“Much has changed in health care since HIPAA was enacted over fifteen years ago,” said HHS Secretary Kathleen Sebelius in the Department of Health and Human Services’ January 17th press release announcing the publication of the long-awaited final omnibus rule with Modifications to the HIPAA Privacy, Security, Enforcement and Breach Notification Rules under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act. “The new rule will help protect patient privacy and safeguard patients’ health information in an ever expanding digital age.” The final omnibus rule will go into effect on March 26, 2013. Covered entities such as anesthesia and pain medicine practices and billing companies including ABC—and their business associates—must be in compliance by September 23, 2013. The final rule changes HIPAA in several important ways: It toughens the definition and consequences of failure to notify affected parties of security and privacy breaches;It strengthens...

The 2013 CPT® Changes and Codebook are now available to health care providers.  Overall, the 2013 changes include 186 new codes, 119 deleted codes, and 263 revised codes. In addition CPT revised 18 modifiers and updated 150 guidelines.  The very good news for anesthesia and pain management providers is only a small handful of these changes directly impact the services they routinely provide.  Following are general comments regarding the 2013 changes: No Anesthesia codes were deleted, revised, or added for 2013.Pain management providers should take note of the four revised codes and one new code in the nervous system section of CPT 2013. The majority of changes occur in the denervation subsection, where CPT revised codes 64612 and 64614 and added 64615 for bilateral chemodenervation of muscles innervated by the facial, trigeminal, cervical spinal and accessory nerves.CPT also changed the parenthetical note for code 76942, ultrasound guidance for needle placement (eg,...

  MEDICARE PAYMENTS AFTER DECEMBER 31st If we go into the New Year without legislation to stop the economy from going over the fiscal cliff—as appears almost certain—there will be no just-in-time SGR fix either.  The Medicare conversion factor applicable to services provided from January 1st onwards will be 26.5% lower, unless and until Congress corrects the problem.  Since the earliest that Medicare will pay claims will be January 14th, however, there is time for Congress to take the necessary action and prevent any remittances from going out at the lower rate, subject to later adjustment.   It is instructive to look at a six-year history of the dates on which Congress passed legislation each year avoiding the impact of the SGR (American Medical News, December 24, 2012): 2006-4.4%0.2%Feb. 8, 2006* 2007-5%0%Dec. 20, 2006 2008 (Jan.–June)-10.1%0.5%Dec. 29, 2007 2008 (July–Dec.)-10.6%0%July 15, 2008* 2009N/A1.1%N/A 2010 (Jan.–Feb.)-21.3%0%Dec. 19, 2009 2010 March-21.3%0%March 2, 2010* 2010...

The acronym “HIPAA” has become a household name since the enactment of the Health Information Portability and Accountability Act of 1996, which, among other things, established rules for protecting and securing patients’ health information. In fact, it is not uncommon to hear about breaches of patient information costing healthcare providers and suppliers six and seven figure civil monetary penalties or settlements. Typically, such settlements and penalties have arisen out of patient complaints that the privacy of their protected health information (PHI) has been compromised. However, beginning November 2011, patient complaints will not be the only way in which the Department of Health and Human Services (HHS) Office of Civil Rights (OCR) will learn about non-compliant entities.Section 13411 of the American Recovery and Reinvestment Act of 2009, which established the Health Information Technology for Economic and Clinical Health (HITECH) Act, requires the Secretary of HHS to “provide for periodic audits to ensure...

Many, if not most, anesthesia practices provide services at ambulatory surgical centers (ASCs) as well as at hospitals.  Some 11 percent of anesthesiologists have invested in the ASC as part owners, according to Medscape’sAnesthesiology Compensation Report: 2011 Results.  Others invest their energy in contracts to staff ASCs.  In either case, it is important to know the economic condition and value of one’s ASC.One way to approach the matter is to analyze the attractiveness of the ASC to a buyer.  Buyers tend to invest in outpatient facilities with room for improvement in performance.  Whether you are considering buying (or selling) an ownership share or entering into or renewing an exclusive contract, the ASC’s appeal to a potential corporate investor such as an ASC management company is relevant.Becker’s ASC Review E-Weekly ran an article with “10 Questions to Evaluate ASC Investment Opportunities” in its June 16, 2012 issue.  Outpatient Surgery Magazine alerted subscribers to a 2009...

