CMS Programs

Academic Medical Centers
The Unique Struggle of Academic Medical Centers

No sector of the healthcare industry has been spared from the disruptive effects of healthcare reform over the past several years, but academic medical centers have often been singled out as particularly vulnerable to the nationwide changes in health delivery. Academic medical centers (AMCs) not only tend to serve high-need…

Knee replacement
CMS Proposes Joint Replacement Coverage at ASCs

CMS announced on August 5 that they are considering whether to provide coverage for hip and knee replacement surgeries at outpatient surgery centers. This kind of coverage could further incentivize patients to choose ambulatory surgery centers (ASCs) over traditional hospitals for outpatient procedures, which worries some hospital leaders. Not only…

Hospital Construction
HCAHPS: What Hospital Patients Care About the Most

Patient experience has taken on new importance in recent years due to new CMS quality and reimbursement initiatives. Today, many hospitals’ Medicare payments are determined in part by their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, a standardized program through which patients rate hospitals on 11 key…

opioids hospitals bottom line
CMS’ Blunt Solution to 340B Problems

Earlier in July, CMS issued a proposed rule outlining changes to the 340B program, an initiative through which qualifying hospitals can purchase outpatient drugs at a discount while receiving CMS payments for the average sale price plus a bonus. The rule dramatically cuts the reimbursements for certain drugs, attempting to…

MACRA
Delays to MACRA Schedule Could Carry Unintended Risks

CMS’ new proposed rule outlining changes to MACRA for 2018 was hailed as good news for providers, expanding reporting exemptions, loosening EHR standards, and delaying cost-based outcome scoring in the Merit-based Incentive Payment System (MIPS). The move was widely anticipated, as HHS secretary Tom Price has publicly stated his intent…

quality of care
Value-Based Purchasing: A Bad Deal for Safety-Net Hospitals?

Hospitals are facing more pressure to improve outcomes and deliver better care than ever before. In addition to the spread of performance-based reimbursement agreements, acute-care providers are also subject to regulatory programs, such as the value-based purchasing (VBP) and readmissions reduction programs, which penalize facilities with low quality scores. Since…

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