Anesthesia Industry and Market News: eAlerts
eAlerts are the latest industry information regarding regulatory changes, helpful compliance reminders, or any number of relevant topics in the fast-paced, ever-evolving specialty of anesthesia.
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March 30, 2015
Once more, the law preventing the Sustainable Growth Rate (SGR) formula from wreaking havoc on Medicare payments to physicians is about to expire. Payments are scheduled to decrease by 21.2 percent on April 1.
March 23, 2015
The New York Attorney General announced, on March 11, 2015, that his office had entered into a settlement agreement with EmblemHealth, Inc., requiring the health plan to cover anesthesiology services provided in connection with an in-network preventive colonoscopy, without any cost-sharing by the patient. The agreement includes a $25,000 penalty and applies not just prospectively but also requires Emblem to send nearly $400,000 of reimbursements to 255 patients who were inappropriately charged co-payments
March 16, 2015
One especially alarming artifact of the Patient Protection and Affordable Care Act (ACA) is the Independent Payment Advisory Board (IPAB). The IPAB is a 15-member panel charged with making proposals to “reduce cost growth” and “improve quality of care for Medicare beneficiaries.” It is required to recommend cost-saving initiatives in any year in which per capita spending exceeds a threshold determined by the government. In addition, the Commission is authorized to make recommendations to “constrain the rate of growth in the private sector.”
March 9, 2015
Health policy dominated the news media last week, with the Supreme Court hearing oral arguments in King v. Burwell, the case with the potential to eviscerate Obamacare, on Wednesday March 4. Demonstrators crowded the steps in front of the Court during the hearing; most urged that the Affordable Care Act (ACA) be left intact.
March 2, 2015
Anesthesiologists’ role in perioperative medicine is rapidly expanding. It is now sufficiently visible that some surgeons are concerned about turf; see Brian Dunleavy’s article Perioperative Surgical Home Promotes Perioperativists in the February issue of General Surgery News online.
February 23, 2015
The compliance deadline for ICD-10, as you have read many times, is October 1, 2015. After three delays since the deadline was originally set for 2011, there may be some doubt—not to say cynicism—about whether the October 1st date will slip too. It may—but the majority of viewers believe that the transition to ICD-10 codes will occur as scheduled.
February 16, 2015
For those anesthesiologists who intend to demonstrate meaningful use (MU) of an electronic health record (EHR) in 2015, CMS’ recent announcement regarding a 90-day reporting period is good news. It is also good news for pain specialists who might face a MU penalty for the first time if they do not participate this year.
February 9, 2015
Price transparency is playing a more and more critical role in health care. As Costs of Care Executive Director Neel Shah, M.D. has stated, “We make purchasing decisions for every other commodity based on transparent price and quality information (think Yelp, Travelocity). Why not healthcare, too?”
February 2, 2015
The Physician Quality Reporting System (PQRS) was one of the hottest topics on attendees’ minds at the January 23-25, 2015 ASA Practice Management Conference in Atlanta. There is still a great deal of confusion regarding how anesthesiologists and pain physicians can satisfy the reporting requirements and avoid the penalties. In addition to explanations given at the Conference, the following recent publications clarify those requirements:
January 26, 2015
Are we heading toward a health care system in which medical care comes with a money-back guarantee? That would seem to be the ultimate stage of accountability. We do not see anesthesia, pain medicine or any other practices offering to refund payments if patients are not satisfied on the horizon. We are aware of only one instance of a money-back offer in health care: Janssen Pharmaceuticals recently entered into an arrangement with the English National Health Service under which Janssen UK will refund the cost of its hepatitis C drug Olysio for patients who do not successfully clear the virus after 12 weeks. Janssen will also offer free access to pre-treatment blood tests to determine which patients are likely to benefit from treatment. (McKee S. Janssen offers NHS to pay for Olysio failures. PharmaTimes Digital, January 15, 2015.)
