CMS

Latest Issue of OR Manager
April 2019

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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CMS updates Star Ratings, proposes future changes

Editor's Note The Centers for Medicare & Medicaid Services (CMS) on February 28 updated its Overall Hospital Star Ratings on the Hospital Compare website and posted potential changes to the Hospital Star Ratings methodology for public comment. The proposed changes would make hospital comparisons more precise and consistent, and allow…

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By: Judy Mathias
March 4, 2019
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CMS releases opioid prescribing mapping tool updates

Editor's Note The Centers for Medicare & Medicaid Services on February 22 released an update to its Medicare Part D opioid prescribing mapping tool and a new Medicaid opioid prescribing mapping tool. The Medicare tool is an interactive, web-based resource that shows geographic comparisons of opioid prescribing rates at state,…

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By: Judy Mathias
February 26, 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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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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