The Experts below are selected from a list of 70521 Experts worldwide ranked by ideXlab platform
Hhs Centers For Medicare Medicaid Services - One of the best experts on this subject based on the ideXlab platform.
-
medicare program Hospital Inpatient prospective payment systems for acute care Hospitals and the long term care Hospital prospective payment system and policy changes and fiscal year 2019 rates quality reporting requirements for specific providers me
Federal Register, 2018Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:We are revising the Medicare Hospital Inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care Hospitals to implement changes arising from our continuing experience with these systems for FY 2019. Some of these changes implement certain statutory provisions contained in the 21st Century Cures Act and the Bipartisan Budget Act of 2018, and other legislation. We also are making changes relating to Medicare graduate medical education (GME) affiliation agreements for new urban teaching Hospitals. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain Hospitals excluded from the IPPS that are paid on a reasonable cost basis, subject to these limits for FY 2019. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for Inpatient Hospital services provided by long-term care Hospitals (LTCHs) for FY 2019. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care Hospitals, PPS-exempt cancer Hospitals, and LTCHs). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible Hospitals, and critical access Hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (now referred to as the Promoting Interoperability Programs). In addition, we are finalizing modifications to the requirements that apply to States operating Medicaid Promoting Interoperability Programs. We are updating policies for the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to the required supporting documentation for an acceptable Medicare cost report submission and the supporting information for physician certification and recertification of claims.
-
medicare program Hospital Inpatient prospective payment systems for acute care Hospitals and the long term care Hospital prospective payment system policy changes and fiscal year 2016 rates revisions of quality reporting requirements for specific providers including changes related to the electronic health record incentive program extensions of the medicare dependent small rural Hospital program and the low volume payment adjustment for Hospitals final rule interim final rule with comment period
Federal Register, 2015Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:We are revising the Medicare Hospital Inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care Hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain Hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural Hospital (MDH)Program and changes to the payment adjustment for low-volume Hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for Inpatient Hospital services provided by long-term care Hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care Hospitals,PPS-exempt cancer Hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible Hospitals and critical access Hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.
-
medicare and medicaid programs Hospital outpatient prospective payment and ambulatory surgical center payment systems and quality reporting programs physician owned Hospitals data sources for expansion exception physician certification of Inpatient h
Federal Register, 2014Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:: This final rule with comment period revises the Medicare Hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2015 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. In this document, we also are making changes to the data sources permitted for expansion requests for physician-owned Hospitals under the physician self-referral regulations; changes to the underlying authority for the requirement of an admission order for all Hospital Inpatient admissions and changes to require physician certification for Hospital Inpatient admissions only for long-stay cases and outlier cases; and changes to establish a formal process, including a three-level appeals process, to recoup overpayments that result from the submission of erroneous payment data by Medicare Advantage (MA) organizations and Part D sponsors in the limited circumstances in which the organization or sponsor fails to correct these data.
-
medicare program Hospital Inpatient prospective payment systems for acute care Hospitals and the long term care Hospital prospective payment system and fiscal year 2015 rates quality reporting requirements for specific providers reasonable compensation equivalents for physician services in excluded Hospitals and certain teaching Hospitals provider administrative appeals and judicial review enforcement provisions for organ transplant centers and electronic health record ehr incentive program fina
Federal Register, 2014Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:We are revising the Medicare Hospital Inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care Hospitals to implement changes arising from our continuing experience with these systems. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Protecting Access to Medicare Act of 2014, and other legislation. These changes are applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain Hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2014. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for Inpatient Hospital services provided by long-term care Hospitals (LTCHs) and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014. In addition, we discuss our proposals on the interruption of stay policy for LTCHs and on retiring the "5 percent" payment adjustment for collocated LTCHs. While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revising requirements for quality reporting by specific providers (acute care Hospitals, PPS-exempt cancer Hospitals, and LTCHs) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching Hospitals and Hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers. We are aligning the reporting and submission timelines for clinical quality measures for the Medicare HER Incentive Program for eligible Hospitals and critical access Hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program. In addition, we provide guidance and clarification of certain policies for eligible Hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions. In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share Hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume Hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.
-
medicare program Hospital Inpatient prospective payment systems for acute care Hospitals and the long term care Hospital prospective payment system and fiscal year 2014 rates quality reporting requirements for specific providers Hospital conditions o
Federal Register, 2013Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:We are revising the Medicare Hospital Inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care Hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain Hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for Inpatient Hospital services provided by long-term care Hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care Hospitals, PPS-exempt cancer Hospitals, LTCHs, and Inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for Hospitals relating to the administration of vaccines by nursing staff as well as the CoPs for critical access Hospitals relating to the provision of acute care Inpatient services. We are finalizing proposals issued in two separate proposed rules that included payment policies related to patient status: payment of Medicare Part B Inpatient services; and admission and medical review criteria for payment of Hospital Inpatient services under Medicare Part A.
Edward Septimus - One of the best experts on this subject based on the ideXlab platform.
