Medicare uses the Inpatient Prospective Payment System (IPPS) to provide fixed, prospectively determined payments to hospitals for inpatient care based on Medicare Severity Diagnosis-Related Groups (MS-DRGs). IPPS aims to encourage efficiency while also exposing hospitals to cost risk. Certain hospitals like sole community hospitals may receive special exempted payments based on historical rates. Components of the IPPS payment like operating costs are fixed prospectively, while others like indirect medical education costs vary by individual hospital. Some inpatient payments occur outside IPPS through cost-based reimbursement.
Uncertain future of medicare pass throughs and add-onsBESLER
Very few items are still settled on your cost report. With so many changes resulting from the ACA and other potential initiatives being discussed every day, your organization should be acutely aware of the total amount of Medicare Revenue that is at risk. There is talk of eliminating, greatly reducing or completely altering payment methodologies that hospitals have become so reliant on for so long. Revenue potentially at risk includes Medicare Bad Debt, Nursing Allied Health, Graduate Medical Education, Wage Index adjustments, and Transplant.
The Uncertain Future of Medicare Add-Ons and Pass-ThroughsBESLER
With so many changes resulting from the Patient Protection and Affordable Care Act (ACA) and other potential initiatives under consideration, a significant amount of your organization’s future Medicare revenue may be at risk. The trend to reduce and/or revamp payment methodologies comes at a time when hospitals face shrinking or non-existent margins. Revenue sources potentially on the chopping block include Medicare Bad Debt, Nursing Allied Health, Graduate Medical Education, Wage Index adjustments, and transplant, to name a few. Additionally, the Office of Inspector General (OIG) continues to add reimbursement-related topics to its annual Work Plan, expanding the areas for potential paybacks or penalties.
In order to help ETC Model Participants prepare for the ETC Model, CMS conducted an introductory webinar on Wednesday, December 9, 2020 from 1 p.m. to 2 p.m. The webinar provided an overview of the ETC Model, including:
Participant selection
The Home Dialysis Payment Adjustment
The Performance Payment Adjustment
The ETC Model timeline, including the timing of payment adjustments
Information about how to communicate with CMS about the ETC Model
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
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http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Learn about the background and impact of Medicare Transfer DRG payments. Includes information about discharge status codes, transfer payment calculations, and examples of overpayment and underpayment scenarios.
How Medicare Indirect Medical Education (IME) Underpayments OccurBESLER
Learn about common problems associated with reimbursement for Medicare Indirect Medical Education (IME) and how your hospital can avoid underpayment situations. Slides include background information on Indirect Medical Education (IME), examples of how reimbursement issues can occur, and additional learning resources.
The CMS Innovation Center held the second in a series of webinar events for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Wednesday, June 8, 2016 from 12:00p.m. – 1:30p.m. EDT. This webinar consisted of a panel discussion focusing on learning from past ESCO participants on what it takes to become a successful applicant and successful ESCO.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare Advantage Value-Based Insurance Design Model team hosted a webinar on Thursday, February 14 from 12:00 p.m. - 1:00 p.m. EST discussing the evaluation findings from the first year of the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering benefit enhancements for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 19 from 4:00pm – 5:30pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Uncertain future of medicare pass throughs and add-onsBESLER
Very few items are still settled on your cost report. With so many changes resulting from the ACA and other potential initiatives being discussed every day, your organization should be acutely aware of the total amount of Medicare Revenue that is at risk. There is talk of eliminating, greatly reducing or completely altering payment methodologies that hospitals have become so reliant on for so long. Revenue potentially at risk includes Medicare Bad Debt, Nursing Allied Health, Graduate Medical Education, Wage Index adjustments, and Transplant.
The Uncertain Future of Medicare Add-Ons and Pass-ThroughsBESLER
With so many changes resulting from the Patient Protection and Affordable Care Act (ACA) and other potential initiatives under consideration, a significant amount of your organization’s future Medicare revenue may be at risk. The trend to reduce and/or revamp payment methodologies comes at a time when hospitals face shrinking or non-existent margins. Revenue sources potentially on the chopping block include Medicare Bad Debt, Nursing Allied Health, Graduate Medical Education, Wage Index adjustments, and transplant, to name a few. Additionally, the Office of Inspector General (OIG) continues to add reimbursement-related topics to its annual Work Plan, expanding the areas for potential paybacks or penalties.
In order to help ETC Model Participants prepare for the ETC Model, CMS conducted an introductory webinar on Wednesday, December 9, 2020 from 1 p.m. to 2 p.m. The webinar provided an overview of the ETC Model, including:
Participant selection
The Home Dialysis Payment Adjustment
The Performance Payment Adjustment
The ETC Model timeline, including the timing of payment adjustments
Information about how to communicate with CMS about the ETC Model
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Learn about the background and impact of Medicare Transfer DRG payments. Includes information about discharge status codes, transfer payment calculations, and examples of overpayment and underpayment scenarios.
