eAlerts

The Latest Twist in the NSA Saga: What Anesthesia Providers Should Know

February 20, 2023

Along the edges of America’s more mountainous regions are roads that motorcyclists call “the twisties”—named for the large number of hard turns that come at you in rapid succession.  These types of winding roads are highly valued by riders as they afford the thrill of leaning into the curves at respectable speed.  But it is not only the biker community that enjoys a good twist.  Readers of novels and viewers of films also get a kick out of the occasional curve ball thrown into the storyline.  With this in mind, we thought it might be of some interest to our readers to share the latest plot twist in the ongoing NSA drama.

Defining Anesthesia Profitability

February 13, 2023

Anesthesia profitability has been defined in many ways over the years, but rarely has it been defined in a way that actually relates to the fundamental economics of the specialty. Physician anesthesiologists used to define it in terms of their own compensation. A profitable practice was one where the physicians earned a good income. This assumed that (a) the volume of services was strong and consistent, and (b) the payer mix was favorable such that the yield per billed unit was above average. While this might have been a good way to designate favorable practices from those that would need a subsidy, it does little to actually measure profitability in a way that allows for its assessment or improvement. The reality today is that most anesthesia practices require some level of financial support from the hospitals they serve. The question is why and how things could be improved.

Paying It Back: Overpayment Obligations of Medicare Providers

February 6, 2023

It was akin to what they call in Louisiana lagniappe (pronounced “lan-yap”), meaning a little something extra.  Except in this case, it was excessively more than expected.  Back in 2019, the U.S. Internal Revenue Service (IRS) seized a Lexus and $919,250 in cash from a Florida man who was mistakenly sent a tax refund of $980,000 on a reported income of $18,497, according to the Tampa Bay Times.  The moral of the story is this: if you receive a windfall of funds that seems too good to be true, it probably is.  That is, it is probably best to assume that someone made a mistake, and it would behoove you to set things straight before going on an unrestrained spending spree.

The Pros and Cons of Automated Anesthesia Records

January 30, 2023

Vendors of automated anesthesia record systems would have you believe they are practically god’s gift to the specialty of anesthesia. They will capture more information about each anesthetic more conveniently and report it back more legibly than paper records ever could. They will also enhance the completeness and accuracy of billing by ensuring that all critical elements necessary to complete a claim are communicated to the billing office. It often sounds too good to be true, which is often the case. Implementing an automated anesthesia record system is not without its challenges and shortcomings.

Compliance Imperatives for 2023: Priorities for Anesthesia and Pain Practices

January 23, 2023

“Plan the work, and work the plan,” as the old saying goes.  Where would any of us be without taking the time to plot a strategy for success as it pertains to education, career, relationships or even the annual summer excursion.  Everything worth attaining requires at least some measure of forethought. 

Chronic Pain Management Update

January 16, 2023

Many of our clients have not made a significant commitment to the management of chronic pain, but it is a constant topic of conversation during strategic planning sessions. For many anesthesiologists, chronic pain is perceived as a logical line of care extension. Afterall, the specialty of anesthesia focuses on spinal and nerve anatomy and the use of powerful analgesics. The problem is that the management of chronic pain patients presents an entirely different set of challenges from surgical and obstetric patients. Moreover, the management requirements of a chronic pain practice are entirely different from those of an anesthesia practice. Today’s question focuses on the impact of the dramatic events of the past few years on chronic pain. In other words, is the potential of getting more involved in chronic pain an option that practices should still be considering?

A New Year’s Smorgasbord: An Assortment of New Guidance for Anesthesia and Pain

January 9, 2023

What a spread.  Holiday dishes taking up three counters were a wonder to behold.  Gazing inevitably led to grazing—a little of this and some of that.  It didn’t take long before the plate was full.  From Thanksgiving to New Years, most Americans were treated to a tasty assortment of satisfying cuisine and rich desserts.  As we look to the beginning of another year, the government has set the table with a buffet of recently passed provisions that touch on a wide array of issues critical, or at least applicable, to most medical groups. 

