OR Manager - February 2019 - 6

Editorial
Editorial
Continued from page 3
in payments for hip and knee replacements
without significant changes in
complication rates. The authors, who
analyzed Medicare claims from 2015
through 2017, attributed most of the
savings to decreased use of post-acute
care services in skilled nursing facilities
and inpatient rehabilitation facilities.
Many organizations have invested
in the infrastructure, technology, and
staff needed to form accountable
care organizations (ACOs) and implement
bundled payments and Medicare
shared savings programs, healthcare
leaders note. According to Chet Speed,
the American Medical Group Association's
vice president for public policy,
physician practices have spent millions
on creating ACOs, and undoing those
" would make no sense. "
Ashish Jha, MD, director of the Harvard
Global Health Institute, echoes
that opinion: " I don't think anyone has
an appetite to go back to where we
were 8 years ago. " He thinks if the ACA
were repealed, Congress would pass
legislation to continue programs that
have been successful-but also would
perhaps reevaluate those like the Hospital
Readmissions Reduction Program
(HRRP), which has produced mixed results.
A recent retrospective study of
the HRRP found a significant increase
in mortality within 30 days of discharge
among Medicare beneficiaries hospitalized
for heart failure and pneumonia,
but not for acute myocardial infarction.
Stay tuned
Preliminary figures from CMS show a
3.8% drop in enrollments on the ACA's
insurance exchanges compared with
2018, but they don't include data from
states that operate their own insurance
exchanges. And although the number
of new enrollees decreased, the numADVISORY
BOARD
Kathryn Adamson, MBA, RN, Salt Lake City, UT
Amy L. Bethel, MPA, RN, NE-BC,
Clinical Professional Development,
UnityPoint Health, Des Moines, IA
Mark E. Bruley, CCE, FACCE,
EIT, Vice President Emeritus,
Accident & Forensic Investigation,
ECRI Institute, Plymouth Meeting, PA
Michael A. Hofmann, BSN, RN,
Regional Director of Perioperative
Services, Ascension NE Wisconsin St
Elizabeth Hospital/Fox Valley Region,
Appleton, WI
Natasha Luster, MSN, RN, CNOR, Nurse
Manager, Surgical Services, Premier
Health-Miami Valley Hospital, Dayton, OH
Casey Orth-Nebitt, BSN, RN, Director of
Surgery, Buena Vista Regional Medical
Center, Storm Lake, IA
Kaye Reiter, MSN, RN, NE-BC, Regional Vice
President, Surgical Services, University
of Colorado Hospital, UC Health Metro
Denver, Denver CO
John Rosing, MHA, FACHE, Executive Vice
President and Principal, Patton Healthcare
Consulting, Naperville, IL
Patricia C Seifert, MSN, RN, CNOR, FAAN
Independent Cardiac Consultant, Falls
Church, VA
Diane Skorupski, MS, RN, CNOR, NE-BC,
Vice President, Surgical Services,
Tampa General Hospital, Tampa, FL
Dawn Vocke, MSN, MBA, RN, CNOR,
Clinical Director, Surgical Service,
UPMC St Margaret, Pittsburgh, PA
David E. Young, MD, Medical Director,
Preanesthesia Testing, Advocate Lutheran
General Hospital, Chicago, IL
ber of returning customers increased
in 2019. It's hard to draw any conclusions
right now, but perhaps more will
be known when CMS releases a report
later this year.
We'll continue to report on trends
likely to rock your world. With so
much happening every day and with
so many distractions, it's hard to filter
out the noise, but we consider it
our duty to bring you the information
that matters. ✥
-Elizabeth Wood
References
Armour S, Kendall B. Federal judge
rules Affordable Care Act is unconstitutional
without insurancecoverage
penalty. Wall Street
Journal. Published online December
15, 2018. https://www.wsj.
com/articles/federal-judge-rulesaffordable-care-act-is-unconstitutional-11544838743.
Barnett
M L, Wilcock A, McWilliams
J M, et al. Two-year evaluation of
mandatory bundled payments for
joint replacement. N Engl J Med.
Published online January 2, 2019.
Commins J. CMS to roll out mandatory
cancer payment model. HealthLeaders
Media. November 8, 2018.
https://www.healthleadersmedia.
com/strategy/cms-roll-out-mandatory-cancer-payment-model.
Kacik
A, Castellucci M. ACA repeal
wouldn't stop transition to valuebased
payment, efforts to lower
durg spending. Modern Healthcare.
December 19, 2018.
Livingston S. Healthcare.gov enrollment
down from 2018 as exchanges
fail to attract new customers.
Modern Healthcare. January 3,
2019.
Wadhera R K, Joynt Maddox K E,
Wasfy J H, et al. Association of
Hospital Readmissions Reduction
Program with mortality among
Medicare beneficiaries hospitalized
for heart failure, acute myocardial
infarction, and pneumonia. JAMA.
2018;320(24):2542-2552.
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