How Medicare Indirect Medical Education (IME) Underpayments OccurBESLER
Learn about common problems associated with reimbursement for Medicare Indirect Medical Education (IME) and how your hospital can avoid underpayment situations. Slides include background information on Indirect Medical Education (IME), examples of how reimbursement issues can occur, and additional learning resources.
The CMS Innovation Center held the second in a series of webinar events for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model on Wednesday, June 8, 2016 from 12:00p.m. – 1:30p.m. EDT. This webinar consisted of a panel discussion focusing on learning from past ESCO participants on what it takes to become a successful applicant and successful ESCO.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare Advantage Value-Based Insurance Design Model team hosted a webinar on Thursday, February 14 from 12:00 p.m. - 1:00 p.m. EST discussing the evaluation findings from the first year of the model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering benefit enhancements for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 19 from 4:00pm – 5:30pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The CMS Innovation Center hosted a repeat of the Thursday, November 6 ACO Investment Model webinar on Tuesday, November 18, 2014, from 2:30pm-3:30pm EST. The webinar provided guidance on the ACO Investment Model (AIM) application to prospective ACO applicants. The webinar included a review of the model eligibility requirements and an explanation of each application question including the spend plan narrative and spreadsheet.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
On Tuesday, April 9 from 2:00 p.m. - 3:00 p.m. EDT the Medicare Advantage Value-Based Insurance Design Model team provided an overview of the model’s main goals and guiding principles, provided a brief review of Medicare Advantage and the Medicare Hospice Benefit, introduced the key model design considerations, and provided a general timeline for the coming months.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Services hosted a webinar on Thursday, April 14, 2016. During this webinar staff provided an overview of the model. A repeat of the webinar was held on Tuesday, April 19.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
On Thursday, April 18 from 1:00 p.m. - 2:00 p.m. EDT the Artificial Intelligence (AI) Health Outcomes Challenge team provided an informational overview of the challenge.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this webinar, staff from the CMS Innovation Center provided an overview of the Demonstration, and offered information about how to apply.
More at: http://www.innovations.cms.gov/resources/GNE_overview.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted the first in a series of open door forums focusing on various aspects of the Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Kidney Care Choices (KCC) Model team hosted a Comprehensive Kidney Care Contracting (CKCC) Model Options finance webinar on Friday, November 22, 2019 from 12:00 p.m. - 1:00 p.m. EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with...PYA, P.C.
PYA Principal Carol Carden co-presented “The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with Value-Based Payment Models” at the 2017 American Health Lawyers Association Physician and Hospitals Law Institute, February 1-3, 2017, in Orlando, Florida.
The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
Implementing Bundled Payments: A Deeper DiveWellbe
A Bundled Payment can be defined as “a single package price that provides a positive margin for a comprehensive and specific set of healthcare services delivered by multiple providers over a specified period of time.”
There is growing consensus that this payment methodology, and the powerful spillover effect from extensive care redesign associated with its implementation, may be the most effective strategy to reduce spiraling healthcare costs.
The secondary hypothesis is that bundled payment creates sufficient financial incentives to encourage multiple stakeholders to re-align and focus on improving the value of healthcare delivered to the patient.
There is data, including from the Connecticut Joint Replacement Institute (CJRI), which supports these hypotheses. Despite growing interest in bundled payment methodology, however, there are numerous upside challenges and downside risks. In this webinar, these issues will be reviewed and a cogent strategy for implementing a bundled payment program presented.
About the Speaker:
Dr. Steven F. Schutzer graduated with Honors from Union College 1974 and then the University of Virginia School Of Medicine in 1978. Dr. Schutzer was a Lieutenant in the Medical Corps of the United States Navy between 1979 and 1981. He did his General Surgical training at the University of Rochester and then completed his Orthopedic Residency at the University of Connecticut in 1985. He was then a Fellow in Adult Hip and Reconstructive Surgery at the Massachusetts General Hospital and entered practice with Orthopedic Associates of Hartford in July 1986.
He is currently on the staff of St. Francis Hospital, Hartford Hospital and the University of Connecticut John Dempsey Hospital. Dr. Schutzer is a Founding Member and the Medical Director of the Connecticut Joint Replacement Institute. He is also President of Connecticut Joint Replacement Surgeons, LLC. Dr. Schutzer is a member of AAOS, AAHKS, and the Orthopedic Research Society.
