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- One Year Out—What Do Anesthesiologists Need to Know About ICD-10-CM Conversion?
- One Year Out—What Do Anesthesiologists Need to Know About ICD-10-CM Conversion?
- Anesthesia Practices Prepare for the Health Insurance Exchanges
- Will the Medicare Physician Value-Based Payment Modifier Affect Your Anesthesia Group?
- Before the Shoe Drops: Anesthesiologists Can Help Hospitals Prevent Certain Hospital-Acquired Infections
- What Anesthesiologists Should Know About Third Party Payer Performance
- CERT Errors of Interest to Anesthesiologists and Pain Medicine Providers: Will the New A/B Contractor CERT Task Force Make a Difference?
- Will Medicare Publish Information on Payments to Anesthesiologists and Other Physicians?
- Legislative Replacement for SGR is on the Horizon for Anesthesiologists and other Physicians
- Drug Manufacturers' Payments to Anesthesiologists are Now Reportable Under the Sunshine Act
- Revisiting Readmissions as a Quality Metric for Hospitals and Anesthesiologists
- Will the Health Insurance Exchanges Mean More Patients for Anesthesiologists?
- New PQRS Reporting Requirements in the Proposed 2014 Medicare Fee Schedule Rule—Limited Impact on Anesthesia
- Looking at Bundled Payments from an Anesthesiology Perspective
- Preventable Hospital Readmissions—Opportunities for Anesthesiologists
- Do the Payers Understand Nerve Blocks for Post-Anesthesia Pain?
- Lessons from Bundled Payment Initiatives for Anesthesiologists
- Anesthesia Group Communications and the Attorney-Client Privilege
- Update on the SGR for Anesthesiologists and Pain Physicians
- Is Your Hospital Ripe for a Merger or Acquisition? What Anesthesiologists Need to Know Now
- When is an Anesthesiologist “Immediately Available?”
- Anesthesiologist Compensation
- Insights for Anesthesiologists: Participating in Hospitals’ New Strategies
- Anesthesiologists and Pain Physicians: Make Sure You are Enrolled in PECOS Now
- Hospitals May Pay for Anesthesia and Pain Medicine EHRs without Violating the Self-Referral or Anti-Kickback Laws
- Proposed “Medical Necessity” Restrictions on Post-Anesthesia Pain Blocks
- PQRS, the Value-Based Payment Modifier and Large Anesthesia Groups
- PQRS Refresher for Anesthesiologists, CRNAs and Pain Physicians
- ACOs, Antitrust and Anesthesiologists
- New Ways for Anesthesiologists to Add Value to the Management of their O.R.s
- Do ACOs Matter to Anesthesiologists and Pain Physicians Yet?
- How Safe Are Anesthesia Practices From a RAC Attack?
- The Sun Shines on Payments from Drug Companies to Anesthesiologists and other Physicians
- What Anesthesiologists and Pain Physicians Should Know about Health Insurance Exchanges
- The Company Model Presents Risks for Anesthesiologists and for ASCs
- Update Your Anesthesia Compliance Program: The Final HIPAA Privacy, Security and Breach Notification Rules Are Here
- Medicare Locality Conversion Factors for Anesthesia Services Through 2013
- 2013 CPT Coding Changes Pain Management and Anesthesia
- What Anesthesiologists Should Know About Health Insurance Exchanges
- Rental Networks, Claims Repricers and Anesthesia Practices
- Anesthesia Managed Care Contract Rates
- Giving Thanks for Anesthesiologists
- The Fiscal Cliff and What it Means to Anesthesiologists
- Final Fee Schedule Rule for 2013 Cuts Conversion Factors, Allows Payment to Nurse Anesthetists for Chronic Pain Services
- Anesthesiologists and Payment for Acute Pain Services
- Sedation by Non-Anesthesia Providers
- The SGR and Anesthesiology — It’s That Time of Year Again
- Anesthesia Business Consultants to Aid Anesthesiologists in Securing the Benefits of Meaningful Use through Complete EHR with F1RSTUse
- Compensating Anesthesiologists for Attending Group Meetings
- The OIG Targets “Personally Performed” Anesthesiologist Services
- A Warning for Anesthesiologists and Pain Physicians about Increased Billings through Better Technology
- Value-Based Purchasing for Hospitals Starts Now—and for Anesthesiologists, in 2015
- Anesthesiologists’ Role in Helping Surgery Centers Meet Their Quality Reporting Requirements
- Protect the Privacy and Security of Your Anesthesia Patients’ Electronic HIPAA Information
- New Hardship Exception for Anesthesiologists to Avoid the EHR Penalty
- Effective Hospital-Anesthesia Group Contracting: Understanding the Relationships Between Finance, Operations and Compliance
- When Negotiations with Carriers Force Anesthesiologists to Go Out of Network
- Anesthesiologists’ Investments in ASCs
- Proposed Changes for Anesthesiologists and Pain Physicians Who Report Measures to the PQRS
- Payment and Quality Changes Affecting Anesthesiologists in the 2013 Proposed Fee Schedule Rule
- What Anesthesia Practices Should Do With Unclaimed Funds Belonging to Patients
- After the Supreme Court Decision: Anesthesiologists Must Proceed With a Perioperative Care Model
- What Does Medicare’s 3-Day Payment Rule Mean for Anesthesia and Pain Practices?
