint ventures with ambulatory surgery centers (ASCs), the August 5 Modern Healthcare reports. This allows hospitals to keep part of the revenue and better aligns…

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By: Judy Mathias
August 10, 2017
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CMS push to value-based care leading to more burnout

Editor's Note The push by the Centers for Medicare & Medicaid Services (CMS) to transform healthcare delivery at community health centers to value-based care is increasing staff dissatisfaction and burnout, this study finds. From 2013 to 2014, clinicians and staff at 296 centers reported statistically significant declines in multiple measures…

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By: Judy Mathias
August 8, 2017
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CMS releases FY 2018 inpatient PPS final rule

Editor's Note The Centers for Medicare and Medicaid Services (CMS) on August 2 issued the FY 2018 Medicare Inpatient Prospective Payment System final rule, which updates Medicare payment and policies when patients are discharged from hospitals. The rule increases rates by 1.2%. This includes an initial market-basket update of 2.7%…

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By: Judy Mathias
August 4, 2017
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AHRQ: Cost trends for inpatient stays

Editor's Note From 2005 to 2014, the average inflation-adjusted cost of a hospital inpatient stay increased by 12.7%, from $9,500 to $10,900, according to new statistics from the Agency for Healthcare Research and Quality (AHRQ). Average costs for stays increased: 16% for Medicaid 18% for private insurance 8% for Medicare…

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By: Judy Mathias
August 2, 2017
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CMS issues 2018 OPPS/ASC proposed payment rule

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on July 13 issued the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. CMS is proposing an update of 1.9% for ASCs, which is a combination of a 2.3% inflation update…

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By: Judy Mathias
July 18, 2017
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CMS proposes paying for outpatient total joints

Editor's Note The Centers for Medicare & Medicaid Services on July 13 issued a proposed rule that updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System. Among the proposals are that Medicare pay for knee replacement procedures performed in outpatient…

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By: Judy Mathias
July 17, 2017
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Editorial

The inaugural Bundled Payment Bootcamp on June 20 in Nashville, Tennessee, was a timely opportunity for healthcare providers to learn how reimbursement is changing the way they do business. Though the uncertain direction of US healthcare legislation continues to cause consternation, this workshop—which will be presented again in fall 2017—clarifies…

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By: Elizabeth Wood
July 13, 2017
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Do Medicare’s latest code changes help or hurt ASCs?

Medicare is increasing approval of higher-acuity procedures performed in the ambulatory surgery center (ASC) setting, creating meaningful opportunities for ASCs. At the same time, however, a number of outpatient procedure codes have been deleted, reduced, or are packaged and considered all-inclusive in a case, without additional payment. “Key changes occurred…

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By: Leslie A. Flowers
July 13, 2017
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Study identifies high-risk groups for readmissions

Editor's Note Comparing rates, characteristics, and costs of hospital readmissions across all ages and insurance types, researchers from Beth Israel Deaconess Medical Center, Boston, found that of more than 12.5 million patients discharged in 2013, approximately 1.8 million were readmitted within 30 days. Medicare patients accounted for 56% of readmissions,…

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By: Judy Mathias
July 11, 2017
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Survey: Physicians unprepared for MACRA

Editor's Note A survey of 1,000 physicians by the American Medical Association and KPMG finds that fewer than one in four believe they are well prepared to meet the 2017 requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), KPMG.com reported on June 28. MACRA reshapes how…

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By: Judy Mathias
July 5, 2017
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