The Medicare-Medicaid Accountable Care Organization (ACO) Model team hosted a webinar on Thursday, June 8, 2017 that covered the high-level processes for assigning beneficiaries to Medicare-Medicaid ACOs and calculating savings/losses generated by Medicare-Medicaid ACOs. The webinar also covered the role of participating states in designing the details of these methodologies.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This open door forum provided follow up information to 2014 Shared Savings Program ACOs applying to AIM, including suggestions and resources to consider when submitting their application. Attendees had the opportunity to ask subject matter experts questions about the AIM application process.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this July 18, 2012 webinar CMS Innovation Center staff discussed how applicants can apply and prepare their budget for the Strong Start funding opportunity.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Thursday, January 30, 2020 to provide information and answer questions about the hospice benefit component recently added to the Value Based Insurance Design (VBID) Model. The Centers for Medicare & Medicaid Services announced in January 2019 that beginning in calendar year 2021, the VBID Model will test including the Medicare hospice benefit in Medicare Advantage.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering population based payments and all inclusive population based payments for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 26 from 4:00pm – 5:00pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Advisor Live: Proposed Episode Payment Models for AMI, CABG, and Hip and Femu...Premier Inc.
On July 25, 2016, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to establish three new bundled payment policies for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) and surgical hip and femur fracture treatment (SHFFT). Collectively, the models are referred to as Episode Payment Models (EPMs). The new payment models will be mandatory for hospitals in particular geographic regions.
CMS proposes to test the EPM models for a five-year performance period, beginning July 1, 2017, and ending Dec. 31, 2021. The proposed rule also includes changes to the Comprehensive Care for Joint Replacement Model and proposes to establish an incentive payment to hospitals for coordinating cardiac rehabilitation and intensive cardiac rehabilitation services. CMS is accepting comments on the proposed rule until Oct. 3, 2016.
This webinar provides an overview of the proposed rule, including:
- Background and rationale for new payment models,
- Inclusion and exclusion criteria,
- Payment methodology,
- Quality performance in the payment methodology, and
- Legal waivers.
The Changing Healthcare System and Impact of MACRAPYA, P.C.
PYA Principal Lori Foley and Consulting Senior Aaron Elias co-presented “The Changing Healthcare System and Impact of MACRA” at the Physician Insurers Association of America’s CEO/COO Meeting.
The Medicare Access & CHIP Reauthorization Act (MACRA) dramatically affected Medicare reimbursements to healthcare providers, as well as provided a new framework for rewarding quality care and reporting on quality measurements. This incentive-based system has the potential not only to change how medicine is practiced, but influence patient perception of care. The presentation will provide the latest information on MACRA implementation, and will detail how the aforementioned changes will impact miscellaneous professional liability insurers.
Learn the relationship between physician productivity and physician pay to better understand how the healthcare system works. Factors like practice expenses and bonuses are also discussed.
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
Speaking before the Georgia Pediatric Practice Managers Association, PYA Consultant and ICD-10-CM Trainer Kim-Marie Walker addressed recent ICD-10 developments along with basic guidance for the transition, including:
• Comparison of ICD-9 and ICD-10
• ICD-10 organizational and structural differences
• Vendor recommendations and available resources
• Transition planning and roles
Digital Content for Physicians in Global MarketsDRG Digital
Overview of emerging trends in physician digital behavior and engagement opportunities across 22 global markets in Latin America, Asia Pacific, the Middle East, and other emerging markets.
• Partnerships with local publishers to distribute content
• Social networks as a critical physician resource
• Demand for patient-oriented and value-added information and services in the evolving healthcare ecosystem
The CMS Innovation Center hosted a repeat of the Thursday, November 6 ACO Investment Model webinar on Tuesday, November 18, 2014, from 2:30pm-3:30pm EST. The webinar provided guidance on the ACO Investment Model (AIM) application to prospective ACO applicants. The webinar included a review of the model eligibility requirements and an explanation of each application question including the spend plan narrative and spreadsheet.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
On Tuesday, April 9 from 2:00 p.m. - 3:00 p.m. EDT the Medicare Advantage Value-Based Insurance Design Model team provided an overview of the model’s main goals and guiding principles, provided a brief review of Medicare Advantage and the Medicare Hospice Benefit, introduced the key model design considerations, and provided a general timeline for the coming months.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Services hosted a webinar on Thursday, April 14, 2016. During this webinar staff provided an overview of the model. A repeat of the webinar was held on Tuesday, April 19.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
On Thursday, April 18 from 1:00 p.m. - 2:00 p.m. EDT the Artificial Intelligence (AI) Health Outcomes Challenge team provided an informational overview of the challenge.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this webinar, staff from the CMS Innovation Center provided an overview of the Demonstration, and offered information about how to apply.
More at: http://www.innovations.cms.gov/resources/GNE_overview.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In follow-up to the March 10, 2015 announcement of the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) hosted the first in a series of open door forums focusing on various aspects of the Model.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Kidney Care Choices (KCC) Model team hosted a Comprehensive Kidney Care Contracting (CKCC) Model Options finance webinar on Friday, November 22, 2019 from 12:00 p.m. - 1:00 p.m. EST.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with...PYA, P.C.
