October 15, 2019 -When Medicare reimbursement depended on location, greater hospital-based versus practice-based payments were associated with higher proportions of outpatient non-invasive cardiac tests performed in the more expensive setting, according to a new study published in JAMA Internal Medicine.
The observational claims-based study of Medicare fee-for-service claims from 1999 to 2015 found that the hospital-based outpatient testing to provider-based office testing payment ratio for non-invasive cardiac tests, which include echocardiography and stress testing with or without imaging, increased from 1.05 to 2.32 from 2005 to 2015.
That increase that was associated with the growing volume of hospital-based testing in Medicare fee-for-service organizations observed from 2008 to 2015, researchers from the University of Colorado and Northwestern University reported.
Hospital-based testing increased by 21.1 percent from 2008 to 43.2 percent in 2015 among Medicare fee-for-service providers, which correlated with the payment ratio between hospital-based outpatient testing to provider-based office testing, the study found.
Meanwhile, the control group three Medicare Advantage health maintenance organizations for which CMS payments do not depend on testing location experienced a decrease in hospital-based testing from 16.6 percent to 15.2 percent, and the volume change had no significant correlation with payment rates.
The shift of non-invasive cardiac services to the more expensive hospital setting resulted in greater costs to traditional Medicare, the study showed. Researchers estimated that the extra costs owing to tests shifting to the hospital-based outpatient setting in the Medicare fee-for-service group totaled $661 million in 2015, including $161 million in patient out-of-pocket costs.
Site-neutral payments may offer an incentive for testing to be performed in the more efficient location, suggested the studys authors.
Site-neutral payments are not a novel concept in traditional Medicare. Section 603 of the Bipartisan Budget Act of 2015 enacted site-neutral payments for new, off-campus provider-based hospital outpatient departments.
The Trump Administration intends to continue on the path to site-neutral payment. The president recently signed an executive order directing the HHS Secretary to ensure that Medicare payments and policies encourage competition and a diversity of sites for patients to access care.
Under the presidents direction, CMS also sought to expand the use of site-neutral payments in 2019 by paying new and old off-campus provider-based hospital outpatient departments the same rate for certain clinic visits. The agency estimated the expansion to reduce Medicare spending by $380 million in the first year of implementation.
However, hospitals and other provider groups have fought to prevent expansions of site-neutral payment policies in Medicare fee-for-service.
The American Hospital Association (AHA), Association of American Medical Colleges (AAMC), and three other healthcare organizations sued CMS over the expansion of site-neutral payments for certain clinic visits, arguing that CMS exceeded its authority by applying the payments to hospital outpatient departments exempted under Section 603 of the Bipartisan Budget Act of 2015. Thirty-eight hospitals later filed a separate lawsuit against HHS alleging the same thing.
In September, a federal judge overturned the Medicare payment policy, ordering CMS to stop reimbursing hospital outpatient departments the lower site-neutral rate.
In general, hospitals oppose site-neutral payments because the lower Medicare fee-for-service rates do not account for the resources needed to run a hospital outpatient department versus a provider-based office. For example, hospitals abide by stricter regulatory requirements, such as having 24-hour nursing care and maintaining discharge planning protocols.
Research has also shown that hospital outpatient departments treat sicker, poor patients compared to provider-based offices, providing evidence for hospitals opposing site-neutral payments.
However, just this week, the American Academy of Family Physicians (AAFP) applauded President Trumps site-neutrality provision in the recently signed executive order.
Current policies that provide differential payments based solely on the site where services are provided are not warranted. Furthermore, these payment differentials create an imbalance in the marketplace which drives consolidation, reduces consumer choice and leads to higher prices for patients, AAFP board chair John S. Cullen, MD, FAAFP, wrote in a letter to President Trump. The AAFP and our members strongly support your efforts on this issue.
The Alliance for Site Neutral Payment Reform, a coalition of patient advocates, providers, payers and employers who support payment parity across site of service, have also argued that site-neutral payments are key to cutting costs in healthcare and preventing hospitals from purchasing physician offices for financial gain.
