Quick Hits: Top News Stories of the Month [Healthcare Financial Management]

CMS Guidance Issued on Inpatient Admissions

The Centers for Medicare & Medicaid Services (CMS) aimed to clarify details surrounding a change to hospital admissions under Medicare through new guidance issued Sept. 5. The socalled "subregulatory guidance" specifies the steps hospitals need to take to admit a patient under Medicare inpatient admission rules that go into effect Oct. 1. "This ruling addresses a number of important issues left unresolved by the two-midnight provisions included in the 2014 final IPPS rule," says Chad Mulvany, director, healthcare finance policy, strategy, and development at HFMA. "It clears up a number of issues and provides clarity on key items like what needs to be included in an admission order, the timing of that order, and how verbal orders are to be handled."

Hospitals Push Back on RAC Efficacy Report

An August report on Medicare contractors by the Office of Inspector General (OIG) does not refute long-standing hospital concerns that the auditors are usually inaccurate, according to provider advocates. The government watchdog report notes that in 2010 and 2011, providers appealed only 6 percent of the 1.1 million claims in which recovery audit contractors (RACs) found that they overbilled Medicare. And only 44 percent of those appeals resulted in overturning the audit findings. The analysis diverged from widely publicized data from an American Hospital Association survey that found hospitals appeal about 41 percent of all denied claims and were successful in overturning 72 percent of challenged RAC denials.

Study: ACO Providers Spread Savings, Not Quality

Participating in accountable care organizations (ACOs) may spur providers to decrease healthcare costs for all of their patients, but not necessarily to deliver higher-quality care, according to new research published in the Aug. 28 issue of JAMA. The researchers found that 11 provider organizations participating in an early ACO in Massachusetts sharply cut their per-beneficiaiy spending on Medicare patients. However, they also found less spillover benefits to health quality for Medicare patients of the ACO providers.

Infections Carry $10 Billion Cost

Infections most frequently acquired in healthcare settings cost at least $10 billion annually, according to new research. A study published by JAMA Internal Medicine estimated five major healthcareassociated infections (HAIs) cost $9.8 billion each year. Surgical site infections cost the most. The study found that central line-associated bloodstream infections were the most expensive, costing $45,814 per case.

Professional Football Team First to Advocate Marketplaces

The Baltimore Ravens became the first professional sports team to promote a coming insurance marketplace, Maryland officials announced. Maiyland Lt. Governor Anthony Brown announced the partnership to promote the Maryland Health Connection, a state marketplace-also known as an exchange-authorized by the Affordable Care Act to begin selling private insurers individual and small group plans on Jan. 1, 2014. The involvement of such teams may prove critical because their core audiences-young men-are considered critical by health policy experts.