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 […]
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 […]