Noteworthy News

Archive for September, 2016


Risk Adjustment Needed for Joint Replacement Model, Study Says

Medicare’s Comprehensive Care for Joint Replacement bundled payment program will penalize hospitals that care for sicker patients unless it is risk-adjusted, according to a new study. The study, published in the journal Health Affairs, is based on an analysis of joint replacement procedures in Michigan between 2011 and 2013 and found that for every one standard deviation from the mean in patients’ medical complexity, the procedure cost the hospital an additional $827. Without risk adjustment, the study concluded, the program could be financially harmful to hospitals that care for more medically complex patients – or it could end up reducing access [&hellip

CMS Posts Tentative List of Essential Community Providers

The Centers for Medicare & Medicaid Services has posted on its web site a draft list of essential community providers for 2018. To qualify as essential community providers, organizations must serve predominantly low-income, medically underserved patients.  Qualified health plans must contract with at least 30 percent of the essential community providers in their markets and must offer contracts in good faith to at least one such provider in each of six categories, including federally qualified health centers, hospitals, and family planning providers. Providers that believe they have mistakenly been excluded from the list may petition for inclusion. Find the draft list [&hellip

Hospital Group Models Risk-Adjusted Medicare Readmissions

The Missouri Hospital Association has published data that demonstrates that risk-adjusting Medicare readmissions based on social determinants of health reduces the readmission rates of hospitals that care for large numbers of low-income patients. The data, modeling, and risk adjustment methodology, developed by the association based on data from Missouri hospitals, published on the association’s “Focus on Hospitals” web site, and described in an article on the NEJM Catalyst web site, showed that SDS [note:  sociodemographic status)-enriched models yielded significant relative reductions in the range of risk-standardized readmission ratios for each of…6 outcomes…Overall, SDS enrichment best improved the 30-day readmission assessments of hospitals that [&hellip

Amid Rising Improper Medicaid Payments, CMS Offers Help

With improper Medicaid payments nearly twice as high as they were just a few years ago, the Centers for Medicare & Medicaid Services is reaching out to state Medicaid programs with suggestions for how to reduce those improper payments. The problem? According to CMS, States are facing greater challenges keeping pace with stricter enrollment requirements, tracking providers who have been excluded from other States’ or Federal health care programs, and generally adapting to changing regulations for qualifications of certain provider types. In a new e-alert, CMS identifies factors that contribute to improper payments – things like ineligible and excluded providers, provider [&hellip

There’s More to Quality Than Readmissions, Study Suggests

Hospitals with high readmissions rates may also have lower mortality rates for some conditions, according to a new study. The study, published in the Journal of Hospital Medicine, found that patients suffering from heart failure, stroke, and chronic obstructive pulmonary disease who are served in hospitals with higher readmission rates have a slightly better chance of survival than if they were treated in hospitals with lower readmission rates. Such findings call into question the value of focusing on readmissions as a measure of the quality of care hospitals provide – a focus exemplified by Medicare’s hospital readmissions reduction program. Find the [&hellip

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