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Wednesday, Sep 28, 2016
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    SMA Informatics
    800 E. Leigh Street
    Suite 206-14 Building One
    Richmond, VA 23219

    Phone: (804) 344-8111
    FAX: (804) 344-8113

    Contact Form: Web Contact Form
Last Modified: August 25, 2016
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News Item - 09/12/2016
WalletHub Lists States With the Best and Worst Health Care
WalletHub, a personal finance website, has listed the best and worst health care states based on 29 metrics including average premiums, coverage rates and physicians per capita. The top five are: Minnesota, Maryland, South Dakota, Iowa and Utah, respectively. The bottom five: Arkansas, Nevada, Mississippi, Louisiana and Alaska.

For more information, click here.
News Item - 08/31/2016
Cesarean birth trends: Where you live significantly impacts how you give birth
The likelihood that an expectant mother will have a cesarean delivery1 is determined in large part by where she lives. An analysis of Blue Cross and Blue Shield (BCBS) companies’ data taken from 3 million deliveries by BCBS commercially-insured members shows that the rate of cesarean deliveries is more than twice as high in some parts of the country than in other parts and that even rates by U.S. Census Division vary by as much as 35 percent.

While geographic variation in cesarean deliveries is stark, the trend nationally may be shifting back toward vaginal deliveries. During a five-year period between July 2010 and June 2015, the cesarean rate decreased slightly each year within the BCBS population, to 33.7 percent from 35.2 percent.

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News Item - 08/11/2016
ICD-10 GEMS for 2017 Available
The 2017 General Equivalence Mappings (GEMs) are available, along with the ICD-10-CM and ICD-10-PCS code updates:

  • Diagnosis: 2017 ICD-10-CM and GEMs webpage

  • Procedures: 2017 ICD-10-PCS and GEMs webpage

News Item - 07/27/2016
Many Well-Known Hospitals Fail To Score 5 Stars In Medicare’s New Ratings
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.

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News Item - 07/22/2016
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.

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News Item - 07/18/2016
New Health System Scorecard Finds Improvement in Most U.S. Communities Since ACA Took Effect
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.

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News Item - 06/20/2016
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.

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News Item - 06/09/2016
CMS to initiate Medicare home health pre-claim review in five states
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.

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News Item - 04/22/2016
Increase in Suicide in the United States, 1999–2014
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).

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News Item - 03/05/2016
The Supreme Court’s wrongheaded decision in Gobeille.
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.

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Understanding MS-DRG Grouping under ICD-10
Understanding MS-DRG Grouping under ICD-10
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!

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SMA White Paper - 08/31/2015
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.

Read the paper...
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