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CMS PROPOSALS TO IMPROVE QUALITY OF CARE DURING HOSPITAL INPATIENT STAYS
On Apr. 26, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospitals Prospective Payment System (LTCH PPS) in Fiscal Year (FY) 2014.
The proposed rule, which would apply to approximately 3,400 acute care hospitals and approximately 440 LTCHs, would affect discharges occurring on or after October 1, 2013.Continue reading...
Analysis Details Wasteful, Fraudulent Claims Paid by Employers
New analysis of commercial insurance claims for 11.6 million individuals and dependents at 150 large employers finds six types of fraudulent or wasteful claims result in $122.6 million in annual overpayments.Continue reading...
Report to the Congress: Medicare and the Health Care Delivery Systemby Glenn M. Hackbarth, J.D., Michael E. Chernew, Ph.D., Mark E. Miller, Ph.D.
The Commission’s June 2013 Report to the Congress examines a variety of Medicare payment system issues. The report discusses competitively determined plan contributions, reducing payment differences across ambulatory settings, bundling post-acute care services, Medicare’s hospital readmissions reduction program, the hospice payment system , and care needs for beneficiaries eligible for both Medicare and Medicaid benefits.Continue reading...
Comment Period on Revised Forms for Prototype Consumer Patient Safety Reporting System Open Until July 8
In an effort to realize the untapped potential of health care consumers to provide local providers with their important perspective regarding adverse events they have experienced, the Agency for Healthcare Research and Quality
has funded the development of a prototype Consumer Reporting System for Patient Safety (CRSPS)
. The prototype is designed for hospitals, systems, group practices, and others to collect information from patients about adverse events that resulted or nearly resulted in harm or injury. The purpose of this project is to test this prototype for its ability to record data from consumers about patient safety events that are defined as an “incident” or “near miss” by the AHRQ Common Formats
To Expand or Not to Expand? States' Medicaid Dilemma
Analysis Finds States that Expand Medicaid will See Budget Gains and Greater Employment
In 2014, many states will expand Medicaid to cover their poor and near-poor residents, but others will not. As the undecided states make up their minds, a new report shows that, in 10 diverse states, very different approaches were taken to analyze impacts. Those states that conducted comprehensive analyses found that Medicaid expansion will see: (a) net state budget gains and (b) increased employment and tax revenues.Learn what factors 10 states are using to make Medicaid expansion decisions.
New brief and data for end-of-life care
A new Dartmouth Atlas brief released today demonstrates that improvements in care have occurred between 2007 and 2010 for chronically ill Medicare patients in their last six months of life.
However, the pace of change varied across regions and hospitals, with some experiencing rapid change while other health systems showed little improvement.Read the brief...
Is the "Private Option" a Viable One for Expanding Medicaid?
New Brief Examines Shifting Medicaid Recipients Into Private Health Plans
States that oppose the ACA’s Medicaid expansion stand to lose millions in new federal funding and risk leaving a sizable portion of their low-income residents uninsured. Some of these states are now considering a plan to provide Medicaid recipients with a voucher to purchase private insurance on the state exchanges. A new policy brief from Health Affairs and RWJF examines whether such a “private option” can be cost-effective and still provide benefits equal to those provided by the traditional Medicaid program.Continue reading...
Declining Medicine Use and Costs: For Better or Worse?
Murray Aitken, Executive Director of the IMS Institute for Healthcare Informatics, discusses key findings from the new IMS Institute report Declining Medicine Use and Costs: For Better or Worse?Continue reading...
Innovation director of CMS is moving on
by Jennifer Haberkorn
The innovation center charged by the health reform law with finding solutions to the toughest questions in health care — how to reduce costs and change the way health care is delivered — is losing its first leader.
Report (OEI 07-09-00440): Improvements Are Needed To Ensure Provider Enumeration and Medicare Enrollment Data Are Accurate, Complete, and Consistent
Health care provider information, including providers' unique National Provider Identifiers (NPIs), is maintained in the National Plan and Provider Enumeration System (NPPES). To enroll in Medicare, providers must supply their NPIs and other information to CMS to be entered into the Provider Enrollment, Chain and Ownership System (PECOS). Accurate, complete, and consistent provider data in NPPES and PECOS help to ensure the integrity of all health care programs. Previous OIG work has revealed ongoing problems with CMS's oversight of provider data, sometimes resulting in improper Medicare payments to fraudulently enrolled providers.Read the report...
Spotting preventable readmissions
Scorecard detects one-in-four high-risk patients before discharge
With hospitals nationwide feeling the burden of Medicare penalties for avoidable 30-day readmissions, C-suite managers have been frantically searching for ways to pinpoint these high-risk patients early on. A recent analysis suggests a low-cost and simple scorecard that detects one out of four of these patients.
With the help of an algorithm that was based on administrative data (SQLape), investigators from Harvard Medical School, looked at potentially avoidable 30-day readmissions at three hospitals in Boston’s Partners Healthcare network. They used the data to formulate a scoring system that included 10 risk factors that hospitals may want to use to spot high-risk (and expensive) patients.