Researchers Target the 7 Deadliest and Most Expensive Emergency Surgeries
by Jim Burger
Together, they account for more than 80% of deaths and inpatient costs.
Seven procedures collectively account for 80% of emergency surgeries, deaths, complications and costs related to emergency surgeries in the United States, a new study published in JAMA Surgery finds.
The 7 — partial colectomy, small-bowel resection, cholecystectomy, operative management of peptic ulcer disease, lysis of peritoneal adhesions, appendectomy and laparotomy — represent a cross-section of surgeries that are either extremely common (appendectomy and cholecystectomy, for example) and/or that have relatively high mortality rates (laparotomy and management of peptic ulcer).
The study was based on more than 400,000 cases between 2008 and 2011. Mortality rates ranged from 0.08% for appendectomies to 23.8% for laparotomies. So while the mortality rate for appendectomies (about 1 of every 1,250 patients) is extremely low compared with most other emergency procedures, its high incidence boosts its importance. In contrast, laparotomies are performed only about 1.4% as often as appendectomies, but have a mortality rate approximately 300 times higher.
Complication rates ranged from 7.3% for appendectomies to 46.9% for small-bowel resections; and mean inpatient costs ranged from $9664.30 for appendectomies to $28,450.72 for small-bowel resections.
The 7 surgeries warrant special attention when it comes to establishing quality standards and reducing costs, say the authors. "National quality benchmarks and cost-reduction efforts should focus on these common, complicated and costly procedures," the authors conclude.
News Item - 04/27/2016
Administration takes first step to implement legislation modernizing how Medicare pays physicians for quality
The Department of Health and Human Services today issued a proposal to align and modernize how Medicare payments are tied to the cost and quality of patient care for hundreds of thousands of doctors and other clinicians. The Notice of Proposed Rulemaking is a first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This legislation – supported by a bipartisan majority and stakeholders such as patient groups and medical associations – ended more than a decade of last-minute fixes and potential payment cliffs for Medicare doctors and clinicians, while making numerous improvements to America’s health care system.
Increase in Suicide in the United States, 1999–2014
by Sally C. Curtin, M.A., Margaret Warner, Ph.D., and Holly Hedegaard, M.D., M.S.P.H.
Suicide is an important public health issue involving psychological, biological, and societal factors. After a period of nearly consistent decline in suicide rates in the United States from 1986 through 1999, suicide rates have increased almost steadily from 1999 through 2014. While suicide among adolescents and young adults is increasing and among the leading causes of death for those demographic groups, suicide among middle-aged adults is also rising. This report presents an overview of suicide mortality in the United States from 1999 through 2014. Suicide rates in 1999 are compared with 2014 for both females and males across age groups, and percentages are compared by method (firearms, poisoning, suffocation, and other means).
Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Proposed Rule Issues for Fiscal Year (FY) 2017
On April 18, 2016 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update fiscal year (FY) 2017 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed rule, which would apply to approximately 3,330 acute care hospitals and approximately 430 LTCHs, would affect discharges occurring on or after October 1, 2016.
IMS Health Study: U.S. Drug Spending Growth Reaches 8.5 Percent in 2015
by Tor Constantino
Specialty Medicine Innovation Drives Growth, Partially Offset by Price Concessions from Manufacturers
Total spending on medicines in the U.S. reached $310 billion in 2015 on an estimated net price basis, up 8.5 percent from the previous year, according to a new report issued today by the IMS Institute for Healthcare Informatics. The surge of new medicines remained strong last year and demand for recently launched brands maintained historically high levels. The savings from branded medicines facing generic competition were relatively low in 2015, and the impact of price increases on brands was limited due to higher rebates and price concessions from manufacturers. Specialty dug spending reached $121 billion on a net price basis, up more than 15 percent from 2014.
CMS launches largest-ever multi-payer initiative to improve primary care in America
CMS launches largest-ever multi-payer initiative to improve primary care in America New Affordable Care Act initiative, designed to improve quality and cost, gives doctors and patients more control over health care delivery
The Centers for Medicare & Medicaid Services (CMS) today announced its largest-ever initiative to transform and improve how primary care is delivered and paid for in America. The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care.
Millions of seniors who depend on Medicare Advantage plans could face additional threats to their coverage and benefits if new payment changes recently proposed by CMS take effect next year, according to a new analysis by Oliver Wyman prepared for America’s Health Insurance Plans (AHIP).
Last month, CMS released proposed changes to Medicare Advantage that will impact the 17 million seniors enrolled in the program. According to the report from Oliver Wyman, these changes, if finalized, would result in an estimated 0.5 to 3.9 percent cut on average to Medicare Advantage payments in 2017.
Understanding the Impact of Medicare Advantage on Hospitalization Rates
by Stephen Petterson, PhD; Andrew Bazemore, MD, MPH; Yalda Jabbarpour, MD; Peter Wingrove, BS
Greater use of Medicare Advantage (MA) over traditional fee-for-service Medicare (TM) in certain populations, and even across small areas, has been associated with fewer overall hospitalizations and avoidable hospitalizations. Proponents suggest that these associations stem from successful care management, and a focus on preventive services and primary care among MA users. Detractors intimate that selection bias of healthier individuals into MA plans and other external factors may favorably influence hospitalization rates more than the structure of MA plans and the incentives this structure creates. We set out to update and advance previous analyses using the most contemporary multi-state hospitalization data.
The Medicare Payment Advisory Commission yesterday released its March report to Congress. The report details fee-for-service payment recommendations for 2017 approved by the commission in January, including recommendations for hospital services and post-acute care. For more information, see the MedPAC factsheet.
ICD-10 to add thousands of new diagnosis and procedure codes in FY 2017
The Centers for Medicare & Medicaid Services and Centers for Disease Control and Prevention will add about 1,900 diagnosis codes and 3,651 hospital inpatient procedure codes to the ICD-10 coding system for health care claims in fiscal year 2017, the agencies announced this week. The large number of new codes is due to a partial freeze on updates to the ICD-10-CM and ICD-10 PCS codes prior to implementation of ICD-10 on Oct. 1, 2015. Both new and revised PCS codes are available at www.cms.gov. The new diagnosis codes will be included in the hospital inpatient prospective payment system proposed rule for FY 2017, expected next month.
Understanding MS-DRG Grouping under ICD-10
Understanding MS-DRG Grouping under ICD-10
by Rayellen Kishbach
Now that ICD-10 is in full swing, we are seeing a lot of activity with providers, payers, consultants and regulators who need to understand how Acute Inpatient and Long Term Care Hospital claims "behave" when the claim is coded in ICD-10. This includes both prospective and retrospective review of claims scenarios to understand MS-DRG grouping. This article offers a basic primer on MS-DRG grouping logic, and research techniques for using related MediRegs Coding Suite tools. If you'd like a personalized training on these tools, or a demonstration of them in action to see if they are a good fit for your research scenarios, please let us know!
OVERVIEW OF THE FY 2016 IPPS FINAL RULE: SUMMARY OF CALCULATION ELEMENTS
New Health Analytics, a national healthcare software developer and data analytics firm, is pleased to announce that it has released a special report with an concise review of the FY 2016 Hospital Inpatient Prospective Payment System (IPPS) Final Rule recently posted by the Centers for Medicare & Medicaid Services.