PYA Principal Carol Carden co-presented “The Vicissitudes of Valuing Value--Legal and Valuation Issues Associated with Value-Based Payment Models” at the 2017 American Health Lawyers Association Physician and Hospitals Law Institute, February 1-3, 2017, in Orlando, Florida.
The presentation addressed:
Emerging alternative payment models (APMs)
The application of fraud and abuse laws and IRS rules to provider network payments
Existing market data and regulatory guidance
Considerations in determining fair market value and commercial reasonableness
Implementing Bundled Payments: A Deeper DiveWellbe
A Bundled Payment can be defined as “a single package price that provides a positive margin for a comprehensive and specific set of healthcare services delivered by multiple providers over a specified period of time.”
There is growing consensus that this payment methodology, and the powerful spillover effect from extensive care redesign associated with its implementation, may be the most effective strategy to reduce spiraling healthcare costs.
The secondary hypothesis is that bundled payment creates sufficient financial incentives to encourage multiple stakeholders to re-align and focus on improving the value of healthcare delivered to the patient.
There is data, including from the Connecticut Joint Replacement Institute (CJRI), which supports these hypotheses. Despite growing interest in bundled payment methodology, however, there are numerous upside challenges and downside risks. In this webinar, these issues will be reviewed and a cogent strategy for implementing a bundled payment program presented.
About the Speaker:
Dr. Steven F. Schutzer graduated with Honors from Union College 1974 and then the University of Virginia School Of Medicine in 1978. Dr. Schutzer was a Lieutenant in the Medical Corps of the United States Navy between 1979 and 1981. He did his General Surgical training at the University of Rochester and then completed his Orthopedic Residency at the University of Connecticut in 1985. He was then a Fellow in Adult Hip and Reconstructive Surgery at the Massachusetts General Hospital and entered practice with Orthopedic Associates of Hartford in July 1986.
He is currently on the staff of St. Francis Hospital, Hartford Hospital and the University of Connecticut John Dempsey Hospital. Dr. Schutzer is a Founding Member and the Medical Director of the Connecticut Joint Replacement Institute. He is also President of Connecticut Joint Replacement Surgeons, LLC. Dr. Schutzer is a member of AAOS, AAHKS, and the Orthopedic Research Society.
The Medicare-Medicaid Accountable Care Organization (ACO) Model team hosted a webinar on Thursday, June 8, 2017 that covered the high-level processes for assigning beneficiaries to Medicare-Medicaid ACOs and calculating savings/losses generated by Medicare-Medicaid ACOs. The webinar also covered the role of participating states in designing the details of these methodologies.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This open door forum provided follow up information to 2014 Shared Savings Program ACOs applying to AIM, including suggestions and resources to consider when submitting their application. Attendees had the opportunity to ask subject matter experts questions about the AIM application process.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
In this July 18, 2012 webinar CMS Innovation Center staff discussed how applicants can apply and prepare their budget for the Strong Start funding opportunity.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar on Thursday, January 30, 2020 to provide information and answer questions about the hospice benefit component recently added to the Value Based Insurance Design (VBID) Model. The Centers for Medicare & Medicaid Services announced in January 2019 that beginning in calendar year 2021, the VBID Model will test including the Medicare hospice benefit in Medicare Advantage.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted an open door forum covering population based payments and all inclusive population based payments for the 2017 Next Generation Accountable Care Organization Model. The open door forum was held on Tuesday, April 26 from 4:00pm – 5:00pm EDT.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Advisor Live: Proposed Episode Payment Models for AMI, CABG, and Hip and Femu...Premier Inc.
On July 25, 2016, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to establish three new bundled payment policies for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) and surgical hip and femur fracture treatment (SHFFT). Collectively, the models are referred to as Episode Payment Models (EPMs). The new payment models will be mandatory for hospitals in particular geographic regions.
CMS proposes to test the EPM models for a five-year performance period, beginning July 1, 2017, and ending Dec. 31, 2021. The proposed rule also includes changes to the Comprehensive Care for Joint Replacement Model and proposes to establish an incentive payment to hospitals for coordinating cardiac rehabilitation and intensive cardiac rehabilitation services. CMS is accepting comments on the proposed rule until Oct. 3, 2016.
This webinar provides an overview of the proposed rule, including:
- Background and rationale for new payment models,
- Inclusion and exclusion criteria,
- Payment methodology,
- Quality performance in the payment methodology, and
- Legal waivers.
The Changing Healthcare System and Impact of MACRAPYA, P.C.
PYA Principal Lori Foley and Consulting Senior Aaron Elias co-presented “The Changing Healthcare System and Impact of MACRA” at the Physician Insurers Association of America’s CEO/COO Meeting.
The Medicare Access & CHIP Reauthorization Act (MACRA) dramatically affected Medicare reimbursements to healthcare providers, as well as provided a new framework for rewarding quality care and reporting on quality measurements. This incentive-based system has the potential not only to change how medicine is practiced, but influence patient perception of care. The presentation will provide the latest information on MACRA implementation, and will detail how the aforementioned changes will impact miscellaneous professional liability insurers.
