Two recent reports on hospital quality and growth in healthcare spending suggest that healthcare providers are making meaningful systemic changes that are improving the value of U.S. health care, according to a Healthcare Financial Management (HFMA) senior executive. The Department of Health and Human Services (DHHS) reported a 17 percent decline in the rate […]
Medicare Shared Savings Program Accountable Care Organizations (ACOs) would have three extra years before they could be punished for poor performance, according to a new proposal from CMS. The proposal is one of dozens of changes to rules governing ACOs that CMS wants to implement. ACOs are affiliations of doctors, hospitals and other providers […]
The Joint Commission’s newly released annual report on hospital quality shows hospitals continue to perform well on quality accountability measures. The report noted that Joint Commission-accredited hospitals achieved 97.6 percent composite accountability measure performance. Nearly 37 percent of the 3,300 Joint Commission hospitals were designated Top Performer on Key Quality Measures, an 11 percent […]
Hospital Outpatient Prospective Payment System (OPPS) rates will increase by 2.3 percent and ambulatory surgical center (ASC) rates will increase by 1.4 percent in 2015, according to the final rule released by CMS in late October. The rate increases are more than originally proposed by CMS and are expected to affect more than 4,000 hospitals […]
Rising prices, not increased utilization, drove increased spending on acute inpatient care, outpatient care and brand prescriptions, according to the Health Care Cost Institute’s 2013 Health Care Cost and Utilization Report. Healthcare spending increased an average 3.9 percent in 2013. Since 2010, health spending per insured person has grown by an average of 3.9 […]
Late last week the Centers for Medicare & Medicaid Services (CMS) announced its $840 million investment in a program aimed at supporting the adoption, development and sharing of quality improvement strategies to improve patient health and reduce healthcare costs. The “Transforming Clinical Practice” initiative is a new, innovative model and one of the largest […]
A new national scorecard on payment reform shows commercial health plans have dramatically shifted how they pay physicians and hospitals, with 40 percent of their payments “value-oriented” in 2014, according to the Catalyst for Payment Reform (CPR). This means that two-fifths of commercial health insurance payments were no longer traditional fee-for-service. Some financial experts […]
Medicare outpatients at critical access hospitals (CAHs) pay significantly more than Medicare beneficiaries at acute care hospitals, according to a new report from the Department of Health and Human Services’ Office of the Inspector General (OIG). OIG noted in its report that policy changes are needed to reduce the amounts those rural patients pay. […]
The Medicare Trust Fund netted over $3 billion from the Recovery Audit Contractor (RAC) Program in 2013, according to a recent report by CMS. RACs found $3.75 billion in improper Medicare fee-for-service payments—$3.65 billion in overpayments and $102.4 in underpayments. Those amounts, plus operating and contingency fees, resulted in the $3 billion figure, significantly […]
Last week we reported the CMS announcement on ACO success—savings of $372 million and $445 million paid in bonuses. But a new report from Avalere Health notes that quality results are not keeping pace with cost reductions. It’s a prime example of ACO payment complexity. Medicare Shared Savings Program (MSSP) ACOs were not required […]