Anesthesia Industry eAlerts
Sent to subscribers every Monday morning, our eAlerts deliver timely updates on regulatory, legislative and practice management developments of interest to anesthesia professionals.
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eAlerts
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PROPOSED PAYMENTS FOR PAIN: Anesthesiologists May Not Like What They See
September 16, 2019
As a follow-up to our recent articles on the proposed Medicare Physician Fee Schedule (MPFS) for 2020 and our trend analysis of acute pain services, we would like to provide additional details on pain codes and their payment. As noted in our treatment of the 2020 MPFS, little is expected to change for anesthesia practices next year, with the notable exception of the acute pain component. We observed generally that some postoperative pain codes—particularly those associated with the somatic nerves—may pay less next year than they do this year. Today, we will be providing you with specific details on the full array of acute pain codes and their expected reimbursement.
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Is Hospital Employment Inevitable for Anesthesia Providers?
September 9, 2019
At ABC we have spent more than 40 years helping our client practices maintain their independence. This has involved aggressively managing their accounts receivables and collections so that they generate enough money to recruit and retain sufficient numbers of qualified providers. It has involved assisting them in the negotiation of their hospital contracts and, where necessary, helping them calculate a reasonable level of financial support where needed. We have also provided a variety of practice management services so that they are seen as a professional and valuable partner to the facility. These are challenging times, though, and many of our clients continue to believe that all of this is just buying time, that ultimately the hospital administration would prefer to have the providers as employees rather than as an independent contractor. We would like to reassure our clients that while this may happen in a few select institutions it is not likely to happen across the board.
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Passing the Baton: Raising Up Leaders in Anesthesia Practices
September 3, 2019, 2019
So many of the client groups we serve are fortunate to have strong and able leaders. We see evidence of this as we meet with our clients, listen to their aspirations, and see the fruits of their success. Running and growing a successful anesthesia practice requires a unique set of skills. Not every anesthesia provider is going to naturally gravitate to such a role. Most clinicians want to focus on their professional specialty. They don’t necessarily wish to be saddled with the extra burden of being business managers. However, in most groups, there are those few (or that one) who have both the desire and acumen to take on the added mantle of leadership.
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The Evolution of Acute Pain Management in Anesthesia
August 26, 2019
As the preeminent provider of outsourced anesthesia billing and management services in America, we are always interested in how anesthesia providers are modifying their practices to take advantage of new pain management modalities and changing patient expectations. Anesthesia is not just focused on the operating room and the delivery suite. It is increasingly concerned with the entire perioperative episode. That includes the diagnosis and treatment of the patient’s post-operative pain.
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What is the Glue that Holds Anesthesia Practices Together?
August 19, 2019
Phase One: Do We Really Need to Form a Group? The specialty of anesthesiology has evolved through three distinct phases since the 1980s. First there were hundreds of anesthesia group formations as individual anesthesiologists, many of whom practiced as independent professional corporations (PCs) coming together to form formal group entities, usually corporations or partnerships. There were many factors driving this process but two of the most important were managed care contracting and hospital contract negotiations. Coming together in formal group created a mechanism that the practice spoke with one voice instead of many.
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The Proposed 2020 MPFS: What Anesthesiologists Can Expect
August 12, 2019
In the final days of July, the Centers for Medicare and Medicaid Services (CMS) released a preview of its proposed changes to the Medicare Physician Fee Schedule (MPFS) for 2020. The release also contained proposals that would affect the Quality Payment Program (QPP) for next year. Together, these recommended provisions constitute 1,704 pages of government-speak that will take some time to review and fully clarify. Nevertheless, we felt it important to provide you with our initial assessment of the “proposed rule,” along with some of the highlights gleaned thus far. Here, then, is our first take on what’s in store for anesthesia practices in 2020.
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How Hard Do Anesthesia Providers Work?
August 5, 2019
As we travel around the country meeting with our anesthesia clients, we are often asked the same questions. Our clients all want to know how they compare to other clients. Are they working as hard? Are they as productive? Do they have the same challenges? We like to remind these clients that every anesthesia practice is unique, which is true. Each client practice is defined by its volume and type of surgical and obstetric cases, its payer mix and the configuration of providers. Location may also be a significant factor: busy urban and suburban practices bear little resemblance to isolated rural practices. The fact is, though, that any comparison of practices must consider both the general specialty challenges and specific market or practice requirements.
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Combatting the Opioid Crisis: The Key Role of Anesthesia Providers
July 29, 2019
A couple of days ago, I came across a news item that left me in a state of stunned disbelief. The most recent findings from the Centers for Disease Control (CDC) showed a downturn in U.S. life expectancy—specifically due to our inability to control heart disease and—wait for it—the increase in opioid abuse. Prior to 2015, the life expectancy index for Americans had not declined in decades, but there have been incremental and steady decreases in that metric from that time to this.
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Do ASA Physical Status Modifiers Still Matter in Anesthesia Billing?
July 22, 2019
This article is intended to inform the reader on the relevance of reporting ASA Physical Status modifiers, in relation to billing.
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What is the Future of Your Anesthesia Practice?
July 15, 2019
Many anesthesia providers perceive that they occupy the bottom rung of the medical food chain, that they are captive to so many other departments in the hospital for the factors that determine their income and lifestyle. Anesthesia is the quintessential service specialty. Whatever patient gets scheduled they must manage through the trauma of surgery. Again! When asked if they have any influence or control in the management of the operating rooms, most believe they have none. The problem is that this can be a self-fulfilling proposition.
