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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April 23, 2018
The second round of audits by the Office of Civil Rights of compliance with the Health Insurance Portability and Accountability Act (HIPAA) may be over, but HIPAA enforcement has not subsided. Anesthesia and pain groups, and their business associates, risk exposure to civil or criminal penalties if they don’t comply with the administrative, technology-related and physical processes and procedures to safeguard protected health information required under HIPAA.
April 16, 2018
We provide an overview of recently proposed legislation from the Senate Health, Education, Labor and Pensions Committee (HELP) and the Health Subcommittee of the House Energy and Commerce Committee to address the opioid crisis in the United States, including a large number of bills related to Medicare and Medicaid payment and coverage that could affect anesthesia and pain groups.
April 9, 2018
Changes to the Recovery Audit Program could be coming in 2018 that would lead to a less punitive, less burdensome and more educational and preventive approach by the government to identifying and correcting improper Medicare payments. Nonetheless, anesthesia practices are advised to be prepared for an audit. We offer recommendations to help groups plan and monitor the audit and appeal process.
April 2, 2018
Changes to the rules regarding opioid prescriptions through Medicare Part D for 2019 include a “hard edit” for opioid prescriptions at or above a cumulative daily equivalent of 90 milligrams of morphine; no more than a seven-day supply of opioid medication for opioid naïve patients; and restrictions on concurrent prescribing of opioids and opioid potentiators, such as gabapentin and pregabalin. We summarize the anesthesia community’s response.
March 26, 2018
We review some aspects of clinical documentation to which anesthesia practices should pay close attention.
March 19, 2018
Anesthesia decision aids are brochures that are specially designed to walk patients through the process of determining whether they would prefer a regional or general anesthetic technique for surgery. Designed for use only when there is no medically “best” option, these aids can help anesthesia providers engage patients in the shared decision-making that is becoming a cornerstone of patient-centered care.
March 12, 2018
Legislation introduced in Virginia would direct health plans to develop protocols for paying physicians for services performed when their credentialing applications are received. The legislation could help streamline a frequently lengthy process that impacts revenue and impedes access to care. We encourage ABC clients to contact their state societies to inquire about existing or planned advocacy initiatives to simplify and shorten the credentialing process.
March 5, 2018
Bundled Payments for Care Improvement Advanced (BPCI Advanced), a new initiative from the Center for Medicare and Medicaid Innovation, was among topics of discussion at the American Society of Anesthesiologists’ practice management conference in New Orleans. We provide an overview of this program and links to resources. As in the past with other new programs, anesthesia practices may want to take this opportunity to learn, observe and see how the model unfolds.
February 26, 2018
Managed healthcare organization Anthem has released a clinical guideline stating that monitored anesthesia care and general anesthesia are not medically necessary for the majority of patients undergoing cataract surgery. We summarize the healthcare community’s response, including efforts by the American Academy of Ophthalmologists to rescind the guideline.
February 19, 2018
In ABC’s experience, issues around proper documentation of medical necessity represent the leading cause of anesthesia claims denials. While medical necessity may be thoroughly shown in the anesthesia record, we encourage anesthesia practitioners to ensure that they share this information with their billing and coding partner. ABC clients with questions are encouraged to contact their account executives.
February 12, 2018
Effective teams, including high-performing teams spanning departments, disciplines and services, are central to the development of a “culture of safety.” Hallmarks of high-performing teams include an aligned vision, complementary skills, achievable goals and metrics, participative leadership, a culture of trust and a preoccupation with failure. We present an overview of a presentation by Jeffrey S. Vender, MD, MBA, at PRACTICE MANAGEMENT™ 2018 in New Orleans.
February 5, 2018
The benefits of surveying patient satisfaction with anesthesia care are becoming increasingly evident in a competitive environment of quality reporting in which anesthesia groups can use reports of outstanding service and communication to help demonstrate value to institutions and payers. We offer highlights of a presentation on measuring patient satisfaction by ASA Board Member James R. Mesrobian, MD, FASA, at the American Society of Anesthesiologists’ PRACTICE MANAGEMENT™ 2018 in New Orleans.
January 29, 2018
Drug shortages remain a serious problem, and anesthesia providers are particularly vulnerable, with anesthesia drugs often among those in short supply. We offer a glimpse of current trends, advocacy initiatives by the American Society of Anesthesiologists and others, research on causes and potential solutions, and programs at individual institutions.
January 22, 2018
Though the low-volume threshold for the 2018 Quality Payment Program has been raised, loosening the requirement for participation by anesthesiologists and nurse anesthetists, anesthesia groups that continue to report quality data through a Qualified Clinical Data Registry can reap some important benefits. We present the anesthesia quality measures for 2018.
January 16, 2018
To improve efficiency in the OR, reduce your hours of over-utilized OR time, increase first-case on-time starts, use an OR manager with a solid grounding in the scientific principles of OR efficiency to drive improvement with electronic notifications, and search the scientific literature to find examples of what works. We summarize these and other recommendations from a presentation by Franklin Dexter, MD, PhD, of the University of Iowa at ANESTHESIOLOGY® 2017.
January 8, 2018
A direct dialogue between the anesthesiologist and patient is best in obtaining informed consent for anesthesia, according to attorney Judith Jurin Semo, JD, who spoke at ANESTHESIOLOGY® 2017. We present a summary of selected takeaways from Ms. Semo’s presentation.
January 2, 2018
With civil monetary penalties, assessments and exclusions based on prohibited conduct and violations of healthcare laws on the rise, anesthesia and pain groups might consider enhancing efforts to improve practice compliance and documentation in 2018. We provide several examples of settlement agreements reported by the Health and Human Services Office of Inspector General.
December 26, 2017
2017 was a year marked by uncertainty and unpredictability. We highlight some of the most significant healthcare- and anesthesia-related stories of the year related to Republican efforts to repeal and replace the Affordable Care Act, the Quality Payment Program, mass casualty events and natural disasters, balance billing legislation, cybersecurity, the opioid crisis, opioid-related fraud and abuse investigations, and the 2018 Medicare Physician Fee Schedule.
December 11, 2017
First described in 2001, the transverse abdominis plane (TAP) block is a peripheral nerve block designed to anesthetize the nerves supplying the anterior abdominal wall (T6 to L1). In a 2011 meta-analysis, the TAP block was shown to reduce the need for postoperative opioid use, increase the time to first request for further analgesia and provide more effective pain relief, while decreasing opioid-related side effects such as sedation and postoperative nausea and vomiting. Studies included a combination of both general abdominal and gynecologic procedures. The introduction of ultrasound has allowed providers to identify the appropriate tissue plane and perform this block with greater accuracy under direct visualization.
December 4, 2017
The 2018 Physician Fee Schedule (PFS) (published in the Federal Register on November 15, 2017) contains significant reductions in the work values for several flat-fee ancillary services. Flat-fee services are those for which payment is determined under the Resource Based Relative Value Scale (RBRVS) and for which time is not a factor in determining the fee.
November 27, 2017
Citing eye-opening statistics from the American Society of Addiction Medicine indicating 52,404 fatal drug overdoses in 2015, healthcare leaders are calling for a multi-pronged effort in combatting the opioid epidemic in America. With their deep pharmacological expertise and clinical experience, anesthesia providers and pain specialists are eminently qualified to initiate and play a central role in such efforts at their institutions. This eAlert explores a framework for education as an essential component of these collaborations. But first, we offer an attorney’s recommendations regarding steps anesthesia providers and pain specialists can take to document compliance carefully in a time of heightened governmental scrutiny.