CMS Rule to Increase Outpatient Payments

The Centers for Medicare & Medicaid Services on Monday proposed increasing hospital outpatient payment rates by 1.8 percent for calendar year 2014.

Under the Hospital Outpatient Prospective Payment System (OPPS) proposed rule, about 4,000 hospitals would see $50.4 billion next year, $4.4 billion more than OPPS payments in 2013. Hospitals that miss hospital outpatient quality reporting requirements would see their payments drop by a statutory two percentage points.

The rule also proposes a 0.9 increase in ambulatory surgical center (ASC) payments. That would give about 5,000 ASCs $3.980 billion next calendar year, up $133 million from ASC payments in 2013.

To improve transparency, CMS also proposed to replace the five levels of outpatient visit codes with a single code for each type of outpatient hospital visit as well as create 29 comprehensive ambulatory payment classification groups (APC) instead of the existing device-dependent APCs.

“We believe that defining certain services within the OPPS in terms of a single comprehensive service delivered to the beneficiary improves transparency for the beneficiary, for physicians, and for hospitals by creating a common reference point with a similar meaning for all three groups and  using the comprehensive service concept that  already identifies these same services when  they are performed in an inpatient environment,” the rule states.

CMS will finalize the 2014 OPPS and ASC payment rates at least 60 days before Jan. 1, 2014, according to guidance from the Office of Information and Regulatory Affairs (OIRA). But the guidance notes that if the CMS regulation is not published in time, hospital outpatient departments and ASCs will recieve incorrect payments next year.

For more:
- here’s the proposed rule (.pdf)
- read the OIRA guidance

Case Managers Impact Hospital Readmissions

Case managers when utilized appropriately can reduce hospital readmissions and deliver more coordinated care in the emergency department, according to a newly published white paper from Huron Healthcare.


With Medexi, case managers now have the real-time ability to conduct alerts to transitional care teams while enhancing communications amongst the primary care physician and transitional care provider. More importantly, care teams are rallied around patients who face 30-day readmissions in real-time, while the patient is in the emergency department – before the readmission takes place!

More than ever, primary care physicians are relying upon the emergency department to evaluate their patients. Hospital readmissions have increased by 17 percent over the past seven years, which is a symptom of information gaps that exists with the disconnect between hospital encounters and community physicians.

A Merritt Hawkins report found primary care doctors generate more revenue for their hospitals than specialists — $1.57 million vs $1.42 million, respectively. Thus, the RAND report recommends that hospital administrators, policymakers, payers and federal research agencies understand the role of the emergency department as it relates to care coordination.

With Medexi Inform, the entire circle of care is notified upon a patients entrance into the emergency department. Our patent-pending algorithm identifies high-risk 30-day readmissions so that transitional care teams may be rallied prior to admission. Medexi Care delivers real-time patient data to the primary care physician such as: HPI, Labs, Radiographic Findings, Prescriptions, Discharge Instructions and communication from the transitional care team through Medexi Bridge.

Rather than relying upon retrospective data, Medexi Reporter allows for real-time metrics and predictive modeling to better future outcomes. Track readmissions, admissions avoided, diagnosis, provider involvement and much more!

To learn how Medexi can deliver care coordination to your facility, call 1-800-325-7103 today.

The ROI of the Medexi Suite

The ability to measure the impact of your investment is vital when investing in a new solution. The CMS Readmissions Reduction Program was legislated under the Affordable Care Act. This program launched in October 2012 and the 1% penalty on 30-day readmissions suddenly became a powerful pain point. In total, 2,217 hospitals will receive penalties ranging from .01% to 1% of total Medicare reimbursement generated during 2012. That percent will increase in the years 2013 and 2014.


Looking Under the Hood

The readmission penalty is complex. Let us provide you with a sample scenario:

  • Total Licensed Beds: 500
  • Annual Medicare Admissions: 10,000
  • AMI, CHF and Pneumonia Medicare Admissions: 1,000
  • AMI, CHF, Pneumonia 30-day Readmissions 230, Expected 200
  • Payment Rate per Readmission: $10,000
  • Cost Related to Excess Readmissions: $300,000
  • Penalty (1 / national readmission rate): 5
  • Annual Penalty: $1,5000,000


These penalties will recoup CMS $280 million alone in the year 2013. The penalties will increase over the next two years and the scope of diagnosis are set to expand to include COPD, Orthopedic Surgeries, etc.


