briefCASE
Dec. 24, 2014

Hospitalists weigh in on observation status
ACMA
From Aug. 13: The Society for Hospital Medicine (SHM) recently released a white paper regarding observation status and the new two-midnight rule. In the paper, SHM reports that only 17 percent of hospitalists surveyed believe the two-midnight rule is an improvement over previous observation policies, while 55 percent believe it has impeded hospitalist workflow. Survey results, based on the responses from more than 300 hospitalists, also found that doctors change the status of 16 percent of their patients daily. More

Readmission reduction: A losing battle?
FierceHealthcare
From Oct. 22: Readmissions may be "beyond a hospital's control," according to a new study published in the American Journal of Managed Care. Researchers, led by Ariel Linden of the University of Michigan School of Public Health, analyzed more than 500 patients in two Oregon community hospitals. They gave half the patients an intervention featuring pre-discharge education and planning, post-discharge follow-up, an available hotline and "bridging" techniques such as daily symptom checks. More

Physician: 'I almost killed a patient' due to advance directive
HealthLeaders Media
From May 7: According to the author Philip Betbeze: While advance medical directives can be a benefit to patients, families and health care costs, misinterpretation of these documents by clinicians is common, says a prominent emergency medicine physician. This can lead to irreversible medical errors. I recently wrote about the idea of making advance directives a condition of obtaining Medicare benefits. Such a move, one major healthcare CEO told me, would be a great way to help reduce the cost of care for patients at the end of life, where so much expensive treatment with dubious results takes place. More

Legislation would factor patient finances into readmission penalties for hospitals
Fierce Healthcare
From June 25: The Senate introduced legislation that would require Medicare to consider patients' finances when deciding whether to punish a hospital for readmission numbers. The bill, sponsored by both democrats and republicans, aims to help hospitals that serve large numbers of low-income patients. It does not specify how to revise the penalty program — leaving it up to Medicare. More

Longer hospital stay equals lower mortality, fewer readmissions
FierceHealthcare
From Nov. 5: One extra day in the hospital cuts costs and significantly reduces the chance of the need to readmit Medicare patients within 30 days, a new study from Columbia Business School found. That extra day slashed the risk of death for patients treated for pneumonia by 22 percent. Mortality for heart attack patients was cut by 7 percent, as were readmission rates, according to an announcement detailing the findings. Overall, the number of heart attack and pneumonia patient lives saved with one more day of hospitalization versus outpatient treatment increased five- to six-fold, the school said. More

Controversial Medicare recovery audits make limited return
Modern Healthcare (Subscription required)
From Aug. 20: The CMS is restarting audits of Medicare fee-for-service claims on a limited basis. The program has been dormant since June 1 when current audit contracts expired. Lauren Aronson, director of CMS' Office of Legislation, sent an email to congressional staffers recently announcing the resumption of the recovery audit contractor program. More

CMS offers to settle disputed short-term hospital claims
FierceHealthFinance
From Sept. 3: The Centers for Medicare & Medicaid Services wants to end the long wrangling with hospitals over short-term inpatient stays. The CMS offered to pay hospitals to settle the cases that are in dispute or under appeal, which may total as many as 800,000. The total sum represents 68 percent of what the hospitals say they are owed, according to a notice posted on the CMS website and could run into the hundreds of millions of dollars, the New York Times reported. More

CMS announces limited restart of RAC reviews
AHA News Now
From Aug. 6: The Centers for Medicare and Medicaid Services will allow current Recovery Audit Contractors to restart a limited number of claim reviews beginning this month, CMS announced. The agency said most reviews will be done on an automated basis. However, a limited number will be complex reviews on certain claims, including spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies, and cosmetic procedures. More

CMS awards 14 more contracts under QIO program restructure
AHA News Now
From July 23: The Centers for Medicare and Medicaid Services recently awarded 14 Quality Improvement Organizations five-year contracts to work with healthcare providers on strategic quality initiatives and provide technical assistance to participants in CMS value-based purchasing programs. Each of the recipients, known as Quality Innovation Network-QIOs, will work with providers in specific states. More

Medicare pilots strive to reduce appeals backlog
Illinois Hospital Association
From July 9: The Dept. of Health & Human Services, Office of Medicare Hearings and Appeals, recently posted on its website information about two pilot programs to address the current backlog of claims currently at the Administrative Law Judge level of appeal. Many of those appeals were the result of payment denials initiated by the Medicare Recovery Audit Contractors. More