HHSC – Learning Collaborative Summit

HHSC has posted information on the August 27th - 28th Statewide Learning Collaborative Summit, including the livestream link and agenda, on the Dates and Deadlines page. Visit us at Garlo Ward, PC … [Read more...]

Non-payment for “Never Events”: Coming to a Long-Term Care Provider Near You

Since October 2008, the Centers for Medicare and Medicaid Services ("CMS") have not paid hospitals for certain hospital-acquired conditions. That is, CMS will not pay for certain conditions that were not present in the patient upon admission. The conditions are, as designated by CMS, conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been … [Read more...]

Four Habits of High-Value Health Care Organizations

The New England Journal of Medicine recently published an article regarding four habits of effective hospitals. Although the article is geared towards, hospitals, the principles below are applicable to any health care organization. Specification and planning - Base choices, transitions, subgroups, and patient pathway on specific, meaningful criteria. Infrastructure design - Create microsystems to meet the needs of patient sub-populations. The author stresses that microsystems create "an … [Read more...]

CMS to Offer Nursing Home Quality of Care Incentive

The Centers for Medicare and Medicaid Services (CMS) announced last week that it will offer cash incentives to improve quality of care in nursing homes. CMS will ask Arizona, Mississippi, New York, and Wisconsin to participate. (Source) Quality of care areas include nurse staffing and the scope and severity of deficiency citations the home has received during inspections. Those with the highest scores/greatest performance will receive performance payment. Acting administrator Charlene … [Read more...]

DADS Alerts: CLASS Clarification, Etc.

The Texas Department and Aging and Disability Services (DADS) notified Community Living Assistance and Support Services (CLASS) providers that Form 8604, the Transition Assistance Services (TAS) Assessment and Authorization, has been replaced by Form 3621-A, CLASS Transition Assistance Services. See the TAS handbook for more information. DADS is offering new forms for programs like Deaf/Blind with Multiple Disabilities, Home and Community-based Services, and Intermediate Care Facilities for … [Read more...]

CMS Seeks to Improve Outpatient Quality of Care

Last week, the Centers for Medicare & Medicaid Services (CMS) announced a final rule that restates its commitment to implementing Value Based Purchasing incentives, one of which is to improve the quality of care with Medicare in hospital outpatient departments (HOPDs). CMS hopes to give hospitals an incentive to improve care by tying quality of care to payments. Kerry Weems, CMS acting administrator, said "In this final rule, we are continuing to pay appropriately for care while working with … [Read more...]

CMS Announces Electronic Prescribing System

As the stereotype goes, physicians' handwriting is notoriously illegible. Last week, the Centers for Medicare & Medicaid Services (CMS) announced a new electronic prescribing system designed to eliminate medication errors caused by people misreading handwritten prescriptions. (Source) Kerry Weems, CMS acting administrator said "more than 1.5 million Americans are injured every year by drug errors. E-prescribing lets providers know—up front—their patients’ medication history and the … [Read more...]

CMS Reports Pay-for-Performance Pilot Success

The Centers for Medicare and Medicaid Services (CMS) announced last week that a pilot pay-for-performance program, which pays doctors based on quality of care, has lowered costs "in some cases" and improved quality of care for patients with congestive heart failure, coronary artery disease, and diabetes. According to CMS, four of the 10 groups participating in the program reduced costs to patients and CMS spending by $17.4 million. Kerry Weems, acting administrator for CMS, said, "We are … [Read more...]

CMS Set to Base Medicare Hospital Reimbursements on Quality of Care

Yesterday, the Centers for Medicare and Medicaid Services (CMS) proposed to change the way it pays Medicare reimbursements to hospitals. (Kaiser Network) CMS seeks to reduce payments by a flat rate (2 percent to 5 percent) to create an "incentive payment pool" for hospitals that meet quality of care thresholds. According to CQ HealthBeat, the plan would create a "Value-Based Purchasing Program." Under this program, a hospital's diagnosis-related group reimbursements would be based on quality … [Read more...]