Go here to read the rest:
Site-of-Service Medicare Reimbursement Led to More Hospital Testing - RevCycleIntelligence.com
- Cardiac Nursing Nursing Schools - RNtoMSN - Find Top Masters in Nursing Programs ... - April 13th, 2018 [April 13th, 2018]
- Associate Degree Nursing Physiology Review - April 18th, 2018 [April 18th, 2018]
- Cardiac Nursing Nursing Schools - Find Top Masters in ... - April 26th, 2018 [April 26th, 2018]
- Cardiac Nursing | Children's Hospital of Philadelphia - April 27th, 2018 [April 27th, 2018]
- Interpret EKGs Strips Like a Boss! (ekg interpretation for ... - May 12th, 2018 [May 12th, 2018]
- Chapter 36: Cardiac Disorders Nursing School Test Banks ... - May 18th, 2018 [May 18th, 2018]
- Cardiac Nursing - 9781416029342 | US Elsevier Health Bookshop - May 28th, 2018 [May 28th, 2018]
- Cardiology and Cardiac Nursing - July 3rd, 2018 [July 3rd, 2018]
- Cardio 2018 | Cardiology Conferences | Cardiac Nursing ... - July 30th, 2018 [July 30th, 2018]
- Nursing Care Plans for Decreased Cardiac output - July 31st, 2018 [July 31st, 2018]
- Cardiovascular Nursing Education Associates - October 14th, 2018 [October 14th, 2018]
- How to Become a Cardiac Care Nurse - Salary ... - December 3rd, 2018 [December 3rd, 2018]
- Cardiac Nursing | Become a Cardiac Nurse or Advance Your ... - December 3rd, 2018 [December 3rd, 2018]
- Cardiology | How to become a Nurse Practitioner - December 7th, 2018 [December 7th, 2018]
- Cardiac Nurse: Career Education for This Nursing Profession - December 16th, 2018 [December 16th, 2018]
- Decreased Cardiac Output - Nursing Diagnosis & Care Plan ... - December 16th, 2018 [December 16th, 2018]
- Cardiac Nursing at the CICU at Children's Hospital of ... - December 16th, 2018 [December 16th, 2018]
- Cardiac Care Nurse Careers & Salary Outlook - 2018 ... - December 16th, 2018 [December 16th, 2018]
- Cardiac Vascular Nursing Certification (RN-BC) | ANCC - December 22nd, 2018 [December 22nd, 2018]
- Cardiac nursing - Wikipedia - December 23rd, 2018 [December 23rd, 2018]
- Cardiac Nurse Salary and Job Description | Cardiovascular ... - December 23rd, 2018 [December 23rd, 2018]
- Cardiovascular Nursing | CNS Careers & Education - December 23rd, 2018 [December 23rd, 2018]
- Cardiac Nursing Nursing Schools - RNtoMSN - December 23rd, 2018 [December 23rd, 2018]
- Nursing Events - Emergency Medicine and Acute Care - January 16th, 2019 [January 16th, 2019]
- Nursing Journals Impact Factor List | Nursing Open Access ... - March 6th, 2019 [March 6th, 2019]
- Cardiac-Vascular Nursing Exam Review - Overview | Online ... - March 8th, 2019 [March 8th, 2019]
- Everything You Need to Know About Cardiac Nursing ... - March 8th, 2019 [March 8th, 2019]
- Decreased Cardiac Output and Ineffective Cerebral Tissue ... - March 17th, 2019 [March 17th, 2019]
- Free Cardiac Vascular Nurse Exam Review - Test Prep - March 30th, 2019 [March 30th, 2019]
- Cardiac Nursing Careers & Salary Outlook - 2019 ... - April 17th, 2019 [April 17th, 2019]
- Cardiology Nurse: Salary, Job Duties and Requirements - April 17th, 2019 [April 17th, 2019]
- Cardiac Nurse Practitioner - Nursing License Map - April 17th, 2019 [April 17th, 2019]
- Cardiac/Vascular Nurse Exam Practice Test (2019) - Mometrix - April 17th, 2019 [April 17th, 2019]
- Cardiac Nursing - Nursing Link - April 17th, 2019 [April 17th, 2019]
- 2019 Cardiac Nursing Conference - eventbrite.com - April 17th, 2019 [April 17th, 2019]
- Role of the Cardiac Nurse | Chron.com - April 17th, 2019 [April 17th, 2019]
- Cardiac SOAP Note - nursing notebooks - April 24th, 2019 [April 24th, 2019]
- Nursing Assessment of the Cardiovascular System - May 17th, 2019 [May 17th, 2019]
- Bayshore Oktoberfest Celebration to Benefit New Emergency Care Center - Newswise - September 23rd, 2019 [September 23rd, 2019]
- Chick-fil-A Employee Performs CPR, Saves Stranger's Life: 'God Placed Me' There - Christianheadlines.com - September 23rd, 2019 [September 23rd, 2019]
- IoT Medical Devices Market 2015 Global Trend, Segmentation and Opportunities Forecast to 2023 - OnYourDesks - September 23rd, 2019 [September 23rd, 2019]
- Beats & Rhythms offers heart disease support for families - The Spokesman-Review - September 23rd, 2019 [September 23rd, 2019]
- With Assisted Living Pickups, Symphony Post-Acute Targets Wider Swath of Care Continuum - Skilled Nursing News - September 23rd, 2019 [September 23rd, 2019]
- Gastrointestinal tract 5: the anatomy and functions of the large intestine - Nursing Times - September 23rd, 2019 [September 23rd, 2019]
- Chick-fil-A employee in Calif. helps save man's life - WPTV.com - September 23rd, 2019 [September 23rd, 2019]
- Business Notebook: SEMO expands public radio reach, local church gets new name - Southeast Missourian - September 23rd, 2019 [September 23rd, 2019]
