Anesthesia Business Consultants

Weekly eAlerts Covering Regulatory Changes, Compliance Reminders &
Other Changes in the Anesthesia Industry

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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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  • Anesthesiologists Should Prepare for the Medicare Comprehensive Care for Joint Replacement (CJR) Payment Model

    November 23, 2015

    CMS has now finalized its proposal to cover total joint replacement (TJR) procedures through a bundled payment methodology.  Under the Final Rule issued on November 16, 2015, some 800 hospitals across the country will be financially responsible for all of the inpatient and postoperative care of patients undergoing total knee or hip replacements from admission until 90 days after discharge.  CMS estimates that the new bundled-payment test will cover about 23 percent of TJR surgeries for which Medicare pays and save Medicare $343 million over the five performance years of the model.

  • How Well Does Measuring Anesthesiologists’ and other Physicians’ Quality Work?

    November 16, 2015

    Studying the 1,400 pages of the Final Fee Schedule Rule for 2016, which CMS released on October 30, has made us stop to think about the status and benefits of quality measurement in healthcare.  In particular, the ever-growing complexity of the Physician Quality Reporting Program (PQRS) and the newer Value Based Payment Modifier seems more likely to generate frustration than to lead to major improvements in healthcare safety and outcomes.

  • Anesthesia Conversion Factors by Medicare Locality

    November 9, 2015

    The national average conversion factor for anesthesia services for 2016 is $22.4426. ABC has just obtained the list of the individual conversion factors for the 90 Medicare geographic localities. The highest conversion factor is $31.10 (Alaska) and the lowest is $18.86 (Puerto Rico). In the continental U.S., the New York City suburbs and San Francisco will see the highest conversion factors. The full list appears below, in state alphabetical order.

  • The Anesthesia Conversion Factor and PQRS Changes in the Final Medicare Fee Schedule Rule for 2016

    November 9, 2015

    The national average Medicare anesthesia conversion factor (CF) effective January 1, 2016 will be $22.4426, down from $22.6093 in 2015, which is a decrease of $0.1667 per anesthesia unit.  Geographically-adjusted CFs for the 90-odd Medicare localities are not yet available.

  • Implications of North Carolina State Board of Dental Examiners v. FTC for Anesthesia and Anesthesiologists

    November 2, 2015

    Early this year, the U.S. Supreme Court ruled that the North Carolina State Board of Dental Examiners (Dental Board) violated the federal antitrust laws by preventing non-dentists from providing teeth whitening services in competition with the state’s licensed dentists in North Carolina State Board of Dental Examiners v. FTC, 135 S. Ct. 1101 (2015). The Dental Board had contended that its activity was immune from antitrust scrutiny under the “state action” doctrine because it was an exercise of the state’s sovereign power. The Court rejected that contention and upheld the Federal Trade Commission’s determination that the Dental Board’s enforcement actions against teeth whitening competitors had illegally restrained trade and did not amount to protected “state action.” To be protected, a state licensing agency such as a board of dentistry or of medicine that is made up of active members of the professions they regulate, such as practicing physicians, must be “actively supervised” by the state.

  • CMS Releases Final Electronic Health Record Incentive Program Stage 3 Rules – Anesthesiologists Retain Exemption

    October 26, 2015

    CMS released the long-awaited final rule on the Electronic Health Record Incentive Program-Stage 3 and Modifications to Meaningful Use in 2015 through 2017 (Final Rule) on October 6, 2015. In this rule, CMS made significant changes to current “Meaningful Use” (MU) requirements with the intent to ease the reporting burden for physicians and other providers and to support interoperability. The Electronic Health Record (EHR) Incentive Program was established by the American Recovery and Reinvestment Act of 2009. Separate Medicare and Medicaid programs provide for incentive payments to eligible professionals (EPs) who are meaningful users of certified EHR technology. The last year in which EPs could earn a Medicare incentive payment was 2014; the Medicaid program provides for incentives through 2016. Starting on January 1, 2015, EPs who do not demonstrate MU under either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program are subject to a payment “adjustment” or penalty—unless they benefit from an exception. The penalty for not demonstrating MU in 2015 is one percent of the EP’s fee schedule payments. It will grow to two percent in 2016 and to three percent in 2017 and 2018.

