Reimbursement

Latest Issue of OR Manager
April 2019
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Accuracy of surgical procedure valuations in Medicare’s Fee Schedule

Editor's Note The Center’s for Medicare and Medicaid Services (CMS) is legally responsible for setting and updating the work element of its relative value units (RVUs), which form the Medicare Physician Fee Schedule used to determine physician payments. In practice, however, updating what is known as the “work RVU” is…

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By: Judy Mathias
April 18, 2019
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Non-opioid pain management gaining favor in ASCs

Pressure to contain opioid overuse in the United States is at a boiling point. The Centers for Disease Control and Prevention reports that overdose deaths linked to opioid prescriptions have increased fivefold over the last two decades. To reduce reliance on opioid prescriptions, the Centers for Medicare & Medicaid Services…

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By: Jennifer Lubell
March 15, 2019
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ASCs react to 2019 regulatory changes

Each year, ambulatory surgery centers (ASCs) adapt to numerous federal regulatory policy reforms. As an example, since 2012, when the Centers for Medicare & Medicaid Services (CMS) launched the Ambulatory Surgery Center Quality Reporting (ASCQR) Program ASCs had been asking for, ASCs have reported data for a changing set of…

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By: Judith M. Mathias, MA, RN
February 20, 2019
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Government payment policies linked to hospital performance fail to improve CAUTI rates

Editor's Note This study found no evidence that value-based incentive programs (VBIPs), which link financial incentives or penalties to hospital performance, had any measurable association with changes in catheter-associated urinary tract infection (CAUTI) rates. Researchers at Boston University School of Medicine analyzed 592 hospitals across the country, and found that…

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By: Judy Mathias
February 14, 2019
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Use of ‘hot spotting’ to identify high-cost surgery patients

Editor's Note Because a subset of patients are responsible for a disproportionate share of Medicare spending, targeting high-cost patients (ie, “hot spotting”) for cost containment efforts would be an effective strategy to reduce costs in surgical patients, this study finds. Using Medicare claims data from 2010 to 2013, University of…

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By: Judy Mathias
February 14, 2019
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Effect of Medicare ACOs on spending for inpatient surgery

Editor's Note Though Medicare Accountable Care Organizations (ACOs) have had some success in reducing spending for medical care, they have not had similar success with surgical spending, this study finds. Of 341,675 patients at 427 ACO hospitals and 1,024,090 patients at 1,531 non-ACO hospitals analyzed, average baseline payments were similar…

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By: Judy Mathias
January 14, 2019
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Editorial

Early in a new year, there’s a tendency to reflect on how past events might inform the future. The January issue of OR Manager looked at 2018 legislative changes and their potential impact on healthcare. In just the past few weeks, several legal and financial actions have already changed the…

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By: Elizabeth Wood
January 14, 2019
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2019 Medicare final payment rule brings big wins for ASCs

The holiday spirit got off to a good start at ambulatory surgery centers (ASCs) across the country with the November 2, 2018, announcement of the Centers for Medicare & Medicaid Services’ (CMS) 2019 Ambulatory Surgical Center Payment System and Quality Reporting (ASCQR) Program Final Rule. Several significant changes ASCs had…

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By: Janet M. Boivin, BSN, BSJ, RN
January 14, 2019
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Reduced readmissions credited to HRRP overstated

Editor's Note Medicare’s Hospital Readmissions Reduction Program (HRRP), which penalizes readmissions for several targeted conditions, has been credited with lowering readmission rates; however, these reductions now appear to be overstated, this study finds. A concurrent change in electronic transaction standards that increased diagnostic coding allowed hospitals to document a larger…

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By: Judy Mathias
January 10, 2019
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CMS underpaid hospitals by $76.8 billion in 2017

Editor's Note The Centers for Medicare & Medicaid Services (CMS) underpaid hospitals by $76.8 billion in 2017, according to data from the American Hospital Association’s Annual Survey of Hospitals. Medicare underpayments totaled $53.9 billion, and Medicaid underpayments were $22.9 billion. Hospitals also provided $38.4 billion in uncompensated care, the January…

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By: Judy Mathias
January 7, 2019
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