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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  • Growing Limits on “Surprise Bills” from Anesthesiologists and Others

    May 31, 2016

    For patients who undergo a surgical procedure, the anesthesiologist’s bill sometimes comes as a surprise.  If the hospital and the surgeon are participating in the patient’s health plan but the anesthesiologist is not in the network and bills the difference between his or her full charge and what the health plan paid, the amount that the patient owes can be a nasty shock.  Large balance bills are often stressful for patients and are a major source of medical debt.

  • Anesthesia Practices Should Think About Price Transparency

    May 23, 2016

    “Transparency” is a word that you will encounter more and more frequently in health policy articles, including ABC’s publications.  Information transparency is a key for enabling healthcare purchasers to make value-based decisions concerning the quality and price of services.  Those data are slowly becoming more available, but they remain largely inaccessible to most potential users.

  • Checklists – As Important As Ever in Anesthesia Patient Safety

    May 16, 2016

    “Patient Safety Issues Spur NIH Shake-Up” was an above-the-fold headline in the Washington Post on May 11, 2016.  NIH Director Francis Collins, MD is replacing top leadership at the 200-bed Clinical Center with a new management team with experience in oversight, compliance and patient safety in the wake of an independent review that found that safety had become “subservient to research demands.”

  • How the MACRA Regulations as Proposed Will Affect Anesthesiologists, Part II (Alternative Payment Models)

    May 9, 2016

    Last week’s e-Alert introduced our readers to the proposed regulations implementing the MACRA Quality Payment Program (Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models).  We focused in Part I on the MIPS pathway, which consolidates Medicare’s current quality, cost and EHR reporting programs and promised an overview of the second major physician payment pathway set forth in the proposed rule, the APM Incentive program.

  • How the MACRA Regulations as Proposed Will Affect Anesthesiologists, Part I

    May 2, 2016

    CMS released the proposed regulations implementing MACRA on April 27, 2016.  New quality-based payment systems will replace and streamline the PQRS, the value modifier and the meaningful use programs.  Physicians will have the opportunity to earn up to a four percent bonus in 2019 based on their participation in the Merit-Based Incentive Payment System (MIPS) or a five percent bonus for participating in a qualifying Alternative Payment Model.

  • A Proposed Update to CMS’s Two-Midnight Rule

    April 25, 2016

    On July 13, 2015, we informed you of CMS’s Two-Midnight Rule.  After much pushback from industry stakeholders and from the judicial system since our alert, CMS proposes to eliminate the notorious payment reduction under the Two-Midnight Rule in its FY 2017 Medicare Inpatient Prospective Payment System (IPPS) Proposed Rule (Proposed Rule).  Though not slated to be finalized until the latter part of 2016, hospitals and their partners can be optimistic that the penalty under the Two-Midnight Rule may soon be a memory. 

  • Colonoscopies Allegedly Safer Without Anesthesia Services—Really?

    April 18, 2016

    A new study appearing in Gastroenterology contends that the overall risk of complications after colonoscopy increases when individuals receive anesthesia services. This study should not lead to any restrictive payment changes. Its analysis is flawed and the actual difference between the West, to which is attributed the highest risk, and the Northeast (lowest) is a clinically-insignificant 1.5 percent, as shown here.

  • Anesthesiologists, Do You Know Where Your Ultrasound Images Are?

    April 11, 2016

    Many pain medicine procedures, and, increasingly, perioperative and critical care procedures such as central venous access are performed using ultrasound guidance (U/S).  Indeed, U/S is an integral part of many CPT® codes, e.g., 20604 [Arthrocentesis, aspiration and/or injection, small joint or bursa, (e.g., fingers, toes), with ultrasound guidance, with permanent recording and reporting].  When and where, and by whom, must those permanent images be stored?  What if another entity, such as a hospital, is responsible for storing them?  According to Sonosite,

  • Anesthesia Practices May Be Subject to the Phase 2 HIPAA Audits

    April 4, 2016

    If you receive a letter by email that begins like this:

  • Dos and Don’ts of Amending the Anesthesia Record

    March 28, 2016

    The anesthesia record, like medical records in general, should be complete and accurate at the time when the physician signs it—ideally.  In practice, it occasionally requires amendment. Given the huge role that accurate documentation plays in our medical payment system, compliance with the rules and regulations governing medical record amendments is important.  Altered medical records have great potential for fraud, especially if the added information helps to raise the level of a billable service, and no one should be surprised if auditors look at any changes closely.

  • Concurrent Cases Can Be a Problem Not Just for Anesthesiologists

    March 21, 2016

    Recent media coverage of surgeons operating in two concurrent cases raises three issues:  (1) patient safety, (2) compliance with the Medicare teaching physician billing rules and (3) transparency vis-à-vis patients.

