What do orthopedic surgery, cardiology, radiology, gastroenterology and urology have in common?  Compensation in all five specialties is higher, on average, than it is for anesthesiology, according to Medscape’s Physician Compensation Report: 2013. Anesthesiology has slipped from fourth place to sixth place among the most highly-compensated specialties since last year’s report.  Average compensation among full-time anesthesiologists as reported by Medscape is $317,000—a number that strikes us as rather low.  The explanation may lie partly in the fact that more respondents reported incomes of less than $200,000 per year than reported earnings in excess of $500,000.  The data apparently include compensation levels at implausibly low levels ($100,000 or less reported by 6% of the respondents).  The mode is $300,000 to $399,999, with 18% reporting compensation of $300,000 to $349,999 and 15% reporting $350,000 to $399,999. Medscape’s Anesthesiologist Compensation Report: 2013. Medscape defines compensation in the standard manner:  “For employed physicians, compensation includes...

“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,...

F1RSTUseTM is the first—and only—full-service EHR management platform built exclusively for anesthesiologists and pain management specialists to satisfy with ease Stage 1 of Meaningful Use as required to earn the Medicare EHR incentive payment.  It is the only product that provides the full service measures to ensure success:  tracking the necessary data points, providing reports of successful measures and ensuring that you are meeting all of the CMS requirements.As a number of physicians have begun to incorporate the F1RSTUse system into their workflow, additional questions regarding the Meaningful Use program have been received.  Read on to learn more about F1RSTUse and how it can support your Meaningful Use program.This checklist has been compiled from questions raised by anesthesiologists, colleagues, facilities, and patients.  1. What is the maximum incentive payment if I start now? – $39,000.  If you have not already enrolled in the F1RSTUse system, the original $44,000 incentive payment is...

The percentage of patients requiring the highest level of service in the emergency department at Faxton St. Luke’s Healthcare in Utica, NY rose 43 percent in 2009, as reported in the New York Times on September 21, 2012.  Level 5 ED visit services (CPT® code 99285) at Baptist Hospital in Nashville, TN increased by 82 percent in 2010, and by a comparable amount at Methodist Medical Center of Illinois in Peoria.  More than 80 percent of Methodist Memorial’s Medicare ED evaluation and management (E/M) claims were for Level 5 services in 2010, as they were at Yuma Regional Medical Center in Yuma, AZ in 2007.  At Baylor Medical Center in Irving, TX, 64 percent of all ED visits for Medicare patients were Level 5 services, and another 16 percent were Level 4.These are just a few examples of hospitals experiencing a startling rate of growth of high-intensity E/M services during the last few...

Many “Covered Entities” within the meaning of the privacy and security provisions of the Health Insurance and Portability Act of 1996 (HIPAA) are managing more and more of their patient information electronically.  Indeed, not moving to electronic health records (EHRs) may cost physicians a percentage of their Medicare remittances—or at least the loss of a potential bonus of up to $44,000—under the EHR Incentive Program, as discussed in our last several Alerts.Collecting, analyzing, reporting and storing electronic patient information present perhaps even greater HIPAA challenges than does the use of paper records, however.  Data entered on a computer can be copied more easily, more cheaply, more prolifically and even passively.  Once unsecured data are moved from the computer on which they are created to other media, manually or wirelessly, controlling the information becomes nearly impossible.  The key word in the preceding sentence is “unsecured.”  The recently finalized HIPAA regulations on Breach Notification impose...

Does the title of this article seem boring – or “timeless,” for readers in a more generous mood? If the answer to either question is yes, that is not altogether a bad thing. The United States Supreme Court decision upholding the Patient Protection and Affordable Care Act alleviated much uncertainty about healthcare reform and all of its ramifications, at least until after the November elections. Trends in the delivery of healthcare that began some time ago will continue. “The coming years will bring continued dealmaking and greater scrutiny of hospital and physician performance on quality and cost control,” as speakers said at the June 2012 Healthcare Financial Management Association Annual National Institute. Quality, safety and practice management are as important as ever to the future of anesthesia practice.Richard P. Dutton, MD, MBA, Executive Director of the Anesthesia Quality Institute, bridges the small valley between traditional mortality and morbidity (M&M) conferences and...