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The Significance of the Anesthesia Public Payer Percentage
July 8, 2019
Baby boomers are the fastest growing age group in the United States. Currently, 14.5 percent of the nation's population is 65 years old or greater. By year 2029, the national population of this same age group will be 20 percent. How is this affecting anesthesia practices today and what are the long-term implications? Demographic trends have the potential to dramatically change the economics of this specialty. -
Special Report from ASA President Linda Mason, M.D., FASA
July 1, 2019
The surprise medical bill issue is of significant importance to ABC and our clients. Since the potential outcome of any federal action would impact all of us, I asked for an update on the issue from the ASA. Below is ASA President Linda Mason’s response.
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The History of the TAP Block in Anesthesia
June 24, 2019
In 2015 CPT added four new codes for transverse abdominis plane blocks (TAP blocks) that was first introduced as a new acute pain modality in 2001. Prior to the establishment of these codes these abdominal nerve blocks could only be billed with the code for other peripheral nerve block (64450), which was essentially a workaround. With the new codes providers had four options:
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The Specialty of Anesthesia and its Future
June 17, 2019
The specialty of anesthesia has been in a constant state of evolution. Many of us understand where we have been and what a typical practice used to look like. Some of us have even come to terms with the current market, but few of us know what the future holds.
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Ultrasound-Guided Procedures by Anesthesia Providers
June 10, 2019
Recently, the American Medical Association (AMA) revised its regulations to allow for the billing of ultrasound guidance (USG) with arterial lines. Historically, such a service was limited to central venous pressure or central line placement (bundled with Swan-Ganz catheters), as well as acute pain blocks. The “unbundling” of this service for arterial line means additional revenue for many anesthesia groups that utilize this clinical practice, at least for now.
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Operating Room Utilization Versus Anesthesia Provider Productivity
June 3, 2019
No aspect of anesthesia practice management has become more important in the current environment than determining appropriate staffing. While hospital administrators strive to reduce anesthesia subsidies, department heads struggle to meet expectations. Department heads see themselves as captive to coverage requirements and administration expectations, as hospital administrators press for more leverage and efficiency. Ultimately, the question becomes how efficient and productive are the anesthesia providers? It is a tough question to answer objectively. There are so many variables that determine a provider’s ability to generate billable units each day. The two key factors, operating room utilization and provider productivity, are inextricably linked with the result that anesthesia providers have very limited potential to impact their productivity. While this may be an obvious reality to any anesthesia provider, it is not always easy to convince administration. The following study is intended to provide some objective data and arguments to anesthesia practices in their struggle to educate administration.
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Anesthesia Under Assault: New Roadblocks to Reimbursement
May 28, 2019
In a follow-up to last week’s alert, we intend to focus once more on ways in which anesthesia providers are encountering new challenges to getting paid. We have noted with increasing concern tactics being employed by some of healthcare’s heavy hitters to delay, decrease and deny payment for services rendered. We’ve all seen claims rejected due to honest errors committed by a payer or other party, but what we’re seeing now is a growing trend on the part of some insurers to reject large numbers of claims for inexplicable reasons.
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Anesthesia Update: Surprise Medical Bills
May 20, 2019
Surprise! Surprise! Surprise! That famous line routinely delivered by a beloved actor from a 60s sitcom is resounding once again—this time in the halls of government. A few months ago, we informed you of a serious effort on Capitol Hill to craft legislation that would put an end to so-called “surprise medical bills.” This month, President Trump added his voice to the debate, calling for quick passage of a bill that would rescue patients from catastrophic costs tied to non-par providers. According to an April 2019 Kaiser Family Foundation survey, some 86 percent of respondents labeled the ending of such surprise bills as either “important” or a “top priority.” There is bipartisan support in the U.S. Congress for such a measure; and, with the president’s recent push, we can expect some type of federal legislation to emerge—perhaps this year.
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Anesthesia Complicated By Hypothermia and Hypotension: A Fresh Look at Old Friends
May 13, 2019
The 2019 ASA Relative Value Guide (RVG) includes minor revisions for two codes that can be billed as adjunct services for an anesthetic. One, 99116, describes anesthesia complicated by the utilization of total body hypothermia, while the other, 99135, reflects the use of controlled hypotension. These codes have been part of the ASA guide for many years, but their usage has been noticeably inconsistent across the country. Such inconsistency raises three questions:
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Endoscopic Anesthesia Revisited: An Update on the Impact of the New GI Codes
May 6, 2019
Few topics have captured the anesthesia community’s attention as completely and for as long as endoscopy and the value of anesthesia services for GI procedures. The consensus of opinion now favors active participation by qualified anesthesia providers to enhance the safety and efficiency of endoscopy care.
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Securing Anesthesia Devices From Cybercrime: What Can Anesthesia Providers Do?
April 29, 2019
As clinicians who rely increasingly on network-connected and interoperable medical devices—an anesthesia machine in the OR that is connected to an anesthesia information management system (AIMS) running on a PC, for example—anesthesiologists and nurse anesthetists should know that, as technology opens doors for information sharing to improve anesthesia safety, quality and learning, the devices they’re using, and by extension, their patients, are at risk.