-
sepsis national Hospital Inpatient quality measure sep 1 multistakeholder work group recommendations for appropriate antibiotics for the treatment of sepsis
Clinical Infectious Diseases, 2017Co-Authors: Edward Septimus, Craig M Coopersmith, Jessica Whittle, Caleb P HaleAbstract:The Center for Medicare and Medicaid Services adopted the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) performance measure to the Hospital Inpatient Quality Reporting Program in July 2015 to help address the high mortality and high cost associated with sepsis. The SEP-1 performance measure requires, among other critical interventions, timely administration of antibiotics to patients with sepsis or septic shock. The multistakeholder workgroup recognizes the need for SEP-1 but strongly believes that multiple antibiotics listed in the antibiotic tables for SEP-1 are not appropriate and the use of these antibiotics, as called for in the SEP-1 measure, is not in alignment with prudent antimicrobial stewardship. To promote the appropriate use of antimicrobials and combat antimicrobial resistance, the workgroup provides recommendations for appropriate antibiotics for the treatment of sepsis.
Megan Mchugh - One of the best experts on this subject based on the ideXlab platform.
-
an advanced look at surgical performance under medicare s Hospital Inpatient value based purchasing program who is winning and who is losing
Journal of The American College of Surgeons, 2014Co-Authors: James M Dupree, Jennifer Neimeyer, Megan MchughAbstract:Background The Centers for Medicare and Medicaid Services (CMS) is beginning to shift from paying providers based on volume to more explicitly rewarding quality of care. The Hospital value-based purchasing (VBP) program is the first in a series of mandatory programs to financially reward and penalize US Hospitals based on quality measure performance. Our objective was to identify the characteristics of Hospitals that perform well (and those that perform poorly) on the surgical measures in CMS' Hospital VBP program. Study Design Using 2008 to 2010 performance data from CMS' Hospital Compare website and the 2009 American Hospital Association annual survey, we examined surgical measure performance for all acute care general Hospitals in the US. Outcomes were determined by a composite surgical performance score indicating the percentage of eligible surgical performance points that a Hospital received. Results There were 3,030 Hospitals included in our study. Composite surgical performance scores were 15.6% lower at public Hospitals than at for-profit Hospitals (p Conclusions The results of our study indicate that public Hospitals perform worse on the surgical measures in the Hospital VBP program. This study raises important questions about the impact that this new, mandatory program will have on public Hospitals, which serve an important safety-net role and appear to be disadvantaged in the Hospital VBP program. This issue should continue to be investigated as these mandatory quality programs are updated in future years.
-
an early look at performance on the emergency care measures included in medicare s Hospital Inpatient value based purchasing program
Annals of Emergency Medicine, 2013Co-Authors: Megan Mchugh, Jennifer Neimeyer, Emilie S Powell, Rahul K Khare, James G AdamsAbstract:Study objective Medicare's new, mandatory Hospital Inpatient Value-Based Purchasing Program introduces financial rewards or penalties to Hospitals according to achievement or improvement on several publicly reported quality measures. Our objective was to describe Hospital reporting on the 4 emergency department (ED)–related program measures, variation in performance on the ED measures across Hospital characteristics, and the characteristics of Hospitals that were more likely to receive performance scores based on improvement versus achievement. Methods This was an exploratory, descriptive analysis. We merged 2008 to 2010 performance data from Hospital Compare with the 2009 American Hospital Association Annual Survey. We calculated a composite score for the 4 ED measures and used Kruskal-Wallis tests to examine differences in performance across Hospital characteristics. We also examined differences in the percentage of scores that were awarded according to improvement versus achievement. Results There were 2,927 Hospitals that qualified for the value-based purchasing program and were included in the analysis. For-profit Hospitals received the highest scores; public Hospitals and Hospitals lacking The Joint Commission (TJC) accreditation received the lowest scores. Public Hospitals had the largest share of scores awarded according to improvement (39.8%); for-profit Hospitals had the lowest (27.8%). Conclusion We found variation in performance by Hospital characteristics on the ED-related program measures. Although public and non–TJC-accredited Hospitals trailed in performance, they showed strong signs of improvement, signaling that performance gaps by ownership and accreditation may decrease. Considering the increasing scope of the value-based purchasing program, ED leaders should monitor both achievement and improvement on the 4 ED-related program measures.
Li Huang - One of the best experts on this subject based on the ideXlab platform.
-
cost effectiveness analysis of nasal continuous positive airway pressure versus nasal high flow therapy as primary support for infants born preterm
The Journal of Pediatrics, 2018Co-Authors: Li Huang, Calum T Roberts, Brett J Manley, Louise S Owen, Peter G Davis, Kim DalzielAbstract:Objective To compare the cost-effectiveness of 2 common “noninvasive” modes of respiratory support for infants born preterm. Study design An economic evaluation was conducted as a component of a multicenter, randomized control trial from 2013 to 2015 enrolling infants born preterm at ≥28 weeks of gestation with respiratory distress, Results Hospital Inpatient cost records for 435 infants enrolled in all Australian centers were obtained. With “rescue” CPAP backup, an incremental cost-effectiveness ratio was estimated of A$179 000 (US$123 000) per ventilation avoided if CPAP was used compared with high flow. Without rescue CPAP backup, cost per ventilation avoided was A$7000 (US$4800) if CPAP was used compared with high flow. Conclusions As sole primary support, CPAP is highly likely to be cost-effective compared with high flow. Neonatal units choosing to use only one device should apply CPAP as primary respiratory support. Compared with high-flow with rescue CPAP backup, CPAP is unlikely to be cost-effective if willingness to pay per ventilation avoided is less than A$179 000 (US$123 000).
