Tag: Reimbursement

GAO: Modest effects from Value-based Purchasing program

Editor's Note A new Government Accountability Office report shows that hospital performance on most quality measures was improving before the Affordable Care Act’s Hospital Value-based Purchasing (VBP) program began in 2012 and has not noticeably changed since then, according to the AHA News. Most inpatient prospective payment system hospitals eligible…

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By: Judy Mathias
October 5, 2015
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ICD-10 debuts October 1

Editor's Note The healthcare industry transitioned to the ICD-10 system October 1, expanding procedure codes from 14,000 to 70,000 for providers and from 44,000 to 72,000 for hospitals. Medicare officials say they won’t deny claims to providers solely for lack of specificity for the first 12 months, but that doesn’t…

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By: OR Manager
October 1, 2015
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Designing and implementing bundled payment program for total hips

Editor's Note A bundled payment program for total hip replacement was associated with similar total costs, lower posthospital costs, shorter length of stay, and similar or higher quality hospital care, in this study. Compared to controls, bundled payment patients had similar length of stay (3.0 vs 3.4 days), higher rates…

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By: OR Manager
September 28, 2015
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Infection prevention tops list of readmission 'action items'

Although most patients spend a brief time in the OR, what happens there significantly impacts a hospital’s 30-day readmission rate. According to a 2015 study in JAMA, complications related to the surgical procedure are the most common cause of readmission after surgery. The researchers analyzed data from the American College…

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By: OR Manager
September 22, 2015
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Deadline looms for CMS orthopedic bundled care program

Only a few months remain before the Comprehensive Care for Joint Replacement (CCJR) goes into effect on January 1, 2016. This orthopedic bundled program, mandated by the Centers for Medicare & Medicaid Services (CMS), is expected to save $153 million as part of the goal to convert 50% of Medicare…

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By: OR Manager
September 22, 2015
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Variation in bariatric surgery costs may impact bundled payments

Editor's Note In this analysis of nearly 25,000 Medicare patients, mean total payments for bariatric surgical procedures varied from $11,000 to $13,000 per episode of care. The index hospitalization was responsible for 75% of total payments, followed by physician services (21%), and postacute care services (2.8%). As hospitals enter Medicare…

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By: OR Manager
September 16, 2015
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Hospitals with high readmission rates penalized for the patients they serve

Editor's Note Hospitals with high readmission rates are being penalized largely because of the patients they serve, this study finds. The results showed that Medicare patients admitted to hospitals with higher readmission rates were more likely to have characteristics associated with a higher probability of readmission, such as more chronic conditions,…

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By: OR Manager
September 15, 2015
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ASCs face Medicare reimbursement challenges

Editor's Note The gap in Medicare reimbursement rates between ASCs and hospital outpatient departments continues to grow, the Wisconsin Health News reports. Reimbursement rates for hospital outpatient departments are updated using the hospital market basket, but rates for ASCs are updated with the consumer price index. The result is that…

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By: OR Manager
September 1, 2015
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Most Medicare ACOs received no bonuses in 2014

Editor's Note Only 97 of 353 Medicare accountable care organizations (ACOs) met targets for quality and slowed spending enough to earn bonuses in 2014, Modern Healthcare reports. This is a continuation of mixed results for the ACO initiative that the Obama administration has targeted for rapid expansion through 2018. The…

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By: OR Manager
August 31, 2015
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CMS announces additional participants for bundled payment initiative

Editor's Note The Centers for Medicare & Medicaid Services announced on August 13 that 360 more organizations have entered into agreements to assume financial risk for an episode of care during the second phase of the Bundled Payments for Care Improvement Initiative. The initiative is testing four bundled payment models…

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By: OR Manager
August 17, 2015
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