eAlerts

When Payment is in Doubt: Anesthesia Examines ABNs

September 26, 2022

Nothing is more frustrating for the entrepreneur than providing an extraordinary service and getting jilted on the payment.  Vincent van Gogh was a Dutch artist who sold or bartered his avant-garde paintings for next to nothing and ended up dying penniless.  Today, his works sell for millions.  Most of us would rather not wait until our demise to obtain our rightful recognition and remuneration.  We’d like to be appropriately compensated in a timely fashion.  That is certainly true of those who labor long and hard in America’s operating suites.

What Makes Anesthesia Billing Unique?

September 19, 2022

The most common question our clients usually ask is whether we are collecting everything that is collectible for their practice. It is a good question, but the answer is more complicated than one might think. It has been said that anyone who asserts that anesthesia billing is easy is either a terrible biller or a terrible liar.

A Subtle Seduction: Anesthesia and the Company Model

September 12, 2022

It sounds good.  A silver-tongued salesman tells you all about it: the bells, the whistles and the elegant appointments.  What he doesn’t talk about is the significant risk involved with his persuasive pitch.  He doesn’t go into the potential cost to the customer—a cost that could be exceedingly high. 

Anesthesia Services Agreement: A Conceptual Perspective

September 6, 2022

Every anesthesia practice must define its relationship with the facilities it serves in terms that are mutually clear and beneficial. For private anesthesia practices, this takes the form of an anesthesia services agreement that needs to be updated and revised as service expectations change and as economic realities evolve. Although employed departments do not go through the same exercise of negotiating an agreement, the business objectives are fundamentally the same. There are three themes that must be discussed and clarified for the relationship to remain viable and productive. The department must be clear as to its responsibilities, risks and rewards. No amount of legal verbiage should obscure these key aspects of the relationship, which is why they should be the initial focus of discussion. The interesting reality is that while most practices have a clear understanding of the first two areas, they are often hard pressed by the third.

The No Surprises Act Final Rule: Impact on Anesthesia

August 29, 2022

“The waiting is the hardest part,” according to legendary rocker Tom Petty.  Well, we have waited for many months to see what is supposed to be the final version of the government’s stance on implementing the No Surprises Act (NSA).  That wait appears to be over . . . well, sort of.  On August 17, the federal departments tasked with promulgating rules relative to the NSA [Health and Human Services (HHS), Labor and Treasury, hereinafter, “the Departments”] issued a final rule that will have a direct effect on anesthesia practices.

The Independent Dispute Resolution Process: A Fresh Look for Anesthesia

August 22, 2022

The No Surprises Act (NSA) was designed to remove the unexpected costs of out-of-network (OON) providers as a barrier to patient care. The legislation placed limits on provider collection efforts that largely favored insurers. The Independent Dispute Resolution (IDR) process was included as a check and balance on the advantages afforded to insurance companies. The IDR, however, has been plagued by a number of issues.

Anesthesia Subsidies: From the Hospital Perspective

August 15, 2022

We know what we believe.  On those topics about which we are particularly passionate, we are usually able to marshal the facts in support of our stance.  Our experience and knowledge base—when coupled with that personal sense of rightness—allow us to be confident in successfully articulating our position.  The problem with all this is that the person you’re trying to persuade also has experience, knowledge and passion, all of which point him or her in a different direction.  They see things through different eyes.  Nevertheless, we should remember that engaging in a dialogue with one holding an opposing view can often provide greater insight for all sides.  In other words, it’s good to get the other person’s point of view.

The Anesthesia Challenge of Early Morning Starts

August 8, 2022

One of the most significant challenges to hospital-based anesthesia practices is the need to make providers available to cover early morning starts. Typically, hospitals will define coverage requirements based on the number of early morning slots they want to make available to surgeons. The reason this turns out to be a problem is that these first-case-of-the-day-starts do not result in a line-up of to-follow cases. In fact, based on a review of a sample of HCA hospitals, 90 percent of the time surgeons perform only one case in the morning. They may then return to their offices to see other patients or take the rest of their line-up to an outpatient facility. The result is low levels of OR utilization in the hospital and an unprofitable situation for the anesthesia practice.

2023 Proposed Fee Schedule: Impact on Chronic Pain

August 1, 2022

We recently provided an alert on the 2023 Medicare Physician Fee Schedule (PFS) Proposed Rule (PR).  In that alert, we focused primarily on those proposals that would be of most interest to the anesthesia community.  Today’s alert centers on some of the key PR provisions that will have potential impact on the specialty of chronic pain management.

Anesthesia Workload and Surgery Risks: A Pivotal Linkage

July 25, 2022

Most major surgeries would not be possible without the skilled services of an anesthesia provider to render the patient unconscious and pain free.  It is the anesthesia provider who ultimately ensures that the patient’s vital functions—including blood pressure, breathing, heart rate and rhythm—remain stable throughout the procedure.  As the demand for such surgical care grows, many clinicians, including anesthesia care teams, are being asked to take care of a greater volume of patients, all while maintaining patient safety.

2023 MPFS Proposed Rule: Impact on Anesthesia

July 18, 2022

It’s one thing to propose; it’s another to follow through.  When a plan is accepted and put into action, the planners can look back with pride on the day their proposals were first put down on the drawing board.  Proposals are important because they are the starting point of fruition and culmination.  Just as every marriage begins with a proposal, so every government regulation begins with a proposed rule.  With this principle firmly in hand, let us now consider the latest proposals emanating from Washington that are bound to have significant implications for the anesthesia community.

