Teamwork: Reduced Medicare FFS LOS by 0.88 day in one month

Teamwork goes a long way. I am very proud of the hospital in Southern CA  for the teamwork shown to reduce Medicare FFS length of stay (LOS) by 0.88 days in one month. We started Interim Work in last week of October 2018. Hospital had not much success to reduce LOS in this area for […]

2019 Medicare Inpatient Only List

2019 Inpatient only list We get several request for CMS Medicare Inpatient only list. Some, if not most, find it harder to find it using CMS website. Even after you find it, it is not posted in an easy   to use format. We have increased font size to make it easier to read, it has […]

The National Quality Strategy

National Quality Strategy Annual Reports: The National Quality Strategy: Fact Sheet: National Quality Strategy (NQS) Webinars: Past webinars: 2017 National Quality Strategy _ Agency for Healthcare Research & Quality About the National Quality Strategy _ Agency for Healthcare Research & Quality Introduction to the National Quality Strategy National Quality Strategy_ Using […]

Children’s Hospitals’ Solutions for Patient Safety Network Saved $130 million and Saved an Estimated 6,044 Children from Serious Harm

As per AHRQ, “SPS Network’s efforts have resulted in significant improvement in pediatric care in its Network hospitals, including improved quality and patient safety across targeted HACs. Since 2012, this national effort has led to an estimated savings of more than $130 million. These reductions have saved an estimated 6,944 children from serious medical harm.x […]

Homeless Patient Aligned Care Teams

As per AHRQ,” in 2016, nearly 40,000 veterans were homeless on a given night in January, with 13,000 living in the streets.” Over the last 7 years, roughly 70 percent of H-PACT enrollees graduated from the program into a regular primary care setting once their situation stabilized and they were able to find permanent housing. […]


MAPPING MEDICARE DISPARITIES IN CHRONIC DISEASES The MMD Tool provides a user friendly way to explore and better understand disparities in chronic diseases, and allows users to: 1) visualize health outcome measures at a national, state, or county level; 2) explore health outcome measures by age, race and ethnicity, sex; 3) compare differences between two […]

The number of opioid treatment programs (OTPs) increased

The number of opioid treatment programs (OTPs) increased 39 percent, from 1,067 to 1,482 OTPs. The number of clients receiving methadone in those facilities increased from 227,000 to more than 356,000 through 2015. Other options for medication-assisted treatment have also seen increased use. The number of clients receiving buprenorphine in facilities increased from about 2,000 […]

Chronic Care Management (CCM) Services Changes for 2017

For 2016, the single CCM code paid approximately $42. Now there are 3 codes and payment can range from approximately $43 to over $141, depending on how complex a patient’s needs are. A given patient can receive either regular or “non-complex” CCM or complex CCM during a service period if applicable (not both). The difference […]

The diagnosis and management of the adult psychiatric patient in the emergency department.

Clinical policy: critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department. AHRQ discusses (1) In the alert adult patient presenting to the emergency department (ED) with acute psychiatric symptoms, should routine laboratory tests be used to identify contributory medical conditions (nonpsychiatric disorders)? (2) In the adult patient with […]

Senior can save on an average 19% annually on insurance premiums

Seniors enrolled in Medicare Advantage insurance plans could save 19 percent annually on health care spending by switching to a lower-cost Medicare Advantage alternative offered in their area, an AHRQ study found. More than 16 million Americans are covered by Medicare Advantage plans. For each year that enrollees remained in their Medicare Advantage plans, researchers […]

The final rule implements policy and operational improvements to the PERM and MEQC programs

Changes to the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control Programs (MEQC) (CMS-6068-F) The final rule implements policy and operational improvements to the PERM and MEQC programs that will reduce state burden, improve program integrity, and promote state accountability. Under this final rule, changes to the MEQC program give states flexibility to […]


We Dance Till It Rains! I heard the tail end of the Joel Osteen’s broadcast when I turned on the TV this morning. I am guessing his message was about the faith and prayers to suggest that if things do not go as expected (in the short or extended periods of time), then one should […]

Proposed new guidelines and restrictions on some of the most widely used pain medications:

Food and Drug Administration Commissioner Scott Gottlieb has proposed new guidelines and restrictions on some of the most widely used pain medications: Drug makers to conduct doctor education programs on immediate-release opioids Explore whether pain-management training should be required for doctors, as well as nurses, pharmacists or other health-care providers; Survey physicians to ensure the […]

The Placebo Effect

The placebo effect is a powerful, robust and consistent demonstration of the ability of our mindset, in this case, the expectation to heal. What we believe and expect matters. It has strong implications for all the areas of our lives including health care. Change your mindset, change the game | Dr. Alia Crum | TEDxTraverseCity

Has Reduction In Readmissions Rate plateaued?

