Are You Ready for the New Joint Commission Ambulatory Care Pain Standards?

In June of this year, The Joint Commission (TJC) released new and revised pain assessment and management standards for all TJC-accredited ambulatory care facilities, critical access hospitals and office-based surgery organizations. These standards are part of TJC's efforts to address disparities between the pain management standards the organizatio...
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Involve Doctors, Caregivers to Improve EHRs: Physician Survey

Health systems could be doing more to help physicians and other members of the care team derive optimal benefit from their electronic health records (EHRs) and other health information technologies, a new survey reports. Among the most important steps organizations can take to make more of their HIT investments are proactively soliciting input from...
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Five New CPT® Codes Support Billing for Telehealth, Remote Monitoring

The American Medical Association (AMA) has introduced new codes in the 2019 Current Procedural Terminology (CPT®) code set that would allow physicians to bill for some remote patient monitoring services and internet consultations.Acceptance of the new codes by the Centers for Medicare and Medicaid Services (CMS) in the 2019 Physician Fee Schedule "...
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Size and Profitability Do Not Go Hand in Hand: Health System Study

A new report throws into question the common wisdom that scale enhances health system operations. The study, by consulting firm Navigant, found no correlation between higher revenues and better operating margins among 104 highly rated hospital systems during 2015-2017, following the expansion in insurance coverage that accompanied the Affordable Ca...
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Mapping the Road to Regulatory Relief

One way to reduce healthcare costs is to reduce the time and resources providers and clinicians are forced to spend complying with the plethora of government healthcare regulations. This is the stance of the American Hospital Association (AHA) and other industry groups, which assert that healthcare organizations and professionals could do a better ...
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Guide Helps Providers Shield Infusion Pumps from Cyberattacks

September 5, 2018The unprecedented connectivity of today's wireless infusion pumps with healthcare systems, networks and other medical devices enhances the efficiency and quality of care. However, that same connectivity exposes healthcare organizations and patients to a slew of new cybersecurity risks. These risks range from access and tampering by...
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Measure Healthcare Equity to Improve Quality: Health Affairs Study

​Healthcare has experienced a meteoric rise in the use of quality measures to determine payment through the Hospital Value-Based Purchasing Program (HVBP), the Merit-Based Incentive Payment System (MIPS) and other programs. An article in Health Affairs argues that what are missing from these programs are measures and payment incentives tied to one ...
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OIG Review Finds $25.8M in Hospital Overpayments for IMRT Planning

A new Office of Inspector General (OIG) audit report indicates that Medicare made as much as $25.8 million in overpayments to hospitals for intensity-modulated radiation therapy (IMRT) planning services during 2013 through 2015.IMRT is an advanced radiation procedure used to treat difficult-to-reach tumors. Payment for the computer-based planning r...
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AHA Outlines Strategies to Stem Medicare Appeals Backlog

August 15, 2018As of June 2017, the Medicare appeals backlog stood at an astonishing 607,402 pending cases at the administrative law judge level. Estimates indicate that it will soar to 950,520 cases by the end of the 2021 fiscal year.To help tackle the overwhelming glut of appeals, a federal judge asked the American Hospital Association (AHA) this...
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Few Patients Use Price Comparison Tools: NBER Study

Despite the fact that most health insurance companies now provide a price transparency tool for beneficiaries, only a tiny minority of patients choose to shop for healthcare services or review provider prices before accessing services, a new study by the National Bureau of Economic Research has found.Researchers analyzed data from a large private i...
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Six Principles for Opioid Prescribing: MGMA Report

When it comes to reducing the risk of opioid abuse and the over-prescribing of opioid medications, medical practices should think in terms of communication, technology and referral management, a new report from the Medical Group Management Association (MGMA) advises.Titled Combating the Opioid Epidemic: Effective Policies and Communication Strategi...
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CMS Proposes Payment, Reporting Changes for 2019

Updates to the Quality Payment Program (QPP), significant revisions regarding documentation and payment for Evaluation & Management (E&M) services, a slight increase in the conversion factor from $35.99 to $36.05, and numerous proposals to streamline reporting and other requirements for eligible clinicians (ECs) are among the highlights of ...
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Blockchain Technology in Healthcare: Disruptor or Fad?

Among emerging technologies, blockchain technology probably ranks somewhere near artificial intelligence and machine learning in the level of discussion being generated about its potential to revolutionize health information technology and the sector itself. An IBM survey reported that 16 percent of 200 surveyed healthcare executives had plans to i...
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Tackle Physician Burnout with Two-Pronged Interventions

The depersonalization, emotional exhaustion and reduced feelings of accomplishment that characterize the phenomenon known as physician burnout—and that remain endemic in healthcare—call for a combination of organizational and individual interventions, a review published in June issue of the Journal of Internal Medicine reports."Both individual‐focu...
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Far-Reaching Opioid Bill Passes House

In what the House Energy and Commerce Committee has described as "the most significant congressional effort against a single drug crisis in history," the House of Representatives has passed, by an overwhelming majority, the bipartisan SUPPORT for Patients and Communities Act (H.R. 6) to curb the growing opioid crisis. The bill will serve as the veh...
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CMS Delays Release of New Hospital Compare Star Ratings

The Centers for Medicare and Medicaid Services (CMS) has postponed an update, originally slated for July, of the Overall Hospital Quality Star Ratings on its Hospital Compare website. The website is designed to serve as an information and decision-making tool for consumers, and is used as a resource by payers and providers as well.CMS said it has d...
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Integrated Services: The CHRONIC Care Act’s Potential—and Possible Pitfalls

Among other things, the CHRONIC Care Act of 2017 will allow Medicare Advantage (MA) plans to offer chronically ill beneficiaries a broader range of services and supports. One of its main purposes is to integrate medical care with non-medical long-term services and supports (LTSS), which could include everything from vision and hearing aids, transpo...
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340B Cuts Could Hurt Small, Rural and DSH Healthcare Providers

The $1.6 billion reduction in the federal 340B Drug Discount Program that went into effect in 2018 could negatively impact the operating performance of many participating non-profit hospitals, credit research firm S&P Global Ratings has reported. The Centers for Medicare & Medicaid Services (CMS) has reduced 340B payments by about 30 percen...
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CMS Explores Direct Provider Contracting, Starting With Primary Care

The Centers for Medicare and Medicaid Services (CMS) is testing the waters on a new alternative payment model (APM) through which the agency would pay participating primary care practices a monthly per-beneficiary fee for certain services, such as office visits and some office-based procedures. As with other APMs, the proposed direct provider contr...
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Studies Show Pros and Cons of Prior Authorization

A recent survey of 1,000 physicians by the American Medical Association (AMA) found that 92 percent believe prior authorizations (requirements by payers to approve a medical service, treatment plan, medication or piece of durable medical equipment [DME] before it is provided) have a negative impact on clinical outcomes. And the American Academy of ...
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