- Balancing Risks, Rewards of Targeting Higher-Acuity Residents in Skilled Nursing - Skilled Nursing News - September 23rd, 2019 [September 23rd, 2019]
- Yorkshire trust's deputy leader takes on nursing director role - Nursing Times - September 23rd, 2019 [September 23rd, 2019]
- Rural ERs see fallout from national nursing shortage - Roanoke Times - September 23rd, 2019 [September 23rd, 2019]
- Peanut butter and cardiac arrest: Diabetic inmate at Holding Center dies - Buffalo News - September 23rd, 2019 [September 23rd, 2019]
- Would you recognise a gradual-onset heart attack? - The Guardian - September 23rd, 2019 [September 23rd, 2019]
- THE BOOKWORM SEZ: Nurse explains ABCDEs of treating people - Goshen News - September 23rd, 2019 [September 23rd, 2019]
- Heartbroken family's tribute to 'brilliant dad' who died choking on food - Hull Daily Mail - September 28th, 2019 [September 28th, 2019]
- Community Rallies For Parsippany Mom Who Had Open Heart Surgery Month After Birthing 4th Baby - Daily Voice - September 28th, 2019 [September 28th, 2019]
- A look at the 40 inmates who have died at Santa Rita Jail in the last five years - KTVU San Francisco - October 2nd, 2019 [October 2nd, 2019]
- Global Cardiac Holter Monitor Market to Witness Heightened Revenue Growth During the Forecast Period 2018 2025 - Space Market Research - October 2nd, 2019 [October 2nd, 2019]
- Seahawks Support Crucial Catch Activities For Cancer Awareness And Early Detection In Collaboration With Virginia Mason, CHI Franciscan - Seahawks.com - October 2nd, 2019 [October 2nd, 2019]
- Former nurse died after accidentally taking paracetamol overdose - Isle of Wight County Press - October 2nd, 2019 [October 2nd, 2019]
- Earn More With Ancillary Services: 10 Things to Know - Medscape - October 2nd, 2019 [October 2nd, 2019]
- Medical Beds And Chairs Market to Record an Impressive Growth Rate During Forecast 2018 2026 - Space Market Research - October 3rd, 2019 [October 3rd, 2019]
- Therapy Strategies Begin to Shift Post-PDPM as Genesis Lays Off 5% of Rehab Staff - Skilled Nursing News - October 3rd, 2019 [October 3rd, 2019]
- Improving inpatient care with MHS GENESIS - Stripes Japan - October 3rd, 2019 [October 3rd, 2019]
- Alkermes Presents New Health Economics and Outcomes Research on Patients With Schizophrenia and Bipolar I Disorder at 2019 Psych Congress - PRNewswire - October 7th, 2019 [October 7th, 2019]
- 16 years fighting breast cancer takes its toll, but Gainesville couple perseveres - Gainesville Times - October 7th, 2019 [October 7th, 2019]
- Irishman in Australia: It wasnt part of the plan to end up in the emergency department - The Irish Times - October 7th, 2019 [October 7th, 2019]
- North America Smart Patient Monitoring Device Market Projected to Worth a value of USD 3729.6 Million by 2027 - Space Market Research - October 7th, 2019 [October 7th, 2019]
- Its Very Unethical: Audio Shows Hospital Kept Vegetative Patient on Life Support to Boost Survival Rates - ProPublica - October 7th, 2019 [October 7th, 2019]
- Letter: Why force qualified nurses out the door? - Greenville News - October 7th, 2019 [October 7th, 2019]
- Saeed Ghani opens 10th Chest Pain Unit of NICVD at New Karachi - UrduPoint News - October 16th, 2019 [October 16th, 2019]
- Faculty Highlights: Recent Grants and Awards | Now - Drexel Now - October 16th, 2019 [October 16th, 2019]
- Learn to save a life - Kent Online - October 16th, 2019 [October 16th, 2019]
- A Kansas Judge With No Law Degree Holds The Futures Of City Residents With Medical Debt In His Hands - Kaiser Health News - October 16th, 2019 [October 16th, 2019]
- It's Very Unethical: Audio Shows Hospital Kept Vegetative Patient on Life Support to Boost Survival Rates - Mother Jones - October 16th, 2019 [October 16th, 2019]
- Englewood Health, one of last independents in region, to merge with Hackensack Meridian - NorthJersey.com - October 16th, 2019 [October 16th, 2019]
- Unions for Sacred Heart nurses and hospital workers schedule strike votes - The Spokesman-Review - October 16th, 2019 [October 16th, 2019]
- These are the 10 best nursing homes in Pennsylvania - PennLive - October 20th, 2019 [October 20th, 2019]
- Surgical nurse who helped with the 'Baby Fae' baboon heart transplant - Redlands News - October 20th, 2019 [October 20th, 2019]
- The 'Angel of Death' Who Killed the Children She Was Supposed to Save - VICE UK - November 1st, 2019 [November 1st, 2019]
- Nurse rewarded for 'beautiful' sensitivity and compassion as a student - Nursing Times - November 1st, 2019 [November 1st, 2019]
- Nurses and hospital workers at Sacred Heart and other hospitals across the state are poised to go on strike - Pacific Northwest Inlander - November 1st, 2019 [November 1st, 2019]