CMS issues coverage plan for COVID-19 vaccines, treatments
Editor's Note The Centers for Medicare and Medicaid Services (CMS) on October 28 issued an interim final rule that requires CMS to cover any COVID-19 vaccines that receive Food and Drug Administration (FDA) authorization at no cost to beneficiaries. The rule also will increase what Medicare pays hospitals for COVID-19…
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…
Successful supply chain management in an ASC
With more technologically advanced procedures being performed in ambulatory surgery centers (ASCs), it’s increasingly important to monitor data on supplies and manage physician preferences for particular implants. Physicians don’t always realize that reimbursement is lower for many procedures performed in an ASC than in hospitals, and therefore they may not…
ASCs reduce Medicare costs $4 billion annually
Editor's Note A new analysis of Medicare payment data by KNG Health Consulting shows that ambulatory surgery centers (ASCs) reduced Medicare costs by $28.7 billion from 2011 to 2018, a savings of more than $4 billion each year. The analysis also shows that, without policy changes, performing procedures on Medicare…
CMS releases 2021 proposed payment rule for ASCs, HOPDs
Editor's Note The Centers for Medicare & Medicaid Services (CMS) on August 4 released the 2021 proposed payment rule for ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). Among the proposals in the rule: CMS proposes to expand the number of procedures that Medicare would pay for when performed…
ASC offsets some revenue loss through 'Hospital Without Walls' waiver
Far fewer cases of COVID-19 have been seen in rural areas of the US than in large urban populations. But even healthcare facilities not inundated with COVID-19 patients have sustained revenue losses and disruptions in standard procedures. One major advantage for Heartland Surgery Center in Kearney, Nebraska, was seeing the…
Proactive payment collection reduces bad debt risk
Establishing policies to collect payment before surgery has grown in importance as high-deductible health plans impose larger out-of-pocket costs on patients. To help manage patients’ expectations about costs and increase the likelihood of collecting payment, some experts believe a culture shift is in order. They say healthcare facilities should be…
Effect of total joint bundled payment program on patient selection
Editor's Note In this study, researchers found little to no significant change in the characteristics of patients having total hip and knee replacement surgery after the Centers for Medicare & Medicaid Services introduced the mandatory bundled payment programs in selected metropolitan statistical areas. The analysis included a matched set of…
CMS proposes changes to total joint bundled payment program
Editor's Note The Centers for Medicare & Medicaid Services (CMS) on February 20 issued a rule proposing changes to the Comprehensive Care for Joint Replacement (CJR) program, which bundles payments to acute care hospitals for hip and knee replacement surgical procedures. CMS proposes extending the CJR model for an additional…
Medicare may overpay for postop care
Editor's Note Medicare may be overpaying surgeons for postoperative care they provide to patients, according to a new Rand Corporation analysis in the January 23 New England Journal of Medicine. The authors of the analysis suggest that federal officials should incorporate ways to more objectively measure the amount of postoperative…
