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May 3, 2018

ACO roundup: Medicare should cut 30-day readmission measures to 7 days, researchers say

Daily Briefing
    • Medicare should cut readmission measures from 30 to 7 days, researchers say. Hospitals have more control over factors that lead to early readmissions (those within seven days of discharge), while outpatient facilities and home caregivers are generally more responsible for factors that lead to late readmissions (those that occur between eight and 30 days after discharge), according to a new study in the Annals of Internal Medicine. The researchers assessed readmission rates and causes for 822 adult patients at 10 academic medical centers between April 2012 and March 2013. They found that early readmissions "were more likely to be amendable to interventions within the hospital and to be caused by factors for which the hospital is directly accountable, such as problems with physician decision making" (linked to 28.9% of early readmissions). In comparison, the researchers concluded that "late readmissions were more likely to be amenable to interventions outside the hospital and to be caused by factors over which the hospital has less direct control, such as appropriate monitoring and managing of symptoms after discharge by the primary care team" (linked to 33.2% of late readmissions). The researchers concluded that Medicare should reduce the timeframe for its Hospital Readmissions Reduction Program from 30 to seven days, among other recommendations.

    • Practices increasingly hire NPs, PAs. More primary care practices and specialty practicing are hiring at least one advanced practice clinician, such as nurse practitioners (NPs) or physician assistants (PAs), according to a new study in JAMA Internal Medicine. According to the study, 35% of primary care practices hired at least one advanced practice clinician in 2016, up from 28% in 2008, while 28% of specialty practices did so, up from 23% in 2008.

    • Our take: CMS' new payment rules are good news for skilled nursing facilities. CMS on Friday released proposed rules increasing payments for skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), hospice providers, and inpatient psychiatric facilities (IPFs) for fiscal year (FY) 2019. Under the proposed rules for SNFs, SNFs' Medicare payments for FY 2019 would increase 2.4%, or $850 million, when compared with FY 2018, and the SNF Prospective Payment Systems' (SNFPPS) existing case-mix classification system would be replaced with the SNF Patient-Driven Payment Model (PDPM) in FY 2019. Meanwhile, under the other proposed rules, IRFs would see their Medicare payments for FY 2019 increase by 0.9%, or $75 million, when compared with FY 2018; hospice providers would receive a 1.8%, or $340 million, increase in Medicare payments for FY 2019; and IPFs would see their Medicare payments increase by 0.98%, or $50 million, in FY 2019.

    From Advisory Board:

    • Transform your business model for Medicaid risk. Join us on Tuesday, May 15 at 1:00 p.m. ET, to learn how, with the increased financial flexibility of Medicaid risk, health systems can adapt their existing care management infrastructure to better manage the Medicaid population.

    Register Here

    • Everything you need to know about the proposed IPPS rule. Join us on Tuesday, May 22 at 3:00 p.m. ET, to get the details of the FY 2019 Inpatient Prospective Payment System (IPPS) Proposed Rule, including proposed changes to rates, MS-DRG groupings, and inpatient quality initiatives.

    Register Here

    Register Here

    Medicare 101: Cheat sheets for Parts A through D

    Through the years Medicare has grown more complicated, including private supplemental insurance and prescription drug coverage. Download our cheat sheets to learn how each of the four parts of Medicare works, and why they’re so important for provider organizations:

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