  • The Burden of Measuring Quality in Anesthesiology and Other Physician Practices

    March 14, 2016

    Donald Berwick, MD, senior fellow at the Institute for Healthcare Improvement (IHI) (and a former CMS administrator) described nine steps to advance healthcare into “the moral era” at an IHI forum in December, 2015.  One of those steps was to “stop excessive measurement.”  Dr. Berwick said:

  • New Guidelines for Managing Postoperative Pain: Anesthesiologists Take Note

    March 7, 2016

    The American Pain Society last month released a set of Clinical Practice Guidelines on the Management of Postoperative Pain. The key recommendation in the Guidelines is for greater use of multimodal pain management strategies.

  • Protect Your Anesthesia Practice Against Ransomware Attacks

    February 29, 2016

    “Ransomware” attacks are malicious intrusions into information systems that encrypt the victim’s sensitive data and demand payment in exchange for a key to unlock the data.  They have become increasingly common in the last few years.  Since January 2013, there have been at least 100,000 cases of recorded ransomware attacks. 

  • Anesthesia Practices Must Refund Overpayments within 60 Days—Final Rule

    February 22, 2016

    The Affordable Care Act requires Medicare physicians and others to report and return overpayments within 60 days after the date when an overpayment is identified.  Four years after publishing its proposed rule, CMS issued a Final Rule on February 6, 2016 with the intent of providing “needed clarity and consistency for providers and suppliers on the actions they need to take to comply with requirements for reporting and returning of self-identified overpayments.”

  • The State of Anesthesiologists’ Exposure to Malpractice Lawsuits

    February 15, 2016

    Being sued by a patient who had a poor outcome is one of the more unpleasant experiences most doctors can contemplate.  The impact of a malpractice lawsuit can be potentially devastating to one’s financial, professional and personal well-being.  But it is not often that bad.  In a survey conducted by Medscape among 4,000 physicians (Peckham C. Medscape Malpractice Report 2015:  Top Reasons Doctors Get Sued—Anesthesiologists.  January 22, 2016), the responding anesthesiologists reported that trial resulted in a verdict for the plaintiff in only two percent of cases.  Another 33 percent were dismissed either by the court or by the plaintiff.  Twenty-four percent were dismissed from the suit either before any depositions were taken or within the first few months.  Forty-one percent settled before reaching the verdict stage, and 10 percent resulted in a verdict in the anesthesiologist’s favor.

  • MACRA Fundamentals for Anesthesiologists

    February 8, 2016

    One of the biggest takeaways from the ASA Practice Management Conference held in San Diego on January 29-31 was the need for anesthesiologists to start thinking about what the Medicare and CHIP Reauthorization Act of 2015 (MACRA) will mean for their practices.

  • Meaningful Use Update for Anesthesiologists and Pain Physicians; Hardship Exception Application

    February 1, 2016

    The Medicare requirement that eligible professionals and hospitals demonstrate “meaningful use” (MU) of electronic health record (EHR) technology has received a lot of attention from provider organizations and in the media recently.  Two significant MU developments have occurred in the last few weeks:  (1) the Centers for Medicare and Medicaid services (CMS) launched a streamlined process for claiming a hardship exemption and (2) CMS Acting Administrator Andy Slavitt stated publicly that the MU program “will now be effectively over and replaced with something better.”

  • Hospitalists and Anesthesiologists and Perioperative Medicine

    January 25, 2016

    There are more nearly 50,000 hospitalists practicing in the U.S. today and the specialty continues to grow rapidly.  A recent American Society of Anesthesiologists (ASA) Health Policy Research paper entitled “Prevalence of Hospitalists in U.S. Community Hospitals” found that between 2012 and 2013, 34 out of 50 states showed an increase in the percentage of hospitals using hospitalists and that the percentage of community hospitals using hospitalists increased by almost five percent during that period.

  • Toward Greater Accuracy in the Use of the Anesthesia Physical Status Modifiers

    January 19, 2016

    Did you know that the American Society of Anesthesiologists (ASA) has published a set of examples to guide the accurate use of the Physical Status (PS; P1-P6) modifiers?  The ASA House of Delegates approved the examples in October 2014.  They appear at

  • Will Colonoscopies Continue to Be Bread-and-Butter Procedures for Many Anesthesia Practices?

    January 11, 2016

    More than 14 million screening colonoscopies are performed each year.  Anesthesiologists and nurse anesthetists participate in a large proportion of these procedures.  There are several developments that may bring down the numbers or at least slow the rate of growth of screening colonoscopies that our readers, especially those whose practices include a significant volume of anesthesia for colonoscopy services, should note.