Another Medicare compliance deadline approaches, and it has attracted a fair amount of attention.  The good news is that it will apply to few pain physicians and even fewer anesthesiologists.  Sometimes it is necessary to explain a new rule or requirement just so that our readers know not to worry.  This is one of those times.By July 1, 2012, those physicians and facilities that are affected are expected to be in compliance with the “3-day payment policy.” The 3-day payment window applies to certain outpatient services provided by hospitals and hospitals’ wholly owned or wholly operated entities, including physician practices.The policy has applied to diagnostic services and related non-diagnostic services since 1998.  The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 broadened the definition of related non-diagnostic services that are subject to the payment window to include any non-diagnostic service that is clinically related to...

On-time case starts can make the difference between profitable and unprofitable operating rooms.  There are multiple causes for late starts, among them clinical complications, unavailable instruments or supplies, unavailable laboratory reports or other paperwork, delays in room turnover and late arrivals on the part of surgeons, patients, and yes, anesthesiologists and nurse anesthetists. Almost all of the problems listed above are within the control of the anesthesiology group in charge of managing the OR.  A June 14th Outpatient Surgery Tip of the Day (www.outpatientsurgery.net) republished four tips to incentivize surgeons and anesthesiologists to arrive on time for scheduled cases.  These tips originally appeared in the November 2010 issue of Outpatient Surgery.   The article by Dan O’Connor was directed to readers who manage both types of physician, but the strategies can be implemented (or at least proposed) by a practice that provides an anesthesiologist-medical director.  Tip No. 1:  Make wake-up calls.  An...

The United States Supreme Court allocated more time to oral argument on the constitutionality of the Affordable Care Act (ACA) last week than it had to any other case in the past 50 years.  Four distinct questions were before the Court during six hours of argument spread over three days.  In chronological order of consideration, these questions were: Does the 1867 Anti-Injunction Act, which bars pre-enforcement litigation over a tax, prevent the Court from hearing the challenge to the insurance mandate? Can Congress compel individuals to buy insurance or pay a penalty (the “individual mandate”)? Can the rest of the ACA survive if the individual mandate is struck down? Can Congress pressure states to expand Medicaid coverage by threatening to withhold funds?The Individual MandateThe room was packed and buzzing with excitement.  Some people clearly had slept outside last night.  Even some of the attorneys general from the challenger states had to...

Please take a moment to participate in the second annual ASA nationwide survey on anesthesia drug shortages. This brief survey will help ASA continue to work with legislative and regulatory policymakers to develop policies that help to avert drug shortages, provide advanced notification and mitigate the effects of drug shortages. Data from last year's survey was instrumental to ASA in demonstrating the urgency of addressing drug shortages.      For this survey to be successful, ASA will again need a high participation rate of members.  Please complete this survey and encourage other ASA members to do so as well. http://www.surveymonkey.com/s/asadrugshortagesurvey I. Revised Anesthesia Conversion Factors CMS has just updated the Medicare conversion factors (CFs) for anesthesia services.  The new national, unadjusted CF is $21.52, up from $21.41 for the first two months of 2012.  Download the list of locality-adjusted CFs here. As noted on the CMS website, “Medicare payment rates under...