Patients who go out of network can present serious collections problems for the physicians who do not participate in the network.   Managed care organizations (MCOs) often send the check to the patient in order to pressure physicians to sign participation agreements, leading to the necessity for practices to collect directly from the patients, something that is especially challenging for hospital-based anesthesiologists and other physicians who do not have ongoing relationships with their patients.MCOs do not like patients going out of network either, and increasingly some payers are going to extreme lengths to discourage that behavior. The efforts of one such payer, Aetna Health of California, Inc., to limit the use of out of network services recently led to the filing of a lawsuit.  On July 3, 2012, the California Medical Association (CMA), three county medical societies, and a coalition of four surgery centers and 60 physicians and one unidentified patient brought an...

The Supreme Court’s decision on the fate of the Patient Protection and Affordable Care Act (PPACA or, more commonly, ACA) is due to be announced at 10:15 on Thursday morning, June 28.  We are not jumping the gun by beginning to write this Alert ahead of the decision – the take-away message is that whether the ACA stands or falls, in whole or in part, anesthesiologists need to continue developing their role in perioperative care.Towards the Perioperative Surgical Home™ Model of CareCoordinated medical care is now an established value and goal in both the public and private sectors.  “Silos” and “fragmentation” are pejorative terms used to describe the type of health care delivery system that policymakers seek to leave behind. Many anesthesiologists began expanding their role in coordinating perioperative care long before the ACA was written, in pre-anesthesia testing through post-operative pain medicine services.  Several years ago, the American Society of Anesthesiologists...

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...

The EHR Incentive Program, often dubbed “Meaningful Use” (MU), has been surrounded by questions and confusion among anesthesiologists and practice administrators since its inception.  Currently, the majority of anesthesiologists and pain physicians are classified as an Eligible Professional (EP) under the Medicare portion of Meaningful Use and most of the public conversation is centered on that program.  However, the Medicaid option offers more flexibility and financial incentive which raises the question, “How does the Medicaid EHR Incentive Program differ from the Medicare portion?”  The major differences between the Medicare and Medicaid programs of Meaningful Use center on:Provider EligibilityProvider EnrollmentFinancial IncentiveAttestation ScheduleProvider Enrollment and Eligibility To be considered a Medicaid EP, an anesthesiologist or pain physician must perform less than 90% of their services in an inpatient setting (POS 21), but also must provide at least 30% of services to Medicaid patients.  According to CMS: Medicaid patients might be fee-for-service encounters where...

This issue of the Communiqué is a keeper. On pages 6 through 10 you will find tables that lay out clearly the Electronic Health Records (EHR) incentive program’s Stage 1 Meaningful Use objectives, the recently proposed changes to Stage 1, and the potential Stage 2 objectives, measures and exclusions as proposed by CMS in March. The objectives, translated into measures, are capabilities that your EHR must have in order for you to qualify for the incentive, which is non-negligible at a maximum of $44,000 per physician, or to avoid the penalty for non-compliance. Even though the proposed changes discussed in the Meaningful Use article by Abby Pendleton, Esq. and Stephanie Ottenweis, Esq. are likely to be different in some respects when CMS issues the final regulation later in the year, it is worth familiarizing yourself with the proposals because understanding the final versions will be that much easier.The Meaningful Use article,...

  A moderated discussion of compensation strategies at last week’s MGMA-ACMPE AAA meeting showed a good deal of flexibility in allowing anesthesiologists to job-share or otherwise to reduce their hours. The groups represented at the discussion were also creative in compensating members for business development and administrative activities. If case loads decline substantially, layoffs may occur, although they are the least favorite option.Along with more than 300 other MGMA-ACMPE Anesthesia Administration Assembly (AAA) members and exhibitors, we participated in the annual AAA meeting in Scottsdale last week.  One breakout session discussion group in particular was so informative that we obtained permission to bring a summary to our readers.About 60 individuals attended the discussion of compensation strategies moderated by Stephen E. Comess, Executive Director, United Anesthesia Services, P.C.  Mr. Comess got the ball rolling on responses to twelve prepared compensation management scenario questions by giving each member of the audience a playing...

