The federal government has cut payments to hospitals with high rates of patient injuries this year. Those hospitals will lose 1 percent of Medicare payments over the federal fiscal year, which runs from October through September. Maryland hospitals are exempted from penalties because that state has a separate payment arrangement with Medicare. Below are the hospitals being penalized and a notation if they were penalized last year:
The nation’s most influential science advisory group was set to tell Congress on Tuesday that the U.S. pharmaceutical market is not sustainable and needs to change.
“Drugs that are not affordable are of little value and drugs that do not exist are of no value,” said Norman Augustine, chair of the National Academies of Sciences, Engineering and Medicine’s committee on drug pricing and former CEO of Lockheed Martin Corp.
Health, United States is the annual report on health, produced by the National Center for Health Statistics and submitted by the Secretary of the Department of Health and Human Services to the President and Congress. The report uses data from government sources as well as private and global sources to present an overview of national health trends. This infographic features indicators relating to adolescent health from the report’s Health Status and Determinants section.
10 Essential Facts About Medicare and Prescription Drug Spending
Prescription drugs play an important role in medical care for 59 million seniors and people with disabilities, and account for $1 out of every $6 in Medicare spending. The majority of Medicare prescription drug spending is for drugs covered under the Part D prescription drug benefit, administered by private stand-alone drug plans and Medicare Advantage drug plans. Medicare Part B also covers drugs that are administered to patients in physician offices and other outpatient settings.
The Centers for Medicare & Medicaid Services today announced it will update the hospital outpatient prospective payment system rates by 1.35% in calendar year 2018 compared to CY 2017. The rule also finalizes CMS’s proposal to drastically cut Medicare payment for drugs that are acquired under the 340B Drug Pricing Program. Specifically, CMS will pay separately payable, non pass-through drugs (other than vaccines) purchased through the 340B program at a rate of the average sales price minus 22.5%, rather than ASP plus 6%. Sole community hospitals in rural areas, PPS-exempt cancer hospitals and children’s hospitals will be excepted from this policy for CY 2018.
For the first time, rates of drug overdose deaths are rising in rural areas, surpassing rates in metropolitan (urban) areas, according to a new report in the by the Centers for Disease Control and Prevention (CDC).
Drug overdoses are the leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. This report analyzed trends in illicit drug use and disorders from 2003-2014 and drug overdose deaths from 1999-2015 in urban and rural areas. In 1999, drug overdose death rates for urban areas were higher than in rural areas (6.4 per 100,000 population versus 4.0 per 100,000). The rates converged in 2004, and by 2015 the rural rate (17.0 per 100,000) was slightly higher than the urban rate (16.2 per 100,000).
The Next Chapter In Transparency: Maryland’s Wear The Cost
by Robert Moffit, Marilyn Moon, François de Brantes, and Suzanne Delbanco
Historically, the State of Maryland’s per capita health spending has been substantially higher than the national average. In an attempt to control health care costs, the state has been administering an all-payer rate setting system for Maryland hospitals—fixing the rates for Medicare and private payers—for more than 40 years. Regardless of one’s view of the desirability of these regulatory interventions, the Maryland system has been unable to address the wide disparity among providers in terms of both price and quality.
Firearm-Related Injury and Death: A US Health Care Crisis in Need of Health Care Professionals
by Darren B. Taichman, MD, PhD; Howard Bauchner, MD; Jeffrey M. Drazen, MD; et al
What would happen if on one day more than 50 people died and over 10 times that many were harmed by an infectious disease in the United States? Likely, our nation’s esteemed and highly capable public health infrastructure would gear up to care for those harmed and study the problem. There would be a rush to identify the cause, develop interventions, and refine them continually until the threat is eliminated or at least contained. In light of the risks to public health (after all, over 500 people have been harmed already!), health care professionals would sound the alarm. We would demand funding. We would go to conferences to learn what is known and what we should do. We would form committees at our institutions to plan local responses to protect our communities. The United States would spend millions or more in short order to ensure public safety, and no elected officials would conceive of getting in the way. Rather, they would compete to be calling the loudest for the funds and focus required to protect our people. Americans should be proud of our prowess at and commitment to addressing public health crises.
Vital Signs: Trends in Incidence of Cancers Associated with Overweight and Obesity — United States, 2005–2014
by C. Brooke Steele, DO; Cheryll C. Thomas, MSPH; S. Jane Henley, MSPH; Greta M. Massetti, PhD; Deborah A. Galuska, PhD; Tanya Agurs-Collins, PhD; Mary Puckett, PhD; Lisa C. Richardson, MD
Data from the United States Cancer Statistics for 2014 were used to assess incidence rates, and data from 2005 to 2014 were used to assess trends for cancers associated with overweight and obesity (adenocarcinoma of the esophagus; cancers of the breast [in postmenopausal women], colon and rectum, endometrium, gallbladder, gastric cardia, kidney, liver, ovary, pancreas, and thyroid; meningioma; and multiple myeloma) by sex, age, race/ethnicity, state, geographic region, and cancer site. Because screening for colorectal cancer can reduce colorectal cancer incidence through detection of precancerous polyps before they become cancerous, trends with and without colorectal cancer were analyzed.
An Analysis of Hospital Prices for Commercial and Medicare Advantage Plans
by Jared Maeda
Prices for hospital admissions have received considerable attention in recent years, both because they are an important component of health care spending and because they can vary widely. In this presentation, we use 2013 claims data from three large insurers to examine the hospital payment rates of those insurers in their commercial plans and their Medicare Advantage plans and compare them with Medicare’s fee-for-service (FFS) rates; we also examine the variation of those rates across and within markets.
An Analysis of Private-Sector Prices for Physician Services
by Daria Pelech
Physicians’ services account for a substantial portion of health care spending in the United States, but research on the prices private insurers pay for those services has been limited. Using 2014 claims data from three major insurers, we analyzed the prices paid for 21 common services and compared them with the estimated amounts that Medicare’s fee-for-service (FFS) program would pay.
Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Proposed Rule, and Request for Information CMS-1677-P
On April 14, 2017, the Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update 2018 Medicare payment and polices when patients are admitted into hospitals. The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care.
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.