Tag Archives: CMS

Re-admissions Penalties: What the Early Adopters are Saying

Thomas Finn - March 11, 2013 8:11 AM | Categories: General News and Commentary, government policy, Healthcare Providers, payers

We’ve all heard about Medicare penalizing hospitals that have unacceptable re-admission rates for select conditions. For obvious reasons, new types of penalties tend to stick in the front of everyone’s brain. The “new deal” for hospitals that exceed the number of expected re-admissions includes a range of penalties, with a maximum penalty increase in 2013 to 2 percent for discharges starting in 2013 and to 3 percent in 2014. Based on those penalties, Medicare may accumulate savings of up to $8.2 billion over the next seven years. More than 2,200 hospitals faced some level of penalty in the first year. The penalties amounted [...]

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Bundled Payment Momentum & Acceptance: It’s About Time

Thomas Finn - October 30, 2012 1:39 PM | Categories: doctors, government policy, Healthcare Providers, payers

As we wrote about last week, patient-centered medical homes and other accountable care-based delivery systems are already being developed and operated successfully under a variety of sanctioned “pilot” programs. There’s a remarkable amount of progress being made, despite the fact that the compensation models, including bundled payment schemes, have yet to be finalized and implemented. Let’s hope the momentum being created by the “pioneers” is not squandered by the bureaucrats.  Wes Champion is senior vice president of Performance Partners for the Premier healthcare alliance and he wrote the following: Last year, the Department of Health and Human Services announced a [...]

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Joint Commission Report Names 620 Hospitals as Top Performers

Thomas Finn - September 19, 2012 7:30 PM | Categories: General News and Commentary, government policy, Healthcare Providers

An independent, not-for-profit organization, the Joint Commission accredits and certifies more than 19,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized as a symbol of quality that reflects a hospital’s commitment to meeting certain performance standards. Standards that, under the Affordable Care Act, continue to evolve by type and importance. Should you care? Yes. A hospital’s CMS Certification Number (CCN) is the hospital’s identification number that is directly linked to its Medicare provider agreement. In other words, the CCN is used for CMS certification. Most hospitals seeking to participate in Medicare’s new [...]

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VHA, TransforMED and Phytel Awarded $20.75M “Innovation Grant”

Thomas Finn - June 20, 2012 5:56 PM | Categories: General News and Commentary, Healthcare Providers, Intermediaries/GPOs +, Supply Chains, Technology

All this talk about the Patient-Centered Medical Home has already given way to the “Patient Centered Medical Neighborhood?” The Center for Medicare & Medicaid Innovation (CMMI) announced Friday that it has awarded a $20.75 million Health Care Innovation Challenge grant to a partnership that includes VHA Inc., the national health care network; TransforMED, a not-for-profit subsidiary of the American Academy of Family Physicians; and, Phytel, Inc., a technology company that leads the field in automated, provider-led population health improvement solutions. The grant will fund a three-year national project involving health care systems, hospitals, and provider practices throughout 16 communities. The [...]

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“The Emergency Room (ER) is No Place to Wait”

Thomas Finn - February 1, 2012 3:37 PM | Categories: General News and Commentary, Healthcare Providers, Supply Chains

The greater Cincinnati area is a highly competitive acute care market, so hospitals don’t just differentiate across service lines; they aggressively promote better patient service as a competitive advantage. Facility cosmetics, better food, complementary amenities are all routinely talked about, but lower ER wait times is the current campaign du jour. Do you think an advertising campaign that promotes lower ER wait times has an audience? Apparently, for most people with any non-life threatening ER experience, that question is not only rhetorical; it’s almost insulting. “Our ability to consistently provide an exceptional patient experience with a strong emphasis on customer [...]

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Measuring Quality: 368 New Ideas For 2012

Thomas Finn - January 11, 2012 6:55 PM | Categories: General News and Commentary, Healthcare Providers

Healthcare Matters would like to welcome this guest post from Jordan Rau of the Kaiser Health News. How should Medicare and Medicaid measure doctors, hospitals, dialysis centers and other health care providers it pays? There are 368 new ideas on the table this year, according to a list compiled by the Centers for Medicare & Medicaid Services. CMS estimates 60 will be adopted in 2012. Figuring out how to fairly and accurately assess the care that health providers are giving is a key component of the Affordable Care Act’s effort to move the government and private insurers away from paying [...]

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Medicare Expanding Competitive Bidding –Program To Save Billions

Thomas Finn - December 2, 2011 1:22 PM | Categories: General News and Commentary, Technology

Amidst all kinds of opposition that includes 145 members of Congress, CMS announced the expansion of its competitive bidding program yesterday.  Although criticism from the home care companies whose margins will be directly impacted was to be expected, 244 sourcing “experts” sent a letter to the President that pointed out a more fundamental problem: “The use of non-binding bids together with setting the price equal to the median of the winning bids provides a strong incentive for low-ball bids – submitting bids dramatically below actual cost. Bidder quantities are chosen arbitrarily by CMS, enabling a wide range of prices to [...]

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CMS Lowers The Bar To Motivate ACO Participation — For the Right Reasons?

Thomas Finn - October 24, 2011 6:28 PM | Categories: General News and Commentary, Healthcare Providers

Editor’s Note: The following is a summary largely by the Centers for Medicare & Medicaid Services (CMS), regarding its recent (October 20 –last Thursday afternoon) and final rulings on Accountable Care Organizations ACOs. Created by the Affordable Care Act (PPACA), these final rules represent significant change to previous proposals (“draft rules”) made by the CMS – draft rules that drew substantial criticism (1300+ public comments) and were widely rejected by the hospitals and physician groups that are the intended beneficiaries of the program. Keep in mind that the ACO concept is a founding tenet of the PPACA (and yet the [...]

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CMS & Competitive Bidding — A Laughable Blind Spot

Thomas Finn - October 18, 2011 6:18 PM | Categories: General News and Commentary, Technology

Back in 2003, the Medicare Modernization Act established a competitive bidding program for durable medical equipment, prosthetics, orthotics and general supplies.  That list became known as “DMEPOS.” Under the program, DMEPOS suppliers would submit bids to the Centers for Medicare and Medicaid Services (CMS) and contracts would be awarded.  The winning bids would replace the DMEPOS fee schedule — it was correctly assumed that money would be saved — and those savings would benefit the out-of-pocket expenses of the intended beneficiaries and, of course, taxpayers. Simple enough. The DMEPOS competitive bidding program would be “phased in.” Put another way, it [...]

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