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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June 29, 2015
The United States Supreme Court has again upheld the Affordable Care Act (ACA). The Court announced its decision in a 6-3 ruling in King v. Burwell on Thursday, June 25, 2015.
June 22, 2015
Last week’s Alert brought a new Fraud Alert from the Office of the Inspector General (OIG) to readers’ attention. The OIG is on the lookout for arrangements in which physicians receive compensation for medical director services that are intended to induce referrals of patients. We wish the OIG were equally interested in the anti-kickback statute ramifications of the “company model,” in which anesthesiologists are asked to share their clinical revenues and thus compensate other physicians and/or facilities for referrals.
June 15, 2015
The OIG issued a Fraud Alert on compensation for medical directorships on June 9, 2015. To avoid potential liability under the federal anti-kickback statute, anesthesiologists and pain physicians who refer patients to their hospitals, e.g., for pre-operative testing, and who receive medical director compensation should be aware of the OIG’s interest in the subject as well as of the basic principles that apply.
June 8, 2015
Are the standard measures of health care quality—structure, process and even outcomes—all that good?
June 1, 2015
The Office of the Inspector General (OIG) reported in May 2015 that Medicare made up to $33.4 million in overpayments for claims on which the place of service (POS) was coded incorrectly during the period from January 2010 through September 2012. (Incorrect Place-of-Service Claims Resulted in Potential Medicare Overpayment Costing Millions.) Reports finding that Medicare has overpaid usually lead to heightened scrutiny of the conduct at issue. Thus it is important that pain physicians, anesthesiologists and their billing staff understand POS coding.
May 26, 2015
On June 30, CMS is going to release information on payments made to physicians during 2014 by pharmaceutical, device and other manufacturers. This will be an update to the information made public for the first time in September, 2014. The current database is available at https://openpaymentsdata.cms.gov/.
May 18, 2015
Post-acute care services are a major driver of spending, particularly for the Medicare population. Nationwide, one in seven surgical patients is readmitted within 30 days, stated Michael Schweitzer, MD, MBA, who chairs ASA’s Future Models of Anesthesia Practice task force and who gave a very thought-provoking talk on “The Future of Anesthesia Practice” at the MGMA Anesthesia Conference in Chicago on May 1, 2015.
May 11, 2015
Medscape is one of the very few organizations that surveys physicians on compensation and practice patterns, breaks out the specialty of anesthesiology and publishes the results for free. The Medscape Anesthesiologist Compensation Report also has one of the larger absolute response rates; in the most recent survey, reported in March 2015, 1179 responses were received from anesthesiologists during the period December 30, 2014 – March 11, 2015. For those reasons alone, it behooves anesthesiology practices to be familiar with the Medscape data. The sample is small. It is probably not representative. As science, the survey does not pass muster. But since there is so little information of any better quality available, the Medscape compensation surveys are being used, usually in conjunction with other surveys such as those published (and sold) by the Medical Group Management Association (MGMA) and American Medical Group Association.
May 4, 2015
The term “Enhanced Recovery After Surgery” and the acronym ERAS are familiar to most anesthesiologists and to other clinicians. Anesthesia administrators and non-physician advisors may not have encountered the ERAS concept yet. Because of burgeoning interest in better evidence-based perioperative care protocols leading to improved patient outcomes in this era of value-based payment, administrators and practice management staff should acquire a basic understanding of the ERAS concept.
April 27, 2015
The Anesthesia Quality Institute’s Qualified Data Clinical Registry (AQI QCDR) became even more valuable with the recent addition of 16 new measures bringing the total number of measures adopted by the AQI for use in its QCDR to 27. With the nine official Medicare Physician Quality Reporting System (PQRS) measures that can also be reported to the QCDR, the combined total of 36 measures will give most anesthesiologists, nurse anesthetists and anesthesiologist assistants ample opportunity to satisfy the PQRS requirements for 2015. The array of available measures should also provide practices with sound choices for their own quality measurement and improvement programs.
April 20, 2015
Leadership has never been more important in anesthesiology than it is today. As the specialty demands and takes ownership of increasing levels of responsibility in healthcare reform, the quality of leadership becomes one the fundamental factors that determine success. Developing the Perioperative Surgical Home (PSH), the most exciting organizational concept to emerge within anesthesiology this century, requires outstanding leaders. So does maintaining the highest quality of patient care in each anesthesiology department or practice.
April 13, 2015
Let us begin with the basic answer to the question in the title of this Alert: anesthesiologists continue to benefit from a specialty-based exemption from the Electronic Health Record (EHR) Incentive Program’s “meaningful use” (MU) requirements, so only those who are have chosen to earn the incentive will be affected directly by the new Stage 3 rules. Pain physicians may be affected, unless their practice meets the EHR program definition of “hospital-based” or they have been granted a hardship exception (see Alert dated February 16, 2015).
April 6, 2015
Cyber attacks on health databases are occurring so frequently that they are only newsworthy when they affect millions of records, as happened with the recently-reported massive Anthem (about 80 million individuals) and Premera Blue Cross (more than 11 million) data breaches. Last year, in fact, was characterized as the “year of the data breach” by some, according to Becker’s Hospital Review, which reports that: “Across industries, the healthcare sector experienced the highest percentage of breaches in 2014, according to Identity Theft Resource. Of the 761 data breaches reported last year, 322 of them came from the healthcare industry.”
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?”