From day to day, the great majority of anesthesiologists, nurse anesthetists, anesthesiologist assistants and their group practices provide excellent patient care.  Most enjoy comfortable relationships with their hospitals and surgery centers, too. The world of health care is changing all around us, though.  Every anesthesia practice needs to understand the more important changes and to adapt, or plan to adapt.  In this issue of the Communiqué, you will find a number of articles that will help you prepare for the short-term and long-term future. We start with Mark Weiss, Esq.’s Protecting Your Exclusive Contract, Your Practice and Your Profits.  Mr. Weiss aptly shows that the process of negotiating your next hospital contract starts the moment you have signed this one.  The anecdote about Walt Disney’s arrival at Universal Pictures’ headquarters in New York to renegotiate the terms of their deal, only to find that Universal, not he, held the copyright in his cartoon character and...

Have you and your group been thinking about how to grow your practice? The trend toward anesthesia practice consolidation continues its momentum. Not only do groups seek more and more opportunities to merge, to acquire other groups and to join larger organizations; they are an increasingly attractive acquisition target.Mark Weiss, Esq.’s article “The Company Model of Anesthesia Services: Will Less Money Lead to Jail Time?” is an excellent review of the development of the troublesome “company model” as well an explanation of the associated compliance issues that you don’t have to be a lawyer to understand.For a different perspective, consider AAA Executive Committee member Franc Galinanes’s article “Anesthesia: The Increasing Consolidation of Our Industry.” As a Senior Director for North American Partners in Anesthesia, Mr. Galinanes is in a good position to discuss the advantages of the three major types of consolidation: practice mergers, joining a larger organization and sale to...

On August 22, 2011, as a result of a directive from President Obama, the US Department of Health and Human Services (“HHS”) issued its Plan for Retrospective Review of Existing Rules (“Plan”). The Plan includes a review from all HHS operating and staff divisions (e.g., the Centers for Medicare and Medicaid Services (“CMS”)) that establish, administer and/or enforce regulation. HHS’ Plan aims to review “existing significant regulations to identify those rules that can be eliminated as obsolete, unnecessary, burdensome, or counterproductive or that can be modified to be more effective, efficient, flexible, and streamlined.” While, on its face, a review of unnecessary regulations appears to be beneficial, looking below the surface reveals that the review may create fundamental changes in medical and anesthesia practice. CMS is contemplating reviewing the conditions of participation (“CoPs”) for anesthesia services (42 CFR 482.52) to eliminate the certified registered nurse anesthetist (“CRNA”) supervision requirement, which could...

Written by: Neda Mirafzali, Esq Kathryn Hickner-Cruz, EsqThe Health Law Partners, P.C., Southfield, MISince the passage of the Affordable Care Act1 and the establishment of the Medicare Shared Savings Program (the “Shared Savings Program”), ACOs have become the new hot topic.Section 3022 of the Affordable Care Act provides that Medicare shall establish the Shared Savings Program and that healthcare providers and suppliers will participate in the Shared Savings Program through ACOs. According to CMS, “ACOs create incentives for healthcare providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Shared Savings Program will reward ACOs that lower growth in healthcare costs while meeting performance standards on quality of care and putting patients first.”2 If an ACO saves money by providing patients with efficient care, then the ACOs can share in a percentage of the savings with Medicare. However, should an ACO fail...

When asked why he robbed banks, Willie Sutton responded, “Because that’s where the money is.”Ambulatory surgery center (“ASC”) owners, often surgeons, seek to obtain a share of anesthesia fees for the same reason. But instead of a gun, many are turning to a new model of money extraction, the so-called “company model.”The abrupt bank robber approach to demanding a kickback is clearly illegal: “Bob, if you want to provide anesthesia at Greenacres ASC, you’ve got to pay us thirty cents on the referred dollar”.Although there are far more ASC owners willing to take the bank robber approach than the industry likely will admit, some ASCs are choosing a slightly softer approach — forcing the anesthesiologists working independently at the ASC to instead work for an ASC affiliated entity that distributes a share of the anesthesia fees back to the ASC owners.“Bob, if you want to provide anesthesia at Greenacres ASC, you’ve...