by Brian J. Moore, Ph.D., and Celeste M. Torio, Ph.D., M.P.H.
Acute renal failure or acute kidney injury is defined as an abrupt decrease in kidney function to the point that the body accumulates waste products and becomes unable to maintain electrolyte, acid-base, and water balance. It can occur when there is impaired blood flow to the kidneys, damage to the kidneys, or urine blockage in the kidneys. It is an increasingly common complication among patients hospitalized for acute illness. It has been associated with increased long-term risk of poor outcomes, including reduced health-related quality of life, increased incidence of chronic kidney disease, accelerated progression to end-stage renal disease, and mortality. These poor outcomes result in greater utilization of health care resources and increased health care costs.
The Next Chapter In Transparency: Maryland’s Wear The Cost
by Robert Moffit, Marilyn Moon, François de Brantes, and Suzanne Delbanco
Historically, the State of Maryland’s per capita health spending has been substantially higher than the national average. In an attempt to control health care costs, the state has been administering an all-payer rate setting system for Maryland hospitals—fixing the rates for Medicare and private payers—for more than 40 years. Regardless of one’s view of the desirability of these regulatory interventions, the Maryland system has been unable to address the wide disparity among providers in terms of both price and quality.
The House Appropriations Committee today released the fiscal year 2017 Omnibus Appropriations bill, the legislation that will provide discretionary funding for the federal government for the current fiscal year.
The bill includes full Appropriations legislation and funding for the remaining 11 annual Appropriations bills through the end of the fiscal year, September 30, 2017. This level meets the base discretionary spending caps provided by the Bipartisan Budget Act of 2015, and provides additional funding for national defense, border security, and other emergency needs.
Health Care In America: An Employment Bonanza And A Runaway-Cost Crisis
by Chad Terhune for Kaiser Health News
In many ways, the health care industry has been a great friend to the U.S. economy. Its plentiful jobs helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs 1 in 9 Americans - up from 1 in 12 in 2000.
As President Donald Trump seeks to fulfill his campaign pledge to create millions more jobs, the industry would seem a promising place to turn. But the business mogul also campaigned to repeal Obamacare and lower health care costs - a potentially serious job killer. It’s a dilemma: One promise could run headlong into the other.
Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.
News Item - 04/16/2017
Public Use File
The Centers for Medicare & Medicaid Services (CMS) has developed a public use file that enables researchers and policymakers to evaluate geographic variation in the utilization and quality of health care services for the Medicare fee-for-service population. The Geographic Variation Public Use File includes demographic, spending, utilization, and quality indicators at the state level (including the District of Columbia, Puerto Rico, and the Virgin Islands), hospital referral region (HRR) level, and county level.
Opioid-Related Inpatient Stays and Emergency Department Visits by State, 2009-2014
by Audrey J. Weiss, Ph.D., Anne Elixhauser, Ph.D., Marguerite L. Barrett, M.S., Claudia A. Steiner, M.D., M.P.H., Molly K. Bailey, and Lauren O'Malley
The opioid epidemic has reached alarming levels in many parts of the United States, affecting the lives of thousands of individuals and families. Between 2000 and 2014, the rate of overdose deaths involving opioids in the United States increased 200 percent. Between 2013 and 2014 alone, the rate of opioid overdose deaths increased 14 percent, from 7.9 to 9.0 per 100,000 population. Hospitalizations related to opioid misuse and dependence also have increased dramatically, with the rate of adult hospital inpatient stays per 100,000 population nearly doubling between 2000 and 2012. The substantial increase over the past decade in the misuse of opioids, which include prescription opioids and illicit opioids such as heroin, has been declared an "opioid epidemic" by the U.S. Department of Health and Human Services (HHS).
CMS Finalizes Hospital Outpatient Prospective Payment System Changes to Better Support Hospitals and Physicians and Improve Patient Care
On Nov 1, the Centers for Medicare & Medicaid Services (CMS) finalized updated payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2017. These finalized policy changes will improve the quality of care Medicare patients receive by better supporting their physicians and other health care providers and reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.
CMS Finalizes the New Medicare Quality Payment Program
Today, the Department of Health and Human Services (HHS) finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program. The new Quality Payment Program will gradually transform Medicare payments for more than 600,000 clinicians across the country, and is a major step in improving care across the entire health care system.
The final rule with comment period offers a fresh start for Medicare by centering payments around the care that is best for the patients, providing more options to clinicians for innovative care and payment approaches, and reducing administrative burden to give clinicians more time to spend with their patients, instead of on paperwork.
Accompanying today’s announcement is a new Quality Payment Program website http://qpp.cms.gov, which will explain the new program and help clinicians easily identify the measures most meaningful to their practice or specialty.
Falls and Fall Injuries Among Adults Aged ≥65 Years - United States, 2014
by Gwen Bergen, PhD; Mark R. Stevens, MA, MSPH; Elizabeth R. Burns, MPH
Falls are the leading cause of fatal and nonfatal injuries among adults aged ≥65 years (older adults). During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized.* To estimate the numbers, percentages, and rates of falls and fall injuries among older adults by selected characteristics and state, CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey. In 2014, 28.7% of older adults reported falling; the estimated 29.0 million falls resulted in 7.0 million injuries. Known effective strategies for reducing the number of older adult falls include a multifactorial clinical approach (e.g., gait and balance assessment, strength and balance exercises, and medication review). Health care providers can play an important role in fall prevention by screening older adults for fall risk, reviewing and managing medications linked to falls, and recommending vitamin D supplements to improve bone, muscle, and nerve health and reduce the risk for falls.
WalletHub Lists States With the Best and Worst Health Care
WalletHub, a personal finance website, has listed the best and worst health care states based on 29 metrics including average premiums, coverage rates and physicians per capita. The top five are: Minnesota, Maryland, South Dakota, Iowa and Utah, respectively. The bottom five: Arkansas, Nevada, Mississippi, Louisiana and Alaska.
An Analysis of Hospital Prices for Commercial and Medicare Advantage Plans
by Jared Maeda
Prices for hospital admissions have received considerable attention in recent years, both because they are an important component of health care spending and because they can vary widely. In this presentation, we use 2013 claims data from three large insurers to examine the hospital payment rates of those insurers in their commercial plans and their Medicare Advantage plans and compare them with Medicare’s fee-for-service (FFS) rates; we also examine the variation of those rates across and within markets.
An Analysis of Private-Sector Prices for Physician Services
by Daria Pelech
Physicians’ services account for a substantial portion of health care spending in the United States, but research on the prices private insurers pay for those services has been limited. Using 2014 claims data from three major insurers, we analyzed the prices paid for 21 common services and compared them with the estimated amounts that Medicare’s fee-for-service (FFS) program would pay.
Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Proposed Rule, and Request for Information CMS-1677-P
On April 14, 2017, the Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update 2018 Medicare payment and polices when patients are admitted into hospitals. The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care.
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.