Jun. 3, 2015

30-day readmission measure fails to account for changing risk factors
Risk factors for readmissions change significantly over the course of the 30 days following hospital discharge, a new study shows, and therefore the current Medicare measure for readmissions doesn't accurately reflect the hospital's accountability for rehospitalizations. Under the Affordable Care Act, the Centers for Medicare & Medicaid Services may reduce payments to acute care hospitals that have excess readmissions within 30 days of discharge. Last year it penalized more than 2,600 hospitals. More

Looming changes apparent in 2016 IPPS proposed rule
VBP monitor
On April 30, the Inpatient Prospective Payment System proposed rule for the 2016 fiscal year was published in the Federal Register. As with regulations from prior years, in the rule's language the Centers for Medicare & Medicaid Services previewed proposed changes to the value-based purchasing program. CMS is seeking public comment on the various changes being proposed. For the 2016 fiscal year, the reduction in based operating MS-DRG payment amount is 1.75 percent. More

Case Management Advocacy: A call to action
Bills have been introduced in Washington, which address issues affecting your daily practice and adversely impacting patient care. The Improving Access to Medicare Coverage Act and the Medicare Audit Improvement Act represent opportunities for case managers to voice concerns related to observation status/the three-day stay requirement and the CMS Recovery Audit Program (formerly RAC). Over the coming months, you will periodically receive email calls to action regarding these issues, which contain a link to ACMA's online Grassroots Action Center. You can also learn more and make your voice heard anytime at Please take a few moments and contact Congress to request support of these bills. ACMA has already provided a message to help you get started — simply customize/add your personal experience, sign your name and send. One click, it's that easy. There is strength in numbers, so we also encourage you to share these issues and direct your colleagues and non-member advocates to join the effort via ACMA's Grassroots Action Center at More

The 2015 National Hospital Case Management Survey results are in
The 2015 National Hospital Case Management Survey final report is now available. Every two years, ACMA conducts an extensive survey to produce 95 percent confidence level data. ACMA randomly selects hospitals from the acute care setting across the United States to participate in this survey, and collects data from more than 400 hospitals.

More than 75 data elements are included in the final report including average case loads, salary ranges and scope of services/functions. Survey data is used by members in organizations nationwide for benchmarking, resource justification and practice improvement.

ACMA thanks those who participated in the Survey — your responses allow us to provide you and your colleagues in case management with valuable data and metrics specific to your daily practice.

The Survey results are available in the Members Only section of the ACMA website under the "Resources" tab.

Login at to download the Survey todayMore

Free online continuing education for ACMA members
ACMA offers continuing education in the Members Only Section of the ACMA website. The Continuing Education Center is designed to enhance your membership by granting up to 30 hours of online continuing education focused on a variety of topics that can be viewed at your convenience. Login to learn more and start earning CEs today — More

ACMA Chapter Events
Innovative case management education near you — learn more at More

From the publisher: Happy anniversary, Medicare and Medicaid
Modern Healthcare
Americans are living longer, more productive lives because of Medicare and Medicaid, signed into law by President Lyndon Johnson a half-century ago. Case in point: The father of a colleague recently passed away after reaching his 101st birthday. He was vigorous to the end — even mustering the curiosity to ask his daughter to explain Twitter and Facebook. Medicare helped ensure his longevity. Medicaid also has made its mark. It has transformed the lives of the disabled and chronically ill, whether the wheelchair-bound grandmother with congestive heart failure or the single mom whose asthmatic child might die without Medicaid coverage.More

10 key points: CMS unveils overhaul to Medicaid managed care
Hospital CFO
CMS has unveiled a regulatory package containing the first major update to Medicaid managed care regulations in more than 10 years. Medicaid managed care, which is aimed at controlling healthcare cost, utilization and quality, has evolved into the dominant delivery system in Medicaid, with more than 42 million Americans enrolled in some form of Medicaid managed care, according to a Kaiser Family Foundation report. The regulations governing Medicaid managed care were last updated in 2002 and 2003, and the proposed rule CMS released recently seeks to "modernize" the system. More

CMS: Successful April Medicare FFS ICD-10 end-to-end testing
RevCycle Intelligence
According to a recent announcement from the Centers for Medicare & Medicaid Services, ICD-10 implementation success is here. Between Monday, April 27 and Friday, May 1, Medicare Fee-For-Service healthcare providers, clearinghouses and billing agencies contributed their collective efforts towards a second successful ICD-10 end-to-end testing week. Testing participation was with all Medicare Administrative Contractors and the Durable Medical Equipment MAC Common Electronic Data Interchange contractor. More

When your doctor leaves your health plan, you likely can't follow
Kaiser Health News
According to author Michelle Andrews: Recently, I addressed a grab bag of questions related to insurance coverage of hearing aids, doctors who drop out of a plan mid-year and what happens if you receive subsidies for exchange coverage but learn later on you were eligible for Medicaid all along.More

Texas puts brakes on telemedicine — And Teladoc cries foul
Kaiser Health News
On a recent trip to Chicago, Patti Broyles felt like she was looking at the world from the bottom of a fish bowl. "This weather was really cold and rainy, and I had a lot of pressure in my sinus area," Broyles said. Since she was nowhere near her primary care doctor in Dallas, she called Teladoc, the largest telemedicine provider in the U.S., for advice. Patients whose employers or insurers have deals with the Dallas-based company can call any time and be connected with a physician on duty within minutes.More

Why the Supreme Court's upcoming ACA ruling matters
Scientific American
In the five years since the Affordable Care Act became law it has survived some 60 recall attempts by the House of Representatives and one major U.S. Supreme Court challenge. Most of the House votes were little more than opportunities to burnish GOP credentials but the latest legal challenge could be a game-changer for the 2010 law designed to help millions of uninsured Americans get health insurance and lower health care costs. At issue is something seemingly insignificant: tax subsidies.More

Hospital discharge day affects dialysis patient readmission risk
Renal & Urology News
Dialysis patients discharged from hospitals on Fridays or Saturdays are at increased risk of readmission within 30 days compared with those who are discharged on other days, according to findings presented at the 52nd congress of the European Renal Association-European Dialysis and Transplant Association in London. The finding suggests that intensified medical attention and monitoring, such as expanded weekend coverage by a dialysis-specific case manager may be needed for patients discharged on Friday or Saturday, researchers concluded. More

Hospitals expected more of a boost from health law
The Wall Street Journal
The health law's expansion of Medicaid in many states hasn't benefited nonprofit hospitals in those states as expected, according to a new report by Moody's Investors Service. Hospitals in the mostly blue states that expanded Medicaid were largely expected to benefit from fewer unpaid bills and more paying customers, but that hasn't generally translated into better operating margins or cash flow, Moody's found.More