Learn the relationship between physician productivity and physician pay to better understand how the healthcare system works. Factors like practice expenses and bonuses are also discussed.
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
Speaking before the Georgia Pediatric Practice Managers Association, PYA Consultant and ICD-10-CM Trainer Kim-Marie Walker addressed recent ICD-10 developments along with basic guidance for the transition, including:
• Comparison of ICD-9 and ICD-10
• ICD-10 organizational and structural differences
• Vendor recommendations and available resources
• Transition planning and roles
Digital Content for Physicians in Global MarketsDRG Digital
Overview of emerging trends in physician digital behavior and engagement opportunities across 22 global markets in Latin America, Asia Pacific, the Middle East, and other emerging markets.
• Partnerships with local publishers to distribute content
• Social networks as a critical physician resource
• Demand for patient-oriented and value-added information and services in the evolving healthcare ecosystem
Appropriate Level of Care and the 2– Midnight Rule Where It Stands as of NOWBESLER
This article from the December 2014 issue of the Lone Star Express, a publication of the Lone Star chapter of HFMA, reviews the current state of the 2-Midnight rule. It reviews key elements of the rule, the focus of Medicare documentation requirements, and best practices for compliance.
Healthcare Retrospect Part 1: All Americans Were UninsuredBESLER
In part one of this three part series, John Dalton, Advisor Emeritus at BESLER Consulting, provides a look at the state of healthcare in America from the 1930s through the 1960s.
HFMA Colorado chapter newsletter, July 2016. While the Comprehensive Care for Joint Replacement (CJR) program is positioned as a “test,” given the infrastructure being put in place by CMS to run the program, CJR is likely just the start of a larger effort by CMS to implement additional mandatory bundled payment programs. Therefore, it’s very important that hospital financial stakeholders become familiar with CJR even if their hospital isn’t currently a participant.
We Turn and Face the Changes - The S-10 Emerges as a Proxy for PaymentBESLER
The Federal Fiscal Year 2017 Hospital Inpatient Prospective Payment System (IPPS) final rule issued a postponement for using data from Worksheet S-10 of the Medicare cost report to determine Medicare Disproportionate Share Uncompensated Care payments.The Centers for Medicare and Medicaid Services originally intended to incorporate WS S-10 in the methodology beginning next October (FFY 2018). However, due to copious and thoughtful observations from commenters, CMS has again put WS S-10 on hold while a number of issues surrounding fairness, consistency and accuracy are deliberated. The hospital community will be engaged in future rulemaking and CMS anticipates WS S-10 will be used for UC payments no later than FFY 2021 (using WS S-10 from cost reports beginning in FFY 2017).So join us as we take a look at the S-10’s key issues and what could have been if the S-10 was employed to determine UC payments sooner rather than later.
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) hosted a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model proposals on Wednesday, August 31, 2016, from noon – 1:00 p.m. EDT.
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CMS Innovation Center
http://innovation.cms.gov
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http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Center for Medicare and Medicaid Innovation hosted a series of two webinars on Wednesday, July 15 and Thursday, July 16, 2015. These webinars focused on providing an overview of the model and provided an opportunity for attendees to ask questions.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
5 Mistakes Hospitals Make with Call Coverage AgreementsMD Ranger, Inc.
This deck covers 5 critical mistakes that hospitals make with call coverage agreements and how to avoid them going forward.
We will cover:
- Effective strategies for setting call rates
- Determining commercial reasonableness
- The most cost-effective ways to pay for call
- Which services are likely to be paid
- ...and more!
How to improve operating margins
● What does operating margin tell you about the organization, and how would
you calculate this ratio?
● Select a local medical service organization and describe how it has
specifically improved its operating margins.
HFMA
Financial Reporting Function
Financial Reporting Function
Financial Accounting Standards Board
(FASB)
FASB standards rest on certain
assumptions:
Ø Monetary unit
Ø Economic entity
Ø Time period
Ø Going concern
Financial Reporting Function
FASB
Two key principles
Ø Cost principle
Ø Full disclosure principle
Financial Reporting Function
Generally Accepted Accounting Principles
(GAAP)
Ø Consistency
Ø Relevance
Ø Reliability
Ø Comparability
Financial Reporting Function
Financial Statements
For Profit Not-for-Profit
Balance Sheet Statement of Financial
Position
Income Statement Statement of Operations
Statement of Cash Flows Statement of Cash Flows
Financial Reporting Function
Accepted Accounting Methods
Ø Accrual
Ø Cash
Ø Fund
Financial Reporting Function
Financial Statement Presentation
Ø Two years are displayed
- Prior year to the right of the current year
Ø Statement of Operations or Income Statement are for a period of
time—typically a month
Ø Statement of Cash Flows reflects a period of time consistent with the
Statement of Operations or Income Statement—typically a month
Ø Statement of Financial Position or Balance Sheet reflect the status
of Assets, Liabilities, and Net Assets/Shareholders’ Equity as of a
day.
