MedPAC finalizes 2018 payment recommendations for hospital services
by AHA News Now
The Medicare Payment Advisory Commission today finalized its recommendation that would update payments for hospital inpatient and outpatient services in 2018 as outlined under current law, that is, an estimated 1.85%. In addition, MedPAC finalized recommendations that would require Medicare to add a modifier on claims for all services provided at off-campus stand-alone emergency department facilities. In other sessions today, MedPAC finalized recommendations that would update physician payments in accordance with current law (estimated at 0.5%), provide no update to payments for ambulatory surgery centers, and require Medicare to calculate Medicare Advantage benchmarks using fee-for-service spending data only for beneficiaries enrolled in Parts A and B.
SHADAC produced new fact sheets with state and county coverage estimates from the 2011–2015 ACS data. The fact sheets provide uninsured rates by characteristics (e.g., age, race/ethnicity, and poverty level) for the pooled years 2011 through 2015. Estimates are available for each state (and the District of Columbia and Puerto Rico) and for all counties within each state. These data are available via a clickable map here, where you can also access a 50-state table of estimates.
CDC: 63% of 2015 drug OD fatalities involved opioids
by HealthDay News
Research discussed in the CDC's Morbidity and Mortality Weekly Report found that over 52,000 Americans died from drug overdose in 2015 and that 63% of those deaths involved opioids. Mortality associated with drug overdose rose 23% between 2010 and 2014, and opioid overdoses have killed more than 300,000 Americans since 2000.
Utah is Nation’s Fastest-Growing State, Census Bureau Reports
Utah’s population crossed the 3.0 million mark as it became the nation’s fastest-growing state over the last year. Its population increased 2.0 percent to 3.1 million from July 1, 2015, to July 1, 2016, according to U.S. Census Bureau national and state population estimates.
American death rate from drugs, alcohol, and mental disorders nearly triples since 1980
Media Contacts: Kayla Albrecht, Dean R. Owen
More than 2,000 US counties witnessed increases of 200% or more in deaths related to substance abuse and mental disorders since 1980, including clusters of counties in Kentucky, West Virginia, and Ohio with alarming surges over 1,000%, according to a new scientific study.
The study examines deaths in 21 cause groups, ranging from chronic illnesses like diabetes and other endocrine diseases, to infectious diseases, such as HIV/AIDS and tuberculosis, to accidents, including traffic fatalities. It explores mortality rates and how they have changed in every US county between 1980 and 2014, creating the most comprehensive view to date of how Americans die.
Five National Health Care Foundations Identify Promising Approaches to Treating Patients with Complex Needs
Five national foundations—The John A. Hartford Foundation, the Peterson Center on Healthcare, the Robert Wood Johnson Foundation, The SCAN Foundation, and The Commonwealth Fund—have launched a digital resource to help health system leaders and insurers improve care for patients with complex medical and social needs.
Developed by experts at the Institute for Healthcare Improvement, The Playbook: Better Care for People with Complex Needs offers insights about patients with complex needs, examples of successful approaches to care, guidance on making the business case for these models, and information about opportunities for policy and payment reform.
The Playbook is being unveiled today at the inaugural meeting of the National Center for Complex Health and Social Needs, led by Jeffrey Brenner, M.D., of the Camden Coalition of Healthcare Providers. The new center is a first-of-its-kind hub designed to convene and develop an emerging field of experts and stakeholders including providers, health and social service systems, researchers, payers, patient and family advocates, and community leaders.
Also released today is a new Commonwealth Fund survey of patients with complex medical needs showing these individuals have far more unmet behavioral health and social service challenges than other adults.
News Item - 11/29/2016
Report recommends federal policies to ensure sustainable U.S. blood system
Medical advances have reduced the demand for blood in the United States, creating financial pressure on the nation’s blood collection centers and threatening their future survival, according to a study prepared by RAND Corporation for the Department of Health and Human Services, released this week. To improve the sustainability of the U.S. blood system, the report recommends that federal officials collect comprehensive data about performance of the blood system; better define appropriate levels of surge capacity; build relationships with brokers and other entities to form a blood “safety net”; build and implement a value framework for new technology; and implement emergency use authorization and contingency planning for key supplies and inputs.
News Item - 11/23/2016
Abortion Surveillance — United States, 2013
by Tara C. Jatlaoui, MD; Alexander Ewing, MPH; Michele G. Mandel; Katharine B. Simmons, MD; Danielle B. Suchdev, MPH; Denise J. Jamieson, MD; Karen Pazol, PhD
Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2013, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2004–2013. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births).
The Centers for Medicare & Medicaid Services late today issued its final rule for the physician fee schedule for calendar year 2017. After application of the 0.5% payment increase required by the Medicare Access and CHIP Reauthorization Act of 2015 and mandated budget neutrality cuts, physician payment rates will increase 0.24% for 2017 compared to 2016. In addition, CMS finalized its proposals to pay for new telehealth services, including end-stage renal disease-related services for dialysis, advance care planning services and critical care consultations, and to expand the Center for Medicare & Medicaid Innovation Diabetes Prevention Program model. The agency also finalized a number of new codes to more accurately pay for primary care, care management and other cognitive specialties, including separate payments to primary care practices that use interprofessional care management resources to treat patients with behavioral health conditions. With respect to Medicare Advantage, CMS finalized its proposals to require health care providers and suppliers to be screened and enrolled in Medicare in order to contract with an MA organization for purposes of providing items and services to Medicare beneficiaries. This provision will begin two years after publication of the final rule and will be effective on the first day of the plan year. The agency also finalized routine releases of two new data sets: one which includes certain MA bid information that is at least five years old, and another with MA and drug plans’ medical-loss ratios. Other proposals finalized by CMS include changes to the quality measurement requirements of the Medicare Shared Savings Program, including revisions to the measure set and quality data validation process; a change to allow individual eligible professionals participating in MSSP to report quality data separately for the purposes of the Physician Quality Reporting System, and to have that data used in PQRS in the event the MSSP Accountable Care Organization fails to report quality data; and updates to the informal review process used in the physician value modifier program. AHA members will receive a Special Bulletin with further details at a later date.
Understanding MS-DRG Grouping under ICD-10
Understanding MS-DRG Grouping under ICD-10
by Rayellen Kishbach
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.