The list of hospital acquired conditions (HACs) subject to a specific payment policy by CMS fails to provide a complete picture of the quality of patient care in a particular hospital, according to a new report by Premier. Although the CMS HACs “are important events to prevent, an exclusive focus on these conditions will […]
The Centers for Medicare & Medicaid Services (CMS) recently issued final revisions to the Medicare conditions of participation (CoPs) that pertain to medical staff organization and participation in hospital governance. The key revisions include the following: Removing the requirement that a medical staff member serve on the governing body Allowing for a unified and […]
Hospitals have decreased the frequency of patient harm and readmissions over the last two years, according to a new report from the Centers for Medicare & Medicaid Services (CMS). Experts credit the new quality initiatives in the Affordable Care Act (ACA), but some patient safety improvements preceded that law. (“Hospitals Boost Patient Safety, But More […]
The Centers for Medicare & Medicaid Services (CMS) has proposed a 1.3 percent increase in payments to hospitals under the inpatient prospective payment system (IPPS) for 2015. However, it projects a decrease in overall payments of about $241 million, primarily because of payment reductions for readmissions and hospital acquired conditions (HAC). Provisions related to readmissions […]
A National Quality Forum (NQF) panel commissioned to study quality and risk adjustment for socioeconomic status suggests that hospitals treating a large number of poor people face significant disadvantages in achieving the high quality necessary for payment under pay for performance. Because Medicare and other payers either are or will be paying hospitals and […]
Last week we reported on a new report that found no conclusive relationship between hospital consolidation and price increases in a community. There is a new wrinkle, however. A hospital or system merger with a large physician group practice may not pass the competition/price increase test. In Idaho last month, a district judge sided with […]
About half of Medicare’s accountable care organizations (ACOs) saved the program money in their first year of operation, but only 25 percent of participants earned a share of those savings, according to an announcement by the Centers for Medicare & Medicaid Services (CMS) on January 30. In 2012, the first year of Medicare’s ACO […]
The Institute of Medicine’s (IOM) Digital Learning Collaborative and members of the Healthcare Financial Management Association (HFMA) have developed a new model that helps hospital executives and boards assess the return on investment of their electronic health record (EHR) systems and how to best configure these systems “to achieve optimal value,” according to a recent […]
Notice: The iProtean Newsletter will be on holiday from December 24 through January 1. Please look for your next newsletter on January 8, 2014. Have a peaceful holiday season and a prosperous New Year! It looks as if a fix to the sustainable growth rate (SGR) formula for paying physicians may be realized in […]
Compliance and risk management efforts of hospitals and health systems should focus on indications from the Department of Health & Human Services (HHS) Office of the Inspector General (OIG) about the direction it intends to take to investigate fraud, waste and abuse. We have talked with OIG investigators over the years who have been straightforward […]