Changes in hospital-acquired conditions, mortality after HACRP
Editor's Note In this study, researchers from the University of Michigan, Ann Arbor, find that hospital-acquired conditions (HACs) targeted by the Centers for Medicare and Medicaid Services (CMS) Hospital-Acquired Condition Reduction Program (HACRP) declined after the program was announced, but 30-day mortality was unchanged. The analysis included 8,857,877 Medicare beneficiaries…
Medicaid expansion reduces uninsured surgical hospitalizations, financial burden
Editor's Note This study from Duke University Medical Center, Durham, North Carolina, finds that Medicaid expansion was associated with a reduction in uninsured surgical hospitalizations. Researchers analyzed state-level data across 44 states and patient-level data across four states, and they compared hospitalizations in expansion and non-expansion states. Uninsured surgery patients…
Culture, communication, and clinical skills essential for ERAS success
Strategies that can achieve the aims of excellence in clinical care, fewer complications, and reduced costs are sorely needed, and the comprehensive implementation of an Enhanced Recovery After Surgery (ERAS) program can help achieve these aims in the surgical population. ERAS pathways have been found to reduce morbidity, hospital stay,…
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…
Association of geriatric-specific characteristics with postop readmissions
Editor's Note In this study from the University of Virginia, new geriatric-specific characteristics were found to raise the risk of elderly surgical patients having unplanned readmissions within a month of leaving the hospital. The four geriatric-specific risk factors for readmission include: cognitive impairment requiring another person to sign the patient’s…
Implications of the rapid growth of NPs in the US workforce
Editor's Note Concerns about physician shortages have led policy makers to advocate for the greater use of nurse practitioners (NPs). From 2010 to 2017, the number of NPs more than doubled from 91,000 to 190,000, this analysis finds. The growth of NPs, which occurred in every region of the US,…
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…
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…
Spending, quality effects of Medicare’s bundled payments for lower-extremity joint replacement
Editor's Note In this study, researchers found that over a 3-year period, compared to no participation, participation in Medicare’s Bundled Payments for Care Improvement (BPCI) program was associated with a 1.6% decrease in average lower extremity joint replacement spending with no changes in quality, driven by early participants. When looking…
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