Predicting Anesthesia Revenue Potential for 2023

January 2, 2023

As we close out 2022, most of our clients are wondering what their revenue will be for calendar 2023. It is a very good and useful question. The fact is that there are three distinct variables in the revenue equation, and each has been impacted by a variety of internal and external factors. The three factors are the volume of cases, the acuity of care provided and the net yield per billed unit. Because surgical cases determine the majority of practice revenue, let us isolate time-based surgical activity for purposes of identifying the factors we should be focused on to get a reasonable idea of the trends that will determine 2023 revenue. The information upon which this review is focused all comes from standard FA reports. While we have identified a sample of large clients for this discussion it is well worth the time to review how each of these factors and issues may determine your cashflow projections.

Year End Federal Spending Package Includes Partial Reduction of Medicare Pay Cuts for 2023

December 27, 2022

Leaders in Congress have agreed on a $1.7 trillion federal spending package that includes a reduction of the Medicare pay cuts for doctors that were looming over 2023. President Biden signed the bill into law on Friday.

2023 Medicare PFS Final Rule: A Deeper Dive

December 19, 2022

Repetition and addition—that’s the formula for effective learning, especially when it comes to mastering a second language.  You go over what you previously practiced and then add new vocabulary words or additional grammar nuances as you progress each day.  At some point, you may even be provided various charts showing verb conjugation and noun declension.  All these teaching strategies are aimed at helping the student gain a better understanding of the material. 

The 2023 Quality Payment Program: Updates for Anesthesia

December 12, 2022

The Merit-based Incentive Payment Systems (MIPS) program is entering its eighth year of operation, and it is still a hotbed of confusion, anxiety and—depending on whom you ask—misinformation.  This is largely because participation in MIPS is extremely dependent on the specialty, the group, the reporting option and the clinician’s commitment to continued participation.  For the past several years, providers were offered an exemption to the program due to the COVID-19 pandemic, but 2023 will not likely continue to enjoy this backstop.  To help dispel some of the stress with navigating MIPS, this alert will walk through the requirements of 2023 reporting and be a resource to review if you have any question about how you need to participate next year.

2023 Fee Schedule: Implications for Anesthesia and Pain Practices

December 5, 2022

“I feel a change comin’ on”; it’s a lyric that Bob Dylan used to express the societal transition that was taking shape in what is now a bygone era.  While there are changes that inevitably come with the rise of each new generation, we are reminded each November of the yearly changes that lay in store for America’s healthcare providers.  Last month, the Centers for Medicare and Medicaid Services (CMS) published the 2023 Medicare Physician Fee Schedule (PFS) Final Rule (FR), which contains changes in reimbursement rates, coding rules, documentation requirements, etc.

Signing on the Dotted Line: The Rules for Anesthesia Record Signatures

November 28, 2022

The delivery man comes to the door with an expensive package.  You greet him, and he asks: “Will you sign for this?”  You’re at the closing for your first house; and, as they hand you a pen and a stack of documents, you say: “I feel like I’m signing my life away.”  There is no doubt that in the modern world we are requested or required to authenticate certain transactions by way of affixing our name to some type of paper or digital medium.  However, this is not just a modern phenomenon.  Remember John Hancock’s bold signature on the Declaration of Independence, or how about the ancient kings who would depress their signet ring into wet clay or soft wax to produce their official signature and seal?

2023 PFS Final Rule: Implications for Anesthesia

November 21, 2022

The yearly ritual begins.  No, it’s not the one that involves the placement of festive lights or the buying of family gifts or the stuffing of oversized birds, but rather the annual unveiling of the government’s newest regulations for healthcare.  The 2023 Medicare Physician Fee Schedule (PFS) was published in the Federal Register on November 18 and, predicably, contains a plethora of changes in process and procedure that will directly impact the practices of America’s healthcare providers. 