Anesthesia Business Consultants (ABC) keeps a keen eye on the continued proliferation of electronic medical record (EMR) technology.  It is not enough to adopt the latest technology, ABC investigates the latest technological advancements in EMR, carefully testing new systems to ensure their compatibility with our renowned OneSourceAnesthesia platform, and working with leading-edge software providers.  Our goal:  to facilitate a smooth transition from paper to electronic billing of anesthesia services.  ABC strategically considers each upgrade from both a technological and functional update—in an effort to provide clients an unparalleled level of service. OneSourceAnesthesia Successfully Integrates EMR with Epic Anesthesia ABC is pleased to announce that we have successfully interfaced with Epic Anesthesia.  ABC worked with Orange Regional Medical Center and its Epic project team on a repeatable approach for electronic professional billing at Orange Regional Medical Center, located in Orange, New York.  The records and billing information, when combined with the automated...

Virtually all large anesthesiology practices have a corporate website. Some are quite detailed and complex. Fewer medium and small practices maintain a web presence. Should every practice consider creating a practice website or upgrading its current site?After examining a number of anesthesia practice websites, one can see that most have common elements and purposes. Before considering website design, the practice should seriously consider the purpose of the website and its intended effects.The reasons given by anesthesia practices for expending the time and money needed to produce an effective website are to implement one or more of the following:Establish a “web presence”Recruit anesthesia personnel via the websiteProvide patient informationAssist in the patient billing processSchedule anesthesiologists via surgeon preferenceInternal uses such as maintaining call schedules, document retrieval and communications.Marketing to patients, surgeons and facilities seeking anesthesia coverage.WEB PRESENCECurrently, almost every business has a website, so anesthesiology practices may believe that they too should...

Consolidation in the hospital sector has proceeded at a rapid pace in the last few years.  Hospitals, like anesthesiologists and other health care professionals and organizations, are seeking the advantages of combined size to secure their future in a marketplace undergoing a revolution with an unknown outcome.  Oral argument before the Supreme Court on the constitutionality of the Affordable Care Act, discussed in our Alert of April 2nd, did nothing to mitigate the uncertainty. The Federal Trade Commission (FTC) scored a significant victory last week when a federal District Court judge in Rockford, Illinois halted the acquisition of Rockford Health System by a competitor, OSF Healthcare System, until the FTC can conclude an administrative review of the deal (including all appeals, which means a delay of at least a year even if the hospitals ultimately prevail). According to the FTC, the acquisition would violate antitrust law by reducing competition in...

The variety of commonly used modalities for the management of post-operative surgical pain makes it imperative that practitioners understand the specific documentation and billing requirements of each option. Listed below are the five most common approaches and their corresponding claims submission guidelines. As is always the case, reimbursement will vary by payer.Intravenous Patient-Controlled Analgesia Management (IV PCA) – Surgeons are reimbursed for routine post-operative pain management as part of their global fee. Due to this fact, Medicare does not allow anesthesiologists to bill for this service. However, many non-Medicare payers do. The physician must see the patient on a post-operative day and document a progress note to include a problem focused history and exam with straightforward medical decision making. The typical code billed for this service is “subsequent inpatient visit” code 99231 (2 units).Patient-Controlled Epidural Analgesia (PCEA) – If an epidural is placed for post-op pain and is not the...

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...

From time to time anesthesia groups find that they need to reassess their administration or decision-making processes. This can involve everything from tinkering with how routine day-to-day administrative activities are carried out, to totally revamping the group’s governance structure.Reassessments can come about for a variety of reasons. There may have been a significant growth in the number of physicians or CRNAs, or an increase in the number of practice locations. The group may have encountered internal strife without adequate governance systems in place. The group may find itself incapable of making decisions or reaching consensus in a timely or efficient manner. A group may have relied too heavily upon busy physicians to carry out non-clinical duties, or one physician may (by choice or otherwise) be overburdened with administrative responsibilities.Issues in a Small Group. One of the assumed advantages of a smaller group is that it can function in a “more efficient” manner....

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...