Readmissions: The rate of reduction in readmissions (dropped from 21.5% to 17.8%) has leveled off in recent years. Does it suggest a plateau in the level of improvements possible under the rule? More than 2,500 hospitals will be subject to a penalty for having too many readmissions. The federal budget will save around $564 million. […]

Transfusing Wisely

A Study Holds Promise to Change Culture of Blood Transfusions in August 2017 Issue of The Joint Commission Journal on Quality and Patient Safety. The overall rate of RBC transfusions without exclusions per 1,000 patient-days decreased from 89.8 to 78.1 percent during the intervention period to 72.8 percent post intervention. A new study in the […]

CMS expects Hospitals to use IM letter and Detail Notice of Discharge by August 28, 2017

Hospitals and Critical Access Hospitals must use these notices no later than Monday, August 28. If you need OMB approval number for the forms, please feel free to contact me. The following updated notices have been approved by the Office of Management and Budget. * Important Message from Medicare • Detailed Notice of Discharge The […]

June is Men’s Health Month

  Celebrate National Men’s Health Week, June 12-18, 2017 As per CMS, “June is Men’s Health Month, and June 12 through 18 is National Men’s Health Week, which ends on Father’s Day. These observances heighten awareness of preventable health problems and encourage early detection and treatment of disease. Help your Medicare patients understand the steps […]

Nurses’ Role In Reducing Length of Stay At The Hospitals: The Basic Nursing Care Edit article

  The basic nursing care plays a vital role in reducing inpatient length of stay. Some may laugh it off thinking it is for the nursing students. The basics were genuine and applicable when I went to nursing school many years ago, and those things are still just as relevant and enforceable today. I have […]

Physical Therapists’ Role In Reducing Length Of Stay At The Hospitals

The Healthcare workers can improve the quality of care through improved communication and collaboration. It sounds good. What does it mean? What does it mean to each of the discipline working at the acute care hospitals? I will try to explain some of the understanding needed to achieve an improved communication and collaboration when it […]

Nurses’ Role In Reducing Length of Stay At The Hospitals

    Most of the hospitals have tendencies to look at the case management department to reduce the length of stay (LOS) at the hospitals. Most of the hospitals we have worked with, LOS is one of the key measurements used by the hospital leadership to measure the success or effectiveness of the case management […]

No Payment For A Non-emergent Use Of The Emergency Department (ED)

    Emergency Room utilization per 1,000 population has increased by 21% from 1999 to 2015 as per data published by The Henry J. Kaiser Family Foundation. The foundation has done a great job to show the utilization of ED by the ownership (the State/Local Government; Not-for-Profit or For-Profit) of the hospitals. You can review […]

National Partnership to Improve Dementia Care and QAPI Call — June 15, 2017

There is a complimentary conference call on Thursday, June 15 from 1:30 to 3 pm Easter Standard Time to discuss to Improve Dementia Care.  To register or for more information, visit MLN Connects® Event Registration. Here is a web link to register for this seminar. During this call, learn about appropriate assessment and evaluation for […]

The Secret To Consistently Successful Results In Case Management

Even after the successful orientation, training, and annual re-training programs in place, many of the leaders and the organizations are still struggling to get the favorable outcomes to achieve desired goals. Why is that? One of the reasons could be that they rely on a job description to tell their employees of the job expectation. […]

The Cost Of Medicare Inpatient Care And The Reimbursement Trends

      When we reviewed the national trends for the hospitals’ cost and reimbursement using MedPAR (Medicare Provider Analysis and Review) data from Federal Fiscal Year 2011 to 2015, it is clear that many hospitals suffered a financial loss in FY 2015 in this area. The cost per case for treating the inpatient level […]

ACA’s Impact On The Individuals Who Pay The Full cost of Insurance Premiums

The Office of the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services released a report that shows the true impact of the Affordable Care Act on the health insurance premiums paid by the individual.   Comparing the average premiums found in 2013 MLR (Medical Loss Ratio) data and 2017 […]