Determining A Fair Compensation Package for Anesthesia Providers

November 14, 2022

One of the most perplexing challenges in the current anesthesia market is determining what is a fair and reasonable compensation package for the physicians and CRNAs in the practice. Because the cost of providers is the biggest item in the budget, it plays a critical role in any request for a subsidy from the hospital. While there is some national data based on surveys of anesthesia practices, the data is not always useful or relevant in setting compensation levels. Because of the national anesthesia manpower shortage, we are seeing more movement of anesthesia providers from one practice to another than at any time in the past. It is relatively easy for providers to jump from one practice to another, and many factors come to bear on their level of satisfaction and their willingness to change. A client practice in the West noted that, after twelve years of relative stability among the team, they have now lost seven providers since the beginning of the year.

Outside Forces: Anesthesia and the Current State of Healthcare

November 7, 2022

You’re doing fine.  At least in terms of your own personal bubble, things seem to be okay.  But there are forces from without that may soon push and poke at that bubble.  Consider the chaos that is certain to ensue when the bubble finally bursts.

The Challenge of Patient Balances for the Anesthesia Practice

October 31, 2022

When it comes to collecting everything that is collectible for the valuable services anesthesia providers administer, there are three primary challenges that every practice must come to terms with. First, there is the fact that, as compared to office-based providers, anesthesiologists and CRNAs have no ongoing relationship with their patients; they rely on hospital staff to gather the critical demographic information necessary to submit claims and receive payment. Second, we live in a society where the expectation is that patients have insurance to cover their medical expenses; but patient balances tend to be looked at as incidental and of lower priority to the patient than other bills such as mortgage or rent, utilities, cable, car payment and groceries. Third, while there are numerous effective strategies to collect the allowable from insurance, there are relatively few approaches that result in consistent collections from the patients themselves. It is these factors that explain why collecting the patient’s balance is often the Achilles heel of accounts receivable management.

When Anesthesia Payment Is in Doubt: Options for Non-Medicare Cases

October 24, 2022

The painters have just arrived.  The large two-story estate looms before them like something out of a Faulkner novel.  The old girl is still sound structurally, but the cracked and aging exterior belies the need of a real makeover.  After two days of stripping the old white paint, applying a deep-penetrating primer and two coats of canary yellow acrylic, the laborers look back with awe and deep satisfaction.  It is then that they are told by the homeowners, who have just returned from a weekend getaway, that they have painted the wrong house.  Oops.

The Value of Acute Pain Management to the Anesthesia Practice

October 17, 2022

There was a time, not too long ago, when many anesthesia practices did not provide much in the way of nerve blocks for acute pain management. Now, it has become the norm for a wide range of orthopedic patients to get nerve blocks intended to provide extended analgesia post-operatively. Experienced practitioners continue to explore new modes of treatment to enhance the post-operative comfort of their patients. The use of TAP blocks for abdominal surgery is a good example of this.

Anesthesia and ABNs: A Few More Considerations

October 10, 2022

A couple of weeks ago, we published an alert dealing with the appropriate usage of advance beneficiary notices (ABNs) for Medicare patients. We primarily focused on voluntary versus mandatory ABN triggering events and provided an example of the mandatory scenario, along with its potential difficulties. You can find that article here: When Payment is in Doubt: Anesthesia Examines ABNs | Anesthesia Business Consultants (anesthesiallc.com). In this alert, we seek to expand on this topic by reviewing additional rules surrounding the usage of an ABN.

In-House Versus Outsourced Billing for Anesthesia

October 3, 2022

There is a natural human tendency to always think that the grass is greener on the other side of the fence. This is especially true with regard to the concept of billing and accounts receivable management. Many an anesthesia practice has migrated from an in-house billing operation to an outsourced option over the past few decades. Some large practices have even decided to bring their billing in house, a cumbersome process that involves setting up an office, hiring staff, finding a computer system and deciding how to manage it all. While there are definitely advantages to each approach there is no silver bullet. Effective anesthesia billing is a complex multidisciplinary activity where failure to manage all the variables appropriately can easily yield disappointing results. It is all too easy to underestimate the complexity of the task.

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