-
Hospital Inpatient costs for single ventricle patients surviving the fontan procedure
American Journal of Cardiology, 2017Co-Authors: Li Huang, Chris Schilling, Kim Dalziel, Siyu Xie, David S Celermajer, John J Mcneil, David S Winlaw, Tim Hornung, Dorothy J Radford, Leeanne GriggAbstract:We estimated the Inpatient resource use for a Fontan patient from birth to adulthood and explored factors that might induce cost differences (2014 US dollar). Inpatient costing records from 4 Hospitals with greatest numbers of Fontan patients in Australia and New Zealand were linked with the Fontan registry database. Inpatient records between July 1995 and September 2014 for 420 Fontan patients were linked, and the most frequent primary diagnoses were hypoplastic left heart syndrome (20.7%), tricuspid atresia (19.7%), and double inlet left ventricle (17.1%). The mean Hospital cost for a Fontan patient from birth to 18 years of age was estimated to be $390,601 (95% confidence interval [CI] $264,703 to $516,499), corresponding to 164 (95% CI 98 to 231) Inpatient days. The cost incurred from birth through to Fontan completion (the staged procedures period) was $219,482 (95% CI $202,410 to $236,553) and the cost thereafter over 15 years was $146,820 (95% CI $44,409 to $249,231), corresponding to 82 (95% CI 72 to 92) and 65 (95% CI 18 to 112) Inpatient days, respectively. Costs were higher in male and hypoplastic left heart syndrome patients in the staged procedures period (p <0.001). Having fenestration was associated with higher costs in the staged procedures period (p <0.001) and lower cost after Fontan over 15 years (p = 0.66). In conclusion, patients with single ventricle congenital heart disease continue to demand considerable Inpatient resources after the staged procedures period. Over 40% of the pediatric Hospital costs for Fontan patients were estimated to occur after the last planned surgery.
-
Hospital Inpatient costs for single ventricle patients surviving the Fontan procedure
'Elsevier BV', 2017Co-Authors: Li Huang, Schilling Chris, Dalziel, Kim M., Xie Siyu, Celermajer, David S., Mcneil, John J., Winlaw David, Hornung, Tim S., Radford, Dorothy J., Grigg, Leeanne E.Abstract:We estimated the Inpatient resource use for a Fontan patient from birth to adulthood and explored factors that might induce cost differences (2014 US dollar). Inpatient costing records from 4 Hospitals with greatest numbers of Fontan patients in Australia and New Zealand were linked with the Fontan registry database. Inpatient records between July 1995 and September 2014 for 420 Fontan patients were linked, and the most frequent primary diagnoses were hypoplastic left heart syndrome (20.7%), tricuspid atresia (19.7%), and double inlet left ventricle (17.1%). The mean Hospital cost for a Fontan patient from birth to 18 years of age was estimated to be $390,601 (95% confidence interval [CI] $264,703 to $516,499), corresponding to 164 (95% CI 98 to 231) Inpatient days. The cost incurred from birth through to Fontan completion (the staged procedures period) was $219,482 (95% CI $202,410 to $236,553) and the cost thereafter over 15 years was $146,820 (95% CI $44,409 to $249,231), corresponding to 82 (95% CI 72 to 92) and 65 (95% CI 18 to 112) Inpatient days, respectively. Costs were higher in male and hypoplastic left heart syndrome patients in the staged procedures period (
Deborah L Reede - One of the best experts on this subject based on the ideXlab platform.
-
diagnosis related groups and Hospital Inpatient federal reimbursement
Radiographics, 2015Co-Authors: Simcha B Rimler, Brian D Gale, Deborah L ReedeAbstract:To understand the complex system of reimbursement for health care services, it is helpful to have a working knowledge of the historic context of diagnosis-related groups (DRGs), as well as their utility and increasing relevance. Congress implemented the DRG system in 1983 in response to rapidly increasing health care costs. The DRG system was designed to control Hospital reimbursements by replacing retrospective payments with prospective payments for Hospital charges. This article explains how these payments are calculated. Every Inpatient admission is classified into one of several hundred DRGs that are based on the diagnosis, complications, and comorbidities. The Centers for Medicare & Medicaid Services (CMS) assigns each DRG a weight that the CMS uses in conjunction with Hospital-specific data to determine reimbursement. A population's DRGs represent the resources needed to treat the medical disorders of that population. Hospital administrators use this information to budget and plan for the future. The Affordable Care Act and other recent legislation affect medical reimbursement by altering the DRG system. Radiologic procedures in particular are affected. This legislation will give DRGs an even larger role in determining reimbursements in the coming years.