Clear differences exist among hospitals and their ability to report on certain measures, but most of this is due to differences in caseloads-a factor over which hospitals have little control. Adopt a broad quality improvement strategy. As hospitals look to improve quality over time and-in the process-improve their star rating, they might consider the following: Strategies for hospitals and health systems Our finding that 5-star hospitals report fewer measures than 1-star hospitals, even when we controlled for hospital characteristics, could be a consideration for CMS as it looks to help lower performing hospitals and considers revisions to the Star Ratings Program's risk adjustment methodology. Thus, hospitals may be best served by focusing on their own population needs and areas for improvement rather than having the Star Ratings Program drive their agenda. The Star Ratings Program is just one of CMS's initiatives to improve health care quality hospitals also may be measured as accountable care organizations, through payment incentive programs, and by other payers using different sets of quality measures. CMS has already made several updates to the program, dropping seven of the measures between the July and December 2016 reporting periods. The Hospital Star Ratings Program was designed to change over time. Hospital quality measurement is going to continue, as evidenced by CMS's continued commitment to improving the Star Ratings Program. Variation in caseloads and the ability to report some measures appear to be tied to performance.Scores for individual outcome measures vary widely.Hospitals that earn a 5-star rating generally have better scores in the heavily weighted categories.There are many ways to achieve a 5-star rating.To shed light on these issues, the Deloitte Center for Health Solutions analyzed the 64 quality measures CMS used in July 2016 to compute the star ratings. CMS developed the program to help consumers make more informed decisions by giving them a way to compare hospitals based on quality ratings.Īfter the initial ratings release, many hospitals sought to better understand how the Star Ratings Program works and determine how they could improve their scores. Waivers on Certain Stark Laws: Any waivers relating to physician self-referral laws (Stark Laws) will expire.The US Centers for Medicare and Medicaid Services (CMS) released the first ratings list for the Medicare Overall Hospital Star Ratings Program on July 27, 2016. Specimen Collection: HCPCS codes for independent labs – $23.46 for specimen collection (G2023) and $25.46 for specimen collection from nursing-home patients (G2024) – will no longer be payable. Price Transparency: Providers will no longer be required to make the cash price for COVID testing public on their website. Referring Physician Requirement to Test: Medicare will require all COVID and related testing performed by a laboratory to be ordered by a physician or non-physician practitioner. Costing Sharing or Prior Authorization: Private commercial health plans will no longer be required to provide COVID-19 testing or vaccines without cost-sharing, prior authorization, or other medical management requirements. Out-of-Network Testing: Commercial health plans will no longer be required to reimburse out-of-network labs for COVID-19 tests based on their listed cash charge. Private payors may also discount their COVID-19 reimbursement rates below the new Medicare rates. The $25 add-on charge for completed testing within two days will be eliminated. Rates for high-throughput testing will be reduced from $75 to $51. High-Throughput Testing Reimbursement: When the PHE ends, HCPCS codes U0003, U0004, U0005 will no longer be payable. Key highlights from the CMS Laboratories: CMS Flexibilities to Fight COVID-19 With the announcement from President Biden that his administration plans to end the COVID-19 Public Health Emergency (PHE) on May 11, 2023, many diagnostic providers are wondering how they will be impacted. CMS has published several provider-specific fact sheets about the PHE waivers and flexibilities, including which have been terminated, have been made permanent or will expire at the end of the PHE. How will the end of the PHE impact laboratory providers?
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