- Tips for Anesthesia Practices to Get the Surgeons to the OR on Time
- OIG to Anesthesia Practices: Think Again Before You Pay Your ASC for the “Franchise”
- Latest Government Fraud Reports and How They Affect Anesthesiologists and Pain Physicians
- As an Anesthesiologist, What Should I Do About Meaningful Use if I am a Medicaid Provider?
- Collecting Payments from Anesthesia and Pain Medicine Patients
- Anesthesiology Plays a Role in Coordinating Management of Knee Replacement Patients, Contributing to Better Outcomes
- What the Proposed 60-Day Overpayment Refund Rule Means for Anesthesia Practices
- A New Quality Tool for Anesthesia Departments
- Managing Compensation for Anesthesiologists, CRNAs and AAs
- Medicare ACOs Are Blooming (With or Without Anesthesiologists)
- The Affordable Care Act, the Supreme Court and Anesthesiologists – Just the Facts, Please
- ICD-10 Delay Will Benefit Anesthesia and Pain Medicine Practices
- Medicare Updates of Interest to Anesthesiologists and Pain Physicians
- Practice Management Companies’ Acquisitions of Anesthesia Practices
- What Anesthesiologists Should Know about Medicare Prepayment Reviews
- Performance Based Compensation: Benchmarking, Monitoring and Improving Quality
- Performance-Based Compensation in Contracts between Hospitals and Anesthesia Groups: Measures
- Demystifying “Meaningful Use” for Anesthesiologists
- The Anesthesia Conversion Factor and the Medicare Fee Schedule, 20 Years Later
- Postoperative Pain Management Procedures Can Still Be Reported Separately from the Anesthesia Service
- Hospital Value-Based Purchasing Program: An Introduction for Anesthesiologists
- 2011 Medicare Rates for Anesthesia and Other Services Extended Through February
- Texas Statute Requires Anesthesia Informed Consent
- Results of Survey Regarding a Network of Anesthesia Practices
- PQRS 2012 for Anesthesiologists and Pain Specialists
- Anesthesia and the Version 5010 Standard
- How Will the Affordable Care Act Affect Anesthesiologists After the Supreme Court Rules?
- Information Technology, Patient Safety and Anesthesia Practice
- Be Careful With What You Say About One Another
- Do the Finalized ACO Regulations Help Anesthesiologists?
- A Major Change to the Perioperative/Anesthesia IT Integration Landscape
- 1 Anesthesia Group + 1 Anesthesia Group > 2 Anesthesia Groups
- Federal Budget Proposals and Medicare Payments for Anesthesia Services
- E-Prescribing by Anesthesiologists and Pain Physicians: Web Portal to Request Exemption is Up and Running
- HIPAA Privacy Rule Update for Anesthesiologists
- Electronic Prescribing: Anesthesiologists Will Soon Be Able to Request Their Exemptions
- The Medicare Bundled Payment Iniative and Anesthesia Services
- Anesthesia Providers: Plan to Revalidate Your Medicare Enrollment When Your Carrier Asks
- Medicare’s eRx and EHR Incentive Programs – Clearing Up the Confusion for Anesthesiologists
- Anesthesia and Social Media
- A Manual for all Anesthesiologists
- The IPAB Threat to Anesthesiologists and All Other Physicians
- Anesthesiology and the Proposed Rule for the 2012 Medicare Fee Schedule
- When is an Anesthesiologist's Signature Good Enough for Medicare?
- Health Plans Tighten the Belt – Around Anesthesiologists’ and Others’ Midsections
- Information from ASA on (1) Joint Commission Requirements and (2) Anesthesia Information Management
- Most Anesthesiologists Will Be Exempt from Medicare Electronic Prescribing Penalties ">
- Anesthesiologists' and CRNAs' Error Rates in Reporting PQRS Measures
- More Facet Joint Injection Pain
- Developing Leaders in Anesthesiology
- Anesthesiologists Visit Congress
- Compliance Update for Anesthesiologists
- Anesthesiologist and CRNA Participation Rates in the Physician Quality Reporting Initiative (PQRS), and New Compensation Data
- Preparing Your Anesthesia Practice for the 5010 Eletronic Transactions Standard
- ACO Proposed Rules–Will the Potential Waivers from Medicare Fraud Laws Benefit Anesthesiologists?
- Anesthesia Practice Cost and Revenue Data
- The Future As Seen From the Anesthesia Administration Assembly Conference
- What Should Anesthesiologists Know About the RACs?
