Pioneer accountable care organizations (ACOs) and Medicare Shared Savings Program (MSSP) ACOs have saved $372 million to date and provided participants $445 million in bonuses, the Centers for Medicare and Medicaid (CMS) reported this week. The results came from preliminary quality and financial results from the second year of 23 pioneer ACOs, and from […]
Two recent studies on emergency departments (ED) show two sides to patients’ use of the ED. Researchers from the Colorado Hospital Association (CHA) reported that Medicaid enrollees added under healthcare reform are both sicker and increasing their use of hospital EDs. The national analysis is based on data from 450 hospitals in 25 states, […]
When hospitals appeal a claim denial by CMS, the wait time for a decision currently averages 489 days compared to the 90 days required by law. Both the American Hospital Association and the Center for Medicare Advocacy have filed lawsuits to compel the Secretary of Health and Human Services to meet statutory deadlines for reviewing […]
Historical revenue growth for not-for-profit hospitals has tended to hover around 7 percent annually, but in the last year, it dropped to 3.9 percent, the lowest level on record, according to a new report by Moody’s Investors Service. Both a drop in hospital admissions (a first) and growth in expenses contributed to the decline. […]
Patient-centered medical homes are one of the delivery system innovations encouraged by the Affordable Care Act (ACA). But recent studies present a mixed picture of the effectiveness of medical homes in improving quality and reducing costs through care coordination. The National Committee for Quality Assurance (NCQA) has been “designating” medical homes since it started […]
Hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users will see an increase of 1.4 percent operating payment rates for inpatient stays in 2015, according to a final rule released last week by CMS. However, overall payments under the Inpatient Prospective Payment System […]
The bundled payment initiative initially attracted about 2,400 providers over the 18 months since it was launched in January 2013. CMS recently announced an additional 4,100 provider candidates in the initiative, bringing the total to approximately 6,500. These candidates will analyze Medicare spending data to decide whether to enter into bundled-payment contracts. Under these […]
30-day readmission penalties may unfairly impact safety net hospitals because those facilities tend to care for more patients with socio-economic challenges, according to researchers and health policy analysts. Earlier this year, the National Quality Forum (NQF) issued a draft report where it noted: “failing to adjust performance measures for socio-demographic factors could produce incorrect […]
Traditionally, Medicare has required that its beneficiaries have at least three days in the hospital to qualify for follow-up nursing home care. The Centers for Medicare and Medicaid Services (CMS) is testing the effectiveness of that requirement by exempting patients at some hospitals participating in certain Affordable Care Act (ACA) pilot projects. These projects have […]
Hospitals may have some leeway with the controversial two-midnight rule. Buried in the Centers for Medicare and Medicaid (CMS) proposed rule to increase outpatient rates (reported here in last week’s newsletter blog) is a plan to alter the two-midnight inpatient admissions rule. The two-midnight rule requires physicians to document that they expect the patient must […]