Becker's Hospital Review

23 CFO / FINANCE Rising ER prices, more high severity cases spurred greater healthcare spending: 7 takeaways By Kelly Gooch A mong the commercially insured, national emergency room use re- mained unchanged from 2009 to 2016, but ER price hikes and greater use of high-severity codes resulted in more ER spending, according to updated data from the Health Care Cost Institute. e data on ER spending, price and utiliza- tion reflects five facility fee current proce- dural terminology codes, which indicate the severity and complexity of an ER visit. Seven takeaways from the data: 1. Overall ER use remained unchanged between 2009 and 2016, but high-severity codes were used more oen during the studied time peri- od, and low-severity codes were used less oen. 2. Average prices for all five codes grew from 2009 to 2016, the data showed. Still, average prices for low-severity codes grew at a slow- er pace. 3. Spending per person for the second-high- est severity ER visit grew by 124 percent over the eight years studied, while spending per person for the highest severity ER visit grew by 145 percent. 4. Among U.S. states and the District of Co- lumbia, Mississippi saw the greatest overall increase in ER spending. Overall ER spend- ing rose 153 percent there from 2009 to 2016. 5. Overall ER spending in 21 states increased by more than 100 percent during the studied time period. 6. Nevada saw the highest overall ER price increase. Overall ER price increased 147 per- cent there from 2009 to 2016. 7. Overall ER price increases of 100 percent or more occurred in 25 states. n Walmart names New England Baptist a partner for hip, knee bundled payments By Morgan Haefner W almart selected Boston-based New England Baptist Hospi- tal, which specializes in ortho- pedic care, as a center of excellence for Walmart employees needing hip and knee replacement procedures. Under the agreement, eligible Walmart medical plan enrollees who undergo joint replacement surgery at NEBH will have their care, travel and lodging fully cov- ered. NEBH will offer the procedure at a fixed price for a bundled care episode. Self-insured companies are increasing- ly contracting directly with providers for specialty care and treatment to trim costs. NEBH has similar arrangements with Uni- Care and General Electric. This is the latest bundled payment con- tract Walmart has signed with a provider. In April, the retail giant teamed up with Atlanta-based Emory Healthcare for an ACO and a bundled payment program for spine surgeries and joint replacements. n Medicare readmission rates vary widely among BPCI Advanced conditions: 4 takeaways By Kelly Gooch T he 90-day Medicare read- mission rates for certain conditions in the Bundled Payments for Care Improvement Advanced Model are as high as 43 percent and as low as 7 per- cent, according to a new analy- sis from health care consultant Avalere. BPCI Advanced, CMS' new volun- tary program, was announced Jan. 9. Initially it will include 32 clinical episodes, with some providers starting participation in selected episodes Oct. 1. Given that readmission rates are one of the quality measures for BPCI Advanced, Avalere released its analysis of these rates for pro- viders thinking about participating in the model. Researchers used the Medicare Standard Analytic 5 percent claims file for 2016 through the third quarter of 2017 to examine clinical care episodes for BPCI Advanced conditions. Readmission rates for 2017 were determined through the examination of how many epi- sodes had at least one readmission within the episode. Here are four takeaways from the analysis: 1. The readmission rate for liver disorders except malignancy, cir- rhosis or alcoholic hepatitis was highest among the BPCI Advanced conditions studied, at 43 percent. 2. The select liver disorders were followed by heart attack and con- gestive heart failure, which had re- admission rates of 34 percent and 36 percent, respectively. 3, Certain BPCI Advanced condi- tions had readmission rates below 20 percent. These were pacemaker, coronary artery bypass graft sur- gery, combined anterior posterior spinal fusion, back and neck except spinal fusion, spinal fusion (non- cervical), cervical spinal fusion, and certain joint replacements. 4. At the bottom of the list was ma- jor joint replacement of upper ex- tremity with a readmission rate of 7 percent. n

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