THE SGR AND ANESTHESIOLOGY—IT'S THAT TIME OF THE YEAR AGAIN
October 22, 2012
With a new calendar year just over two months away, the medical and healthcare communities have begun the annual flurry of end-game activity seeking to influence payment rates. Anesthesiologists need little reminder of the Sustainable Growth Rate (SGR) threat and the 27 percent cut in Medicare payment that will take effect on January 1, 2013, unless Congress intervenes.
On October 15th, more than 100 national medical societies, including the American Society of Anesthesiologists, sent letters to the Senate Finance Committee, the House Ways and Means Committee and the House Energy and Commerce Committee highlighting the urgency of fixing the SGR problem for a new reason:
The sustainable growth rate (SGR) formula is an enormous impediment to successful health care delivery and payment reforms that can improve the quality of patient care while lowering growth in costs. Physicians facing the constant specter of severe cuts under the SGR cannot invest their time, energy, and resources in care re-design. The first step in moving to a higher performing Medicare program must be the elimination of the SGR formula. The status quo is bad for patients, physicians, and taxpayers.
We are no more optimistic now than in prior years, however, that the SGR is about to be eliminated. The price tag for blocking the 27 percent cut for just one year would be $18.5 billion, or $271 billion over the 10-year period 2013-2022 analyzed in a study released by the Congressional Budget Office last summer. Most observers expect that Congress will simply pass another short-term fix either in late 2012 or in early 2013. Although the election will be behind us and the legislators’ seats will be safe for another term, the courage on the part of Congress to face the wrath of physicians and our allies is not there.
Alternatives to a one-year fix were reviewed in a November 14, 2011 article in FierceHealthFinance. These included:
- The Medicare Payment Advisory Commission (MedPAC) proposal to repeal the SGR, which would be financed in part by a decade-long payment freeze to physicians beginning with a 5.9 percent reduction in payments to specialists for three consecutive years. Organized medicine’s understandable opposition caused FierceHealthFinance to give this proposal a 40 to 50 percent likelihood of adoption.
- An American Medical Association proposal to repeal the SGR and replace it with a five-year period of Medicare updates based on practice costs. During that period, the Center for Medicare and Medicaid Innovation would conduct pilot projects to determine what might work as a permanent replacement. FierceHealthFinance gave this proposal a surprisingly high 50 percent chance.
- The latest in a series of proposals simply to "reset" the SGR by erasing the accumulated prior deficits mandated to be offset with cuts to future payments. Although this has been supported by the medical community, it has had not gotten through a gridlocked Congress, and received a less than ten percent likelihood of passage. Current sentiment regarding the national debt would not seem to increase that likelihood.
- A proposal to divide the SGR into different spending targets, including major procedures, minor procedures, imaging and diagnostics, physician-administered drugs, and anesthesia services. The intent is to isolate drug costs, which have been growing rapidly and now amount to approximately 10 percent of the SGR’s component costs. After a couple of years of isolation, theoretically there would be enough political will to remove Part B drug costs from the SGR formula altogether, relieving the program of one of its biggest pressure points. Pharmaceutical industry lobbying will prevent this proposal from going anywhere. FierceHealthFinance estimated its odds at less than 5:100.
- Private contracting with Medicare patients. As readers know, physicians cannot contract for higher payment rates with Medicare beneficiaries unless they opt out of Medicare totally for a minimum of two years. The Medicare Patient Empowerment Act (H.R. 1700, S. 1042), introduced in May, 2011 and most recently signed by Congressman Jeff Flake (R-AZ) earlier this month, would allow patients and physicians to negotiate rates outside of the Medicare mandates. Patients could submit claims directly to Medicare and assign payment to their doctors. They would be responsible for amounts in excess of those paid by Medicare, without limit. This bill additionally would override most state balance billing laws. The newsletter gave it less than a one percent chance of passage, and we would concur, given the views and interests of patient organizations like the AARP.
All in all, it is highly improbable that Congress will repeal the SGR and allow Medicare spending on physicians’ services to rise more than one or two percentage points (if that) in the near term. Will 2013 be the year in which cuts are upheld? So it will seem, on or around November 2nd, when CMS is due to release the final fee schedule rule for next year—but the final rule will almost certainly not be the final word. CMS has no authority to override the operation of the SGR. Congress does have that power, however, and we anticipate the usual intervention at the end of this year or at the start of next. We hope it will be the former, to avoid claims confusion. As always, we will share further information as soon as it is available.
Attention Pain Physicians Concerned About the E-Prescribing Penalty
CMS has announced that beginning November 1, 2012, it “will re-open the Quality Reporting Communication Support Page to allow eligible professionals the opportunity to request a significant hardship exemption for the 2013 eRx payment adjustment. Significant hardship requests should be submitted via the Quality Reporting Communication Support Page on or between November 1, 2012 and January 31, 2013. Please remember that CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final. Important—Please note that this is for the 2013 eRx payment adjustment only. Hardship exemption requests for the 2014 payment adjustment will be accepted during a separate timeframe later in calendar year 2013.”
With best wishes,
Presdient and CEO