What Makes for an Ideal Relationship Between an Anesthesia Practice and the Hospital Administration?

July 11, 2022

Too many anesthesia practices are experiencing a less than collaborative relationship with the administration of the facility where they provide services. Given what an important role anesthesia plays in the management of the operating rooms, this can be a particularly troubling state of affairs. Anesthesia services bring such value to the facility.  The anesthesia provider does more to enhance the patient’s overall surgical experience than the surgeon, leading many to wonder why the relationship is not more compatible. Obviously, part of the explanation is historical. In many facilities the anesthesia providers were the masked men about whom little was known. More recently, many in the administration see them as the annoying providers who are always asking for a bigger subsidy or other forms of financial support.

Proposed Conversion Factors for 2023 Released

July 8, 2022

On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule regarding policy changes for payments under the Medicare Physician Fee Schedule (PFS), effective on or after January 1, 2023. 

Anesthesia’s Assessment of Physical Status

July 5, 2022

The world of tomorrow, as envisioned by futurists, such as Ray Kurzweil, Elon Musk and others, may very well witness an evolutionary shift where artificial intelligence and advanced robotics inexorably lead to significant changes in the essence of humanity.  Some foresee a symbiosis between man and machine, where the human consciousness is uploaded into an indestructible robotic shell, fulfilling the age-old quest for immortality.

The Impact of the No Surprise Billing Act on Anesthesia Providers: A Quick Update

June 27, 2022

Although the No Surprise Billing Act was intended to protect patients from excessive surprise medical bills, it has had some unintended and ironic implications for anesthesia providers. As is so often the case with new regulations developed in Washington, the specific details of the proposed change tend to be rather intimidating. Many practice managers were concerned that the bill would represent another attempt to chip away at practice revenue. The point is that many of the details of this act simply don’t really impact hospital-based anesthesia practices that participate with most insurance plans. It should also be noted that, as the Medicare and Medicaid populations continue to grow, the impact of their discounted rates tends to drive down the average overall yield per billed unit. In other words, the downward pressure on payments has little to do with the new law and everything to do with fundamental demographic trends related to an aging American population. 

Exceptions to the Rule: What Anesthesiologists Can Do During Medical Direction

June 20, 2022

There is always, it seems, an exception to every rule—an “exception that proves the rule.”  It’s always “i” before “e,” except after “c,” right?  You can turn right on red, except in those jurisdictions that don’t allow it.  Exceptions to rules are pervasive throughout our daily life, and they exist in the anesthesia world, as well.

The Anesthesia Strategic Challenge

June 13, 2022

Routine can be a good thing.  It keeps us on track and hopefully continuing on a positive path.  Every morning, you make up the bed.  Every evening, you walk a mile.  It’s just what you do.  Yes, routine is fine, as long as it doesn’t become a rut or perhaps something even worse.  Doing what we’ve always done before, in the same way we’ve always done it, can potentially be detrimental to our long-term wellbeing given the fact that the world around us is constantly changing.  Perhaps we should do a little changing, too.

Measuring Profitability: The New Anesthesia Reality

May 31, 2022

Conventional wisdom holds that anesthesia practices are captive to the facilities they serve. It is the location of the facility that determines the payer mix of its patients, which is the critical determinant of the effective yield per unit billed. It is the effectiveness of the facility’s strategic plan that determines the nature and consistency of surgical and obstetric procedures performed. It is also the facility’s philosophy and commitment to its surgeons that determines the productivity of the operating rooms; many stretch the staff thin trying to provide OR availability. More often than not, it is the desire to provide 7:30 starts that drives down OR productivity, especially when the facility does not consistently get the to-follow cases. Changing corporate philosophy and behavior is never easy, especially when the anesthesia team is focused on providing a professional service. It has often been said about anesthesia that when the surgeons say jump, their response is “how high?” The beliefs and strategies that got us to where we are today will not get us to where we need to be tomorrow to survive. Nothing could be more accurately descriptive of the anesthesia specialty.

Out-of-Network Anesthesia: Latest Developments

May 23, 2022

It is an oddity of human nature that we are drawn to television programs that continue to extend the story, where succeeding episodes build upon the plotlines of the last.  What used to be relegated to the day-time soap operas of the sixties and seventies became commonplace in nightly dramas from Dallas to Downton Abbey.  Remarkably, that soap opera feel can occasionally be found in the twists and turns of the federal rulemaking process.

Anesthesia Payer Contracting: A Challenging New Reality

May 16, 2022

Historically, the ability to negotiate favorable contract rates has been a distinguishing feature of the most successful anesthesia practices. Increasingly, though, the ability to offset severely discounted public payer rates with favorable commercial rates is eroding. There are many factors that determine the actual net yield per billed ASA unit. Some affect certain practices more than others, payor mix for example. No anesthesia practice is totally immune from the inexorable erosion of the revenue potential of its anesthesia services. Most practices have experienced an increase in their Medicare population of about one percent per year as the American population ages.

Improved Patient Outcomes: Anesthesia Leading the Way

May 9, 2022

The trail boss in the series Rawhide was in charge of the whole shebang, but he needed a Rowdy Yates to drive them doggies home.  We’re talking about the ramrod—the one who would keep the cattle moving as a single unit and in the same direction.  He would do this by putting together a team of wranglers, each of whom had a specific task to take on; and, so, it was the ramrod who exercised an indispensable position of leadership.

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