Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings
by Jordan Rau
The federal government released its first overall hospital quality rating on Wednesday, slapping average or below average scores on many of the nation’s best-known hospitals while awarding top scores to dozens of unheralded ones.
The Centers for Medicare & Medicaid Services rated 3,617 hospitals on a one- to five-star scale, angering the hospital industry, which has been pressing the Obama administration and Congress to block the ratings. Hospitals argue the ratings will make places that treat the toughest cases look bad, but Medicare has held firm, saying that consumers need a simple way to objectively gauge quality.
Data Brief: Evaluation of National Distributions of Overall Hospital Quality Star Ratings
Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide care to their patients. This information can help consumers make informed decisions about their health care. The Centers for Medicare & Medicaid Services (CMS) has been posting quarterly hospital quality star ratings based on patients’ experience of care on the Hospital Compare website since April 16, 2015.
To continue our efforts to make quality of care information more readily available, we developed an Overall Hospital Quality Star Rating (Star Rating) that reflects comprehensive quality information about the care provided at our nation’s hospitals. We have previously stated our intention to begin posting this overall star rating on Hospital Compare in 2016, which we expect to begin shortly.
New Health System Scorecard Finds Improvement in Most U.S. Communities Since ACA Took Effect
by The Commonwealth Fund
Many U.S. communities saw gains in their health and health care between 2011 and 2014, but wide variation in progress indicates there is room for improvement across the country, The Commonwealth Fund’s newly updated Scorecard on Local Health System Performance finds.
Those areas of the U.S. that improved did so largely because more people had insurance coverage and could afford to get the care they needed, and because health care providers performed better on quality and efficiency measures—such as limiting hospital readmissions. The Affordable Care Act (ACA) has contributed to many of these improvements, the researchers say.
Medicare Will Use Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting in 2018
On June 17, the Centers for Medicare and Medicaid Services (CMS) released a final rule implementing Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), requiring laboratories performing clinical diagnostic laboratory tests to report the amounts paid by private insurers for laboratory tests. Medicare will use these private insurer rates to calculate Medicare payment rates for laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) beginning Jan. 1, 2018. The final rule includes provisions to ease administrative burdens for physician office laboratories and smaller independent laboratories.
CMS to initiate Medicare home health pre-claim review in five states
by AHA News Now
The Centers for Medicare & Medicaid Services yesterday announced a pre-claim review demonstration for all Medicare fee-for-service home health services in Illinois, Florida, Texas, Michigan and Massachusetts. Start dates will be determined in the coming months, but will be no earlier than Aug. 1 in Illinois, Oct. 1 in Florida, Dec. 1 in Texas, and Jan. 1 in Michigan and Massachusetts, the agency said. Under the three-year demonstration, the home health provider, billing entity or beneficiary will be encouraged to submit to the relevant Medicare Administrative Contractor a request for pre-claim review, along with relevant documentation, within 30 days of the beneficiary’s first treatment and before submitting the final claim.
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).
The Supreme Court’s wrongheaded decision in Gobeille.
by Nicholas Bagley
It never fails. You leave the country for a much-needed vacation and the Supreme Court drops an opinion you’ve been waiting for.
On March 1, in Gobeille v. Liberty Mutual, the Supreme Court rebuffed Vermont’s effort to lift the veil of secrecy surrounding health-care prices. In an opinion by Justice Kennedy, the Court held that ERISA prevented Vermont from applying its transparency law to require self-insured employers to report price data to a new state database. (For background, I’ve got an article in the New England Journal of Medicine on why I think the Court is wrong. Or just read Justice Ginsburg’s dissent.)
I’m late to the party, but I wanted to offer a few thoughts on the decision.
First, Gobeille will blow an enormous hole in the all-payer claims databases that eighteen states have moved to establish. Because two-thirds of all employers self-insure, the databases will lose about two-thirds of the data that they hoped to collect. That data loss will be non-random, too.
Study raises doubts that bundled payments cut costs
by Ron Shinkman
Many CMS models have yet to reduce spending
Bundled payments have been touted as a potential savior for keeping soaring healthcare costs in check, but a new analysis by the Kaiser Family Foundation (KFF) has raised early doubts about some of the initiatives being undertaken by the Centers for Medicare & Medicaid Services (CMS).
Alternate payment models such as bundled payments are continuing to grow dramatically. A recent American Medical Association study found nearly 60 percent of medical practices were enrolled in an alternative payment model.
Why Americans Have Shorter Lifespans Than People in Similar Nations
by Steven Reinberg
Study finds shootings, crashes and drug overdoses contribute to a 2-year gap in life expectancy
Car crashes, shootings and drug overdoses, which cause more than 100,000 deaths a year in the United States, may explain why Americans' life expectancy is lower than in similar countries, a new study suggests.
Americans' life expectancy is about two years shorter than residents of Austria, Denmark, Finland, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden and the United Kingdom. For U.S. men, that difference translates into 76.4 years versus 78.6 years, while it means 81.2 years versus 83.4 years for women, the researchers reported.
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.