What differentiates Medexi from other companies? We’re high tech, high touch! While our software serves as an early warning system for high-risk readmission, we also bridge with patients into their home within 24 hours of discharge. Our Transitional Care Providers visit with the patients in-home to provide eduction, compliance and follow up. If your hospital already has a transitional care team in place, then Medexi is the intelligence you need to rally those teams around patients who meet transitional criteria.


The Medexi ROI

When you redirect 30 readmissions you’ve paid for Medexi for an entire year! To put this number into perspective, last month our transitional care providers reduced a facilities readmission rate by 28%, thus the Medexi ROI was completed within 30 days. Furthermore, hospital systems receive enormous return in network referral revenue, decreased administrative costs, decreased faxing, less test redundancy and improved operation efficiency.


The Bottom Line

Healthcare systems in the future will be judged and penalized based on care coordination and patient satisfaction scores. Medexi 360 is completely vendor-neutral which has the ability to work with all systems and requires no installation within the hospital. To learn more about how Medexi can help your organization, contact us for a free demo.

Medexi to Release Version 2.0

Includes over 15 new features that promise to deliver.

Mesa, Arizona – April 8, 2013 : Medexi has announced today that version 2.0 of its care coordination software will be available in May 2013. Version 2.0 release will include over 15 new features with a completely enhanced user interface and analytics engine. Complete with it’s early warning system for 30-day readmissions, Medexi continues to bridge the information gaps between hospitals and community providers.

“The response to our solution at HIMSS13 was simply fantastic.” said Dan Deublein, Medexi’s CEO. “We learned very quickly that health care is changing from one that rewards volume aggregation to one that rewards value creation. Medexi creates and delivers that value by delivering a single view of each patient throughout the care continuum.”


Medexi is currently making user interface improvements, extending in-message communication system, enhancing it’s early warning system and continuing to work with Transitional Care Providers who extend the Software as a Solution. “Medexi 360 is the intelligence that rallies transitional care teams in real time, before patients are admitted to the hospital. Partnering with Bridge to Care Solutions, we can now impact those patients lives with in-home visits to further educate, inform and bridge patient care”, said Deublein.

While Medexi continues to grow at a rapid pace, the companies main focus is still on improving care coordination for better patient outcomes. For many systems (even those launching ACOs) simply aren’t ready to function within the ACO model. The model, rewarded for keeping patents healthy and out of the hospital, depend largely on care networks and highly effective care management to operate across the care continuum. Because most technologies in health care aren’t vendor neutral, this creates episodic care that disrupts the continuum. For more information on how Medexi can help integrate your organization, visit our website or contact us for more information.


Medexi at HIMSS a Hot Topic

With over 35,000 attendees, 1,160 exhibitors with President Bill Clinton delivering the keynote, HIMSS13 can legitimately be called the superbowl of all Healthcare IT conferences worldwide. All the usual companies presented at the conference such as McKesson, Cerner and Epic. However, it was the 10×10 booth of Medexi who’s mission is to create an integrative view of a patient that garnered some attention.

Medexi Booth

Medexi is a company whose mission is to build solutions extended with live transitional care providers to improve care quality and patient outcomes. Through an Early Warning System that initiates the transitional care team when a high-risk patient enters the emergency department, care providers can now initiate real-time transitions prior to the patient being admitted to the hospital. The Medexi Care dashboard allows all community physicians to view patient presentations in real-time, thus bridging the information gaps that currently exist between hospitals and physicians.

Coupled with the exposure of the Medexi demo at HIMSS and the heavy booth traffic, it is clear that this company has a proven solution when it comes to the integration of a patient. “With the implementation of the Medexi 360 system, we can better manage the transitional care process and are better positioned to negate risk and preserve our bottom line.” - Tony Marinello, CEO of Mountain Vista Medical Center.