Financial Reporting Function
Ratio Analysis
Ø Liquidity Ratios
Ø Profitability Ratios
Ø Asset Efficiency Ratios
Ø Capital Structure Ratios
Ø Operating Indicators
Financial Reporting Function
Ratio Analysis
Ø Liquidity
- Current ratio
- Quick ratio
Current ratio = Current Assets/Current Liabilities
Quick ratio = (Cash + Marketable Securities + Net
Accounts Receivable)/Current Liabilities
Financial Reporting Function
Ratio Analysis
Ø Profitability
- Operating margin
- Return on assets
Operating Margin = [(Operating Revenue-Operating
Expenses)/Total Operating Revenues] x 100
Return on Assets = Excess of revenues over expenses/
Total Assets
Financial Reporting Function
Ratio Analysis
Ø Asset efficiency
- Total asset turnover
- Inventory turnover
Total Asset Turnover = Total Operating Revenue/ Total
Assets
Inventory Turnover = Total Operating Revenue/ Inventory
Financial Reporting Function
Ratio Analysis
Ø Capital structure
- Debt to Capitalization
- Debt service coverage
Debt to Capitalization = [Long-term Debt/ (Long-term Debt
+ Unrestricted Net Assets)] x 100
Debt Service Coverage = (Excess of revenues over
expenses + Depre.
Modern Relationships Between Physicians, Hospitals, and Long-Term Care Provid...PYA, P.C.
PYA Consulting Manager Aaron Elias co-presented “Modern Relationships Between Physicians, Hospitals, and Long-Term Care Providers in a Time of Risk-Based Contracting,” along with Jeanna Palmer Gunville, a shareholder at Polsinelli.
Emerging hscrc methodologies case pohl (final)James Case
This presentation highlights the emerging methodologies the HSCRC will utilize to ensure success under CMS Model Demonstration project ("the new Waiver).
Sustainability and Transition Policy in Action (GF Session) - Tural Gulu, Az...OECD Governance
This presentation was made by Tural Gulu, Azerbaijan, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
NYU Langone Medical Center’s TJA BPCI Experience: Lessons in How to Maximize ...Wellbe
The Bundled Payments for Care Improvement (BPCI) Initiative began generating data in January of 2013. Dr. Iorio will outline the challenges and benefits of implementing BPCI for Total Joint Arthroplasty at an urban, tertiary, academic medical center with a hybrid compensation model. Early results from the implementation of a Medicare BPCI Model 2 primary TJA program demonstrate cost-savings with an improvement in quality of care metrics and continued cost savings through year 3 of our experience. Changes in patient optimization, care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the Bundled Payment for Care Initiative, thus bringing increased value to our TJA patients.
Maximizing Value in a Bundled Environment – Keys to Success:
• Evidence based, cost effectiveness analysis
• Standardized protocol adoption
• Transparent data
• Perioperative Patient Optimization
• Care management
• Physician-hospital alignment with Gain sharing
• Enhanced pain relief and rehabilitation protocols
• Blood management and rational VTED prophylaxis
About the Speaker:
Richard Iorio, MD, is the William and Susan Jaffe Professor of Orthopaedic Surgery at New York University Langone Medical Center Hospital for Joint Diseases and Chief of Adult Reconstruction at NYU Langone HJD. He co-founded Labrador Healthcare Consulting Services, Responsive Risk Solutions, and the Value Based Healthcare Consortium in 2015. He is a member of the Board of Directors for LIMA, the Lifetime Initiative for the Management of Arthritis. Dr. Iorio is a national expert in physician and hospital quality and safety and a leader in the implementation of alternate payment paradigms in orthopaedic surgery.
Di McIntyre's presentation at the Department of Science and Technology (DST) international seminar on a National Health Insurance (NHI) from 6 – 7 December 2012 at the CSIR Conference Centre, Pretoria.
The 2021 Hospital Inpatient Prospective Payment System (IPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement. As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2021 IPPS Final Rule to quickly give you insight into the most important changes. BESLER remains your trusted advisor and we look forward to helping you identify areas of revenue opportunity for your facility.
The 2020 Hospital Outpatient Prospective Payment System (OPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement.
As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2020 OPPS Final Rule to quickly give you insight into the most important changes.
BESLER remains your trusted advisor and we look forward to helping you identify areas of revenue opportunity for your facility.
Annually, CMS proposes changes to the Inpatient Prospective Payment System (IPPS) rules that can impact how IPPS facilities are reimbursed from Medicare – either positively or negatively.
