CMS

Latest Issue of OR Manager
March 2019

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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Researchers pinpoint factor that predicts unplanned readmissions

Editor's Note The widely used “LACE index,” which assesses a patient’s risk of hospital readmission, has a “blindspot” because it fails to consider whether patients are on Medicaid, West Virginia University researchers say. LACE stands for length of stay, acuity, comorbidity, and emergency department. To assess the predictive value of…

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By: Judy Mathias
January 17, 2019
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Follow pain management standards to ensure survey success

Postoperative pain management has always been a major focus of patient care. However, the opioid crisis is increasing the challenges healthcare leaders face because of the call for a national change in modalities of pain management. Regulatory bodies, specifically, are executing control to confront the opioid epidemic head on, making…

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By: Judith M. Mathias, MA, RN
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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Medicare’s bundled payments for joint replacements show moderate savings

Editor's Note In the first 2 years of Medicare’s Comprehensive Care for Joint Replacement (CJR) program, there was a modest reduction in spending per procedure without an increase in complication rates, this study finds. Comparing costs associated with 280,161 joint replacement procedures in 803 hospitals required to participate in the…

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By: Judy Mathias
January 3, 2019
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Effect of CJR bundled payment program on care delivery

Editor's Note Participation in the Comprehensive Care for Joint Replacement (CJR) bundled payment program was associated with changes in care delivery and compensation practices, this study finds. This survey of 73 orthopedic surgeons found that those practicing in CJR hospitals were more likely to report their hospitals had implemented programs…

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By: Judy Mathias
December 6, 2018
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Most hospitals will get increased Medicare payments in 2019

Editor's Note The Centers for Medicare & Medicaid Services announced December 3 that more than 1,550 hospitals will share $1.9 billion in bonus payments under the Hospital Value-Based Purchasing Program for FY 2019. Though it is a slight decline from FY 2018, average performance scores were higher at 38.1%, compared…

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By: Judy Mathias
December 6, 2018
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CMS: New online tool compares cost differences for outpatient procedures

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on November 27 launched a new online tool that compares Medicare payments and co-payments for certain outpatient surgical procedures performed in hospitals and ambulatory surgery centers. The “Procedure Price Lookup” tool will help Medicare patients consider potential cost differences when…

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By: Judy Mathias
November 29, 2018
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