  • Telemedicine Is in Anesthesiologists’ Future

    October 19, 2015

    Telemedicine, in one form or another, is going to be part of most physician practices within the next decade.  For many doctors, it will arrive sooner, if it is not already here.  Five years ago, Dr. Girish Joshi wrote in the ASA Newsletter (Global Patient Perioperative Care through Clinical Pathways, ASA Newsletter. 2010; 74(8):10-12):

  • When Payers Ask Anesthesiologists to Refund Overpayments

    October 12, 2015

    The third-party medical payment system is so complicated that incorrect payments are not uncommon.  Sometimes the error is in the provider’s favor.  The health insurer may ask the provider—in this instance, the anesthesia practice—to refund an alleged overpayment.  How should the practice handle such requests?  The American Medical Association (AMA) has published an excellent Overpayment Recovery Toolkit, which we summarize in this Alert while referring readers to the 14-page Toolkit for more detailed information.

  • Cadillacs in Anesthesia Practices

    October 5, 2015

    One feature of the Affordable Care Act (ACA) that has received limited attention is the high-cost plan tax (HCPT), aka the “Cadillac plan” tax.  Beginning in 2018, employer health benefit plans with a value exceeding certain thresholds will be subject to an excise tax of 40 percent on the incremental costs of those benefits.  This tax is likely to affect anesthesia practices in two ways:  (1) in many instances, patients with employer-provided insurance may be responsible for a greater share of their health costs and (2) practices that offer relatively rich health benefits may themselves owe the excise tax.

  • Aligning Anesthesiologists’ Interests with Those of Their Ambulatory Surgical Centers

    September 28, 2015

    There are more than 5,400 Medicare-certified ambulatory surgical centers (ASCs) in the US today.  Ten more opened within the last month, not an unusual number, according to the latest issue of Becker’s ASC Review.  The Anesthesia Quality Institute’s Anesthesia in the U.S. 2015 shows that the number of cases performed in freestanding surgery centers reported to the National Anesthesia Clinical Outcomes Registry has gone from under 40,000 in 2010 to more than 80,000 in 2014.  Certainly a significant proportion of the anesthesia workforce—anesthesiologists, nurse anesthetists and anesthesiologist assistants—provides services in independent ASCs.  ASCs are even more vital to the practice of pain medicine, which is one of the big four ASC specialties, along with ophthalmology, orthopedics and gastroenterology.

  • What is a Valid Anesthesiologist’s Signature on a Medical Record, and What Does it Mean?

    September 21, 2015

    What does it mean when an anesthesiologist signs a patient’s medical record?  What happens if the anesthesiologist’s signature is missing?

  • HIPAA Privacy Breach Penalties: Don’t Let Them Happen to Your Anesthesiology Practice

    September 14, 2015

    Have you conducted an enterprise-wide analysis of the risk of a loss of unsecured electronic protected health information (ePHI)?  Do you have in place a written policy specific to the removal of hardware and electronic media containing ePHI into and out of your office or OR suite?

  • Payment Reform Abbreviations for Anesthesiologists Part II After the VM: MACRA, MIPS and APMs

    September 8, 2015

    In last week’s Alert, we looked at Medicare’s Value-Based Modifier (VM) and the Quality and Resource Use Reports (QRURs) that will explain how the VM will affect individual payments.  This week we will take a closer look at where Medicare’s move from volume to value will be heading after the VM system sunsets at the end of 2018, as laid out in the payment reform legislation (H.R. 2) that did away with the Sustainable Growth Rate (SGR) methodology in April of this year:

  • More Alphabet Soup for Anesthesiologists, CRNAs and AAs—the Medicare QRURs

    August 31, 2015

    Next year, all physicians in groups of ten or more eligible professionals (EPs) will be subject to the Medicare Value-Based Payment Modifier (VM).  Larger groups with 100 or more EPs are already seeing VM adjustments based on their 2013 performance.