Proposed updates are posted in April and issued as a final rule in October of each year. Because IPPS hospitals are paid based on Medicare Severity Diagnosis Related Groups (MS-DRG), additions, deletions, or alterations to MS DRGs can affect how hospitals should submit claims to Medicare.
2020 Inpatient Prospective Payment System (IPPS) Final Rule Summary - BESLERBESLER
The 2020 Hospital Inpatient Prospective Payment System (IPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement.
As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2020 IPPS Final Rule to quickly give you insight into the most important changes.
Research Report - Insights into Revenue Cycle ManagementBESLER
The findings in this report are based on online research conducted in October 2018 among 102 respondents employed in leadership roles within finance, revenue cycle, reimbursement and HIM in U.S. hospitals and acute-care facilities.
With hospitals and acute-care facilities under increasing pressure to optimize the revenue cycle, BESLER and HIMSS Media conducted a new study to identify the biggest industry challenges and potential opportunities for improvement. The study included over 100 respondents employed in leadership roles within finance, revenue cycle, reimbursement, and health information management (HIM) in U.S. hospitals and acute-care facilities.
2019 outpatient prospective payment system final rule key pointsBESLER
The 2019 Hospital Outpatient Prospective Payment System (OPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement.
As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2019 OPPS Final Rule to quickly give you insight into the most important changes.
BESLER remains your trusted advisor and we look forward to helping you identify areas of revenue opportunity for your facility.
2019 inpatient prospective payment system final rule key pointsBESLER
The 2019 Hospital Inpatient Prospective Payment System (IPPS) Final Rule has been issued and changes are on the way that can affect your organization’s Medicare reimbursement.
As part of our commitment to help protect and enhance your Medicare revenue, we’ve developed this expert analysis of the FY 2019 IPPS Final Rule to quickly give you insight into the most important changes.
BESLER Transfer DRG Revenue Recovery Service HFMA Peer Review key findings - 02BESLER
Healthcare Financial Management Association’s (HFMA) Peer Review designation spotlights healthcare products and services that objectively earn top ratings during a thorough evaluation process. Part of the evaluation process prior to designation is surveying the product’s current clients and prospects on a variety of topics that measure quality and effectiveness.
BESLER Transfer DRG Revenue Recovery Service HFMA Peer Review key findingsBESLER
Healthcare Financial Management Association’s (HFMA) Peer Review designation spotlights healthcare products and services that objectively earn top ratings during a thorough evaluation process. Part of the evaluation process prior to designation is surveying the product’s current clients and prospects on a variety of topics that measure quality and effectiveness.
Creating A New Mindset - Fully Embracing Revenue IntegrityBESLER
Revenue Integrity is an exciting addition to the existing healthcare revenue cycle process. Revenue Integrity brings together a holistic focus on our responsibility to ensure appropriate billing and compliance in all financial aspects of healthcare.
Revenue Integrity has ushered in an elevated level of awareness to healthcare financial organizations along with improved healthcare delivery.
Although, Revenue Integrity is still fairly new, it has proven to be a catalyst for change both in the financial and clinical functions of hospitals and doctors’ offices.
Published January, 2017 - First Illinois Speaks
Author: Maria C. Miranda, FACHE, Director, Emerging Payment Models
Introduction: While the Comprehensive Care for Joint Replacement (CJR) program is positioned as a “test,” given the infrastructure being put in place by the Centers for Medicare and Medicaid Services (CMS) to run the program, CJR is likely just the start of a larger effort by CMS to implement additional mandatory bundled payment programs. Therefore, it’s very important that hospital financial stakeholders become familiar with CJR even if their hospital isn’t currently a participant.
Electronic health record (EHR) implementations can be operationally invasive and can have significant financial implications. Organizations may see a reduction in net revenue, an increase in accounts receivable days and a slowdown in cash collections. With several NJ providers in the process of moving to an Epic HIS and EHR environment, preserving net revenue, maintaining consistent cash and ensuring accurate financial reporting should be among the provider’s primary conversion goals. We have worked with several providers throughout the country who have undergone a recent Epic conversion and thought it would be beneficial to share conversion lessons learned from these providers. A consistent phrase in the Epic conversion world is ”Big Bang,” indicating that every module that’s been purchased is implemented at the same time. The conversion timeline is an eighteen month journey and has been described as a conversion like no other. More and more providers are moving towards the “Single Billing Office” (SBO) solution, meaning hospital, physician and potentially other entities such as home health appear on a single statement. This alone is a significant change for hospital providers.
Healthcare Retrospect Part 3: Achieving The Triple AimBESLER
In part three of this three part series, John Dalton, Advisor Emeritus at BESLER Consulting, discusses the effects of the PPACA and the path towards achieving the triple aim.
Healthcare Retrospect Part 2: Skyrocketing Costs and the Emergence of Rate S...BESLER
In part two of this three part series, John Dalton, Advisor Emeritus at BESLER Consulting, provides a look at the state of healthcare in America from the 1960s through the 1990s.
