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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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.
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.
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.
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
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.
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.
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.
July 6, 2015
“Don’t put anything in an e-mail message or on Facebook that you wouldn’t want to see on the front page of the New York Times.” We have all heard that warning many times. In the wake of a widely-reported malpractice and defamation judgment awarded by a Virginia jury to a patient whose anesthesiologist made unpleasant statements to colleagues during the patient’s colonoscopy, one wonders whether the warning should be updated to read: “Don’t say or write anything negative about anyone, anywhere, or you may be sued.”
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.”