January 19, 2015
On many lists of the top five, or ten, or twenty trends to watch this year are bundled payment programs. Bundled payments are taking hold more and more firmly. Although traditional fee-for-service is still the dominant method of payment for anesthesia services, we should all be familiarizing ourselves with emerging payment methodologies including bundled or “episode of care” systems along with accountable care organizations and shared savings programs.
January 12, 2015
If anesthesiologists and pain specialists are like other physicians, at least as far as this question goes, online rating web sites like HealthGrades and Vitals do not provide much useful information on provider quality.
January 5, 2015
Does your practice have any Medicare appeals pending? If you have appealed a decision within the last several years, be prepared to wait a long time for a ruling. The backlog of provider appeals has grown so that the system is heavily overloaded, causing at least a two-year delay for appeals to be heard at the Administrative Law Judge (ALJ) level. One of the key contributing factors is the RAC program. The number of appeal from RAC determinations has grown exponentially since the program began in 2011. In 2013 alone, there was a 506 percent increase in appealed RA program claims over fiscal year 2012, versus a 77 percent increase in appealed claims not related to the RA program during that same period of time.
December 29, 2014
As we write this Alert on Christmas Day, we are thinking about the tumultuous year gone by. So much is changing so fast that it’s hard to stop long enough to catch our breath. Below are some of the developments through 2014 that are going to shape our future, immediate and long-term. Inclusion of a particular change or trend does not mean that it was necessarily among the most important; nor does omission mean that a given development was less momentous. There are far too many issues for an exhaustive list.
December 15, 2014
It is rare that a patient’s conduct drives his or her physician to terminate the relationship, but it does happen—not necessarily in anesthesiology care, where ongoing patient relationships are the exception, but certainly in chronic pain practices. Such an ending is uncomfortable for all the parties involved. There are ways, however, to make the process smoother and less fraught with risk for the practice.
December 8, 2014
If you provide anesthesia for a Medicare patient undergoing a screening colonoscopy, you will be able to collect 100 percent of the allowable amount from Medicare and will not need to bill the patient for any co-payment or deductible, beginning on January 1, 2015. You must, however, identify the service as screening rather than diagnostic or therapeutic through the use of the appropriate modifier on your claim.
December 1, 2014
Is your anesthesia or pain medicine practice participating in any bundled payment programs? Bundled payments are single payments to providers or health care facilities (or to a combination of both) for all services furnished during an episode of care or over a certain time period. Distribution of the single payment among the providers often entails a gainsharing and/or pay-for-performance arrangement to incentivize cost reduction and improve quality of care. With many bundled payment packages including orthopedic, spine or cardiovascular service lines, it is almost certain that some anesthesiologists are involved.
November 24, 2014
CMS decided to make all procedures zero-day because the Office of the Inspector General has identified a number of surgical procedures that include more visits in the global period than are being furnished in fact and on average.
November 17, 2014
The last two issues of the Alert reviewed changes to the Physician Quality Reporting System (PQRS) and to the Value-Based Payment Modifier (VM) announced in the Final Fee Schedule Rule for 2015. This week we will note for the record some of the most meaningful numbers in the Final Rule—the conversion factors—and explore developments regarding two of CMS’ transparency ventures, the Physician Compare website and the Open Payments program.
November 10, 2014
CMS released the Final Rule on the Physician Fee Schedule containing next year’s Physician Quality Reporting System (PQRS) requirements on October 31, 2014. As expected, Measure #30, Timing of Antibiotic Prophylaxis-Administering Physician, has been deleted from the list of measures available for either claims-based or registry reporting. So has the Back Pain Measures Group (Measures #148-151) and Measure #142, Assessment for Use of Anti-Inflammatory or Analgesic Over-the-Counter (OTC) Medications, but CMS did not ultimately remove Measure #109, Osteoarthritis: Function and Pain Assessment, from the list.
November 3, 2014
The Final Fee Schedule Rule for 2015 applies the 2017 Value Based Payment Modifier to all anesthesiologists, CRNAs and AAs, regardless of group size, and increases the amount of payment at risk for groups with 10 or more eligible professionals) to 4 percent.