The benefits of revenue cycle and compliance collaborationBESLER
This presentation highlights the importance of the working relationship between hospital Revenue Cycle and Compliance teams. This complimentary partnership can become seamless by utilizing the data analytics obtained from 835 and 837 data sets, Return to Provider (RTP), CERTs, Readmissions, ZPICs, HACs, RACs and Transfer DRGs. The combination of this data can assist in quickly identifying and resolving issues prior to provider submission, reducing days in AR and improving cash in the door.
The LACE index identifies patients that are at risk for re-admission or death within thirty days of discharge. It incorporates four parameters. "L" stands for the length of stay of the index admission. "A" stands for the acuity of the admission. Specifically, if the patient is admitted through the Emergency Department vs. an elective admission. "C" stands for co-morbidities, incorporating the Charlson Co-Morbidity Index. "E" stands for the number of Emergency Department visits within the last 6 months.
LACE sores range from 1-19 and as mentioned above predict the rate of re-admission or death within thirty days of discharge. Below is an example of how to calculate the LACE index. A score of 0 - 4 = Low; 5 - 9 = Moderate; and a score of ≥ 10 = High risk of re-admission.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
3. Medicare/Medicaid - Background
• Medicare = Federal Program
• Medicare regulations apply to all applicable health care
entities/practitioners across the country
• Main governing agency for Medicare:
The Centers for Medicare and Medicaid Services (CMS)
• Medicaid = State Program
• Medicaid regulations vary by State
3
5. Medicare – Inpatient Prospective Payment System
(IPPS) Defined
• IPPS system was effective October 1983
• Applies to acute care hospitals
• What does IPPS mean?
• A fixed, prospectively determined amount for each inpatient hospitalization based on
Medicare severity diagnosis-related groups (MS-DRGs);
• One of the purposes of the IPPS system was to encourage hospitals to operate more
efficiently;
• However, hospitals also run the risk for higher costs under IPPS as well
• IPPS is based on the law of averages – cost of some inpatient stays under IPPS
may be greater or less than the IPPS payment
5
6. Medicare – Inpatient Prospective Payment
System (IPPS) - Exemptions
• Certain types of hospitals may not automatically receive the IPPS rates:
• Sole Community Hospitals (SCH)
• Medicare Dependent Hospitals (MDH)
• Currently MDH Status is set to expire March 31, 2014. Beginning April 1, all hospitals that
previously qualified for MDH status will no longer have MDH status.
• These types of hospitals are afforded special payment protection and payments
may be based upon hospital specific rates from a certain base year
• Congress established prospective payment systems (PPS) for other healthcare
facilities separate from IPPS:
• Rehab, Psych, long-term care hospitals (LTACs), SNF, HHA and Hospice
6
7. Medicare – Inpatient Prospective Payment System
(IPPS) - Exemptions
• Certain types of hospitals still receive cost-based reimbursement:
• Children’s hospitals
• Cancer hospitals
• RNHCIs (Religious Nonmedical Health Care Institution)
• Critical Access Hospitals
7
8. Medicare – Inpatient Prospective Payment System
(IPPS) – Prospective vs. Hospital Specific Components
• Technically – only operating and capital portion of IPPS is truly “prospective”
• These prospective items are NOT reconciled at any point in the future
• These prospective items are the same for each MS-DRG based upon a similar
category of hospitals (some variations with prospective components as well)
• Other components of IPPS are hospital specific (will vary by hospital):
• Indirect Graduate Medical Education (IME)
• Disproportionate Share (DSH)
8
9. Medicare – Other Inpatient Payments
• Some areas of inpatient acute care Medicare reimbursement fall outside of IPPS
(but are reported and settled on a cost report each fiscal period):
• Direct Graduate Medical Education (DGME) (note that the Indirect Medical Education
component for teaching hospitals is included in IPPS)
• School of Nursing
• Transplants
• High percentage of ESRD add-on
• Medicare bad debts
9
10. Medicare – Other Inpatient Payments
• Each respective methodology of Medicare reimbursement is as follows:
• DGME – Per Resident amount (caps apply and three year rolling average)
• School of Nursing, Transplants – cost-based reimbursement
• High percentage of ESRD add-on – fixed amount based upon ratio of chronic ESRD patients to total Medicare specified DRGs
• Medicare bad debts – submitted and audited logs
• Each of these categories are reimbursed through interim “pass-through”
payments
• Pass through payments are made bi-weekly and are not processed through any
claims payment mechanism
10
11. Medicare – Other Inpatient Payments
• The pass through payments are estimates until compared to final audited cost
report data
• Monies will be exchanged for these categories of reimbursement between
hospitals and the Medicare program for each cost reporting period
• IPPS also includes an add-on to IPPS for outlier cases
• Outlier cases are unusually expensive cases and this reimbursement can mitigate
large financial losses
11
12. For timely updates related to
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