  • A Role for Anesthesiologists in CMS’s New Comprehensive Care for Joint Replacement Payment Program

    August 24, 2015

    Most of the hospitals located in any of 75 Metropolitan Statistical Areas (MSAs) would be required to participate in a new program that bundles the payment for joint replacement surgeries under a proposal issued by CMS on July 9, 2015.  As necessary members of the team that performs joint replacement surgeries, anesthesiologists in those MSAs should consider approaching their hospitals early in order to be sure of a seat at the table.  And they should be prepared to share both the opportunity and the risks.

  • Anesthesia Group Victorious in Whistleblower Lawsuit Based on Reasonable Interpretation of “Emergence”

    August 17, 2015

    One of the largest anesthesia groups in the Midwest has won an important victory in US ex rel Donegan v. Anesthesia Associates of Kansas City, 2015 WL 3616640 (W.D. Mo., June 9, 2015), a False Claims Act (FCA) lawsuit initiated by a whistleblower several years ago.  On June 9, 2015, a federal district court in Missouri granted the defendant’s motion for summary judgment, effectively ending the case unless the plaintiff or “relator” files and wins an appeal.

  • CMS Issues 13 New FAQs Clarifying its Recent ICD-10 Guidance

    August 10, 2015

    On July 6, 2015, as we advised readers in our Alert of July 20th, the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) jointly announced efforts to help physicians prepare for the October 1st changeover to ICD-10 diagnosis coding.  The joint announcement indicated that or a full year from October 1, 2015, Medicare review contractors will not deny physician claims “based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.”  Confronted with many requests for a clarification of what constitutes “a valid code from the right family,” CMS issued a longer set of Frequently Asked Questions (FAQs) on July 27, and then revised those FAQs again on July 31.  The short answer is that a “valid” code is one consisting of three to seven characters but “a three-character code is to be used only if it is not further subdivided,” and the right “family” is, as we suspected, CMS-speak for what ICD-9 and ICD-10 call “categories” of codes.

  • Where Will the Insurance Company Mergers and Acquisitions Leave Anesthesiologists?

    August 3, 2015

    The value of healthcare acquisitions in the U.S. in the first seven months of 2015 is now more than $356 billion.  The final figure for all of 2014 was $326.1 billion, according to the Wall Street Journal

  • More Survey Data on Compensation for Anesthesiologists and Other Physicians

    July 27, 2015

    The amount of physician compensation is one of the key issues in every negotiation between anesthesiologists and anesthesiology groups and hospitals or health systems.  What is the fair market value for an anesthesiologist?  And how much do you have to offer to attract him or her?  There is no definitive set of data, just a handful of surveys, some free and some for sale at hefty prices.  Practices that are sufficiently large or that have a long history often realize that their own internal information may be the best available.  In the interest of covering as many bases as possible and providing the greatest amount of data on which interested readers may perform their meta-analyses, we bring to your attention the latest public physician compensation information, released last week by Modern Healthcare in its Physician Compensation: 2015 report.

  • ICD-10 Is Less of a Threat to Your Anesthesia Practice Income – For Now

    July 20, 2015

    On July 6, 2015, the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) jointly announced efforts to help physicians prepare for the October 1st changeover to ICD-10 diagnosis coding.  The AMA and CMS will be offering webinars, on-site training, articles and national conference calls to educate providers and ease the transition throughout the summer.

  • Anesthesiologists as Their Hospitals’ Partners: Understanding the Two-Midnight Rule

    July 13, 2015

    In order to engage fully with their hospital partners, anesthesiologists need to understand some of their institutions’ concerns.  While our readers may not hold the solutions, familiarity with pressures on the hospitals can only help in negotiating the relationships, day-to-day and at contract renewal time.  The Two-Midnight rule is a current hospital hassle of which anesthesiologists should have some awareness.