Medicare

Latest Issue of OR Manager
September 2020

Study challenges concerns about HRRP

Editor's Note This study from the division of cardiology at Dallas’ University of Texas Southwestern Medical Center and the Yale School of Medicine, New Haven, Connecticut, challenges concerns about Medicare’s Hospital Readmission Reduction Program (HRRP)--ie, that it leaves patients more vulnerable and increases postdischarge mortality rates. Analyzing inpatient and outpatient…

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By: Judy Mathias
January 16, 2020
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CMS considering reimbursement for coronary interventions at ASCs

Editor's Note In a proposed rule, the Centers for Medicare & Medicaid Services (CMS) is considering whether to reimburse for percutaneous coronary interventions (PCIs) at ambulatory surgical centers (ASCs), the September 20 tctMD reports. As of May 1, 2019, approximately 22 states allowed for coronary interventions to be done outside…

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By: Judy Mathias
September 24, 2019
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Joint Commission refines requirements for practitioner credentialing, privileging, and evaluation

Editor's Note The Joint Commission announced on August 14 that accredited hospitals and critical access hospitals will be able to supplement local data with data acquired from Medicare-certified hospitals and critical access hospitals for the purposes of practitioner credentialing, privileging, and evaluation (focused and ongoing). The supplemental data may not…

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By: Judy Mathias
August 15, 2019
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CMS penalty program not linked to hospital safety improvements

Editor's Note The Centers for Medicare and Medicaid Services (CMS) hospital penalization in the Hospital Acquired Condition Reduction Program (HACRP) was not associated with significant changes in rates of hospital acquired conditions (HACs), 30-day readmissions, or 30-day mortality and does not appear to drive meaningful clinical improvements, this study finds.…

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By: Judy Mathias
July 11, 2019
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HHS forms group to streamline quality programs

Editor's Note The Department of Health and Human Services (HHS) announced on July 9 that it has formed a summit of key industry stakeholders and government leaders to provide insight as the Trump administration seeks to streamline, improve, and align measures used across federal healthcare quality programs. The Quality Summit,…

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By: Judy Mathias
July 11, 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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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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Joint Commission: Additional changes made to elements of performance

Editor's Note The Joint Commission announced on August 15 that additional changes will be made to elements of performance (EPs) in the Nursing and Provision of Care, Treatment, and Services chapters of the accreditation manuals for critical access hospitals and deemed-status hospital programs, effective January 1, 2019. The Centers for…

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By: Judy Mathias
August 17, 2018
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Effects of quality improvement in bariatric surgery patients

Editor's Note This retrospective study of patients undergoing bariatric surgery found that hospitals with the largest reductions in serious postoperative complications had the greatest decrease in Medicare payments. Researchers ranked 562 hospitals (37,329 patients) into quintiles. The top 20% of hospitals had a decrease in average serious complication rate of…

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By: Judy Mathias
June 18, 2018
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Joint Commission: Loss of deemed status must be reported beginning July 1

Editor's Note The Joint Commission on June 6 announced that beginning July 1, it will need to be notified if an accredited organization loses its deemed status after a Centers for Medicare & Medicaid Services (CMS) complaint survey or validation survey. When CMS removes an organization’s deemed status and places…

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By: Judy Mathias
June 8, 2018
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