Tag: Reimbursement

CMS finalizes 2016 payment rules for physicians, hospitals

Editor's Note The Centers for Medicare & Medicaid Services (CMS) has issued its final rules detailing how it will pay for services provided by physicians and other healthcare professionals in 2016. Key policies finalized in the rules include: Updates to the “Two-Midnight” rule, which clarifies when inpatient admissions are appropriate…

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By: Judy Mathias
November 2, 2015
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Hospitals with high readmission rates penalized for the patients they serve

Clinical and social characteristics not included in Medicare’s current risk-adjustment methods explained much of the difference in readmission risk between patients admitted to hospitals with higher versus lower readmission rates, a study finds. The Medicare Hospital Readmissions Reduction Program penalizes hospitals with higher than expected 30-day readmission rates by reducing…

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By: Judith M. Mathias, MA, RN
October 28, 2015
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‘Dropless’ cataract surgery could save Medicare billions

Editor's Note Wider adoption of “dropless” cataract surgery could save Medicare more than $7.1 billion over the next 10 years, a new study finds. In addition, patients could save an additional $1.4 billion for out-of-pocket costs for pharmaceutical co-payments, and states could save $124 million in Medicaid payments. The dropless…

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By: Judy Mathias
October 27, 2015
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Differences in 30-day readmission rates after total hips

Editor's Note Researchers found significant differences in the odds of 30-day readmissions after total hip arthroplasties on the basis of race, socioeconomic status, and payer. African American and Hispanic patients had a higher risk of readmissions than white patients. Lower socioeconomic status was linked to higher odds of readmission. Medicare…

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By: Judy Mathias
October 15, 2015
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Effect of hospital safety-net burden on surgical costs, outcomes

Editor's Note In this study on the effect of patient and hospital factors on surgical outcomes and costs at safety-net hospitals, researchers found that hospital resources and not necessarily patient factors lead to inferior outcomes and increased costs. Hospital Compare data from the Centers for Medicare & Medicaid Services website…

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By: Judy Mathias
October 15, 2015
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Price increases much lower in ASCs than hospital outpatient departments

Editor's Note For six outpatient surgical procedures, prices paid to ASCs grew in line with general medical prices, whereas prices paid to hospital outpatient departments for the same procedures climbed sharply, this study finds. Private insurers paid ASCs considerably more than Medicare for the same procedures. Medicare pays ASCs a legislated…

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By: Judy Mathias
October 14, 2015
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Validity of CAUTI metric used for value-based purchasing questioned

Editor's Note Two different measurement systems are used to track performance in lowering the rate of catheter-associated urinary tract infections (CAUTIs). The Agency for Healthcare Research and Quality metric has shown a 28.2% decrease in CAUTIs since 2010, whereas the Centers for Disease Control and Prevention’s metric has shown a…

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By: Judy Mathias
October 13, 2015
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Magnet hospitals associated with better patient experience

Editor's Note Magnet recognition is associated with better patient care experiences, which may enhance reimbursement for hospitals, this study finds. Nurse researchers compared 212 Magnet hospitals with 212 non-Magnet hospitals. Patients in Magnet hospitals gave their hospitals higher overall ratings, were more likely to recommend their hospitals, and reported more positive…

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By: Judy Mathias
October 9, 2015
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ICD-10 transition begins well, further tests coming

Editor's Note The ICD-10 transition began well last week because of the time and effort spent preparing the new codes, but claims rejections could cause further problems towards the end of the month, according to Modern Healthcare. Organizations most likely to have trouble will be the smaller providers and health…

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By: Judy Mathias
October 7, 2015
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CMS issues final rules on “meaningful use”

Editor's Note The Centers Medicare & Medicaid Services on October 6 released final rules on “meaningful use” for electronic health records. The rules cover three components of the electronic health records meaningful use program: It finalizes modifications to stages 1 and 2, covers requirements for stage 3, and it addresses the…

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By: Judy Mathias
October 7, 2015
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