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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  • Is it Time to Add TAP Blocks to Your Anesthesia Practice?

    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.

  • 2018: Anesthesiologists to See Cuts to Some Ancillary Procedure Payments

    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.

  • Pain Doctors, Anesthesia Providers: Team Up with Hospitals on Opioids—and Check Your Own Documentation

    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.

  • 2018 Physician Fee Schedule Includes Modest Anesthesia Increase

    November 20, 2017

    The 2018 Physician Fee Schedule (PFS) published by the Centers for Medicare and Medicaid Services (CMS) in the Federal Register on November 15, 2017 has set a national conversion factor (CF) of $35.9996 for non-anesthesia services.  This includes all evaluation and management codes as well as all surgical procedures.  This represents a 0.5 percent positive adjustment, as required by the Medicare Access and CHIP Reauthorization Act (MACRA).  Although the increase is modest, this is the first year in several years that clinicians have not had to wait until March for implementation, which means you will have accurate numbers beginning on January 1, 2018.

  • 2018 Physician Fee Schedule Slashes Reimbursements for Some GI Anesthesia Services

    November 13, 2017

    The Centers for Medicare and Medicaid Services (CMS) will publish the final rule for the 2018 Medicare Physician Fee Schedule (PFS) in the Federal Register on November 15, 2017.  The final rule includes several changes of significance to anesthesia providers and pain specialists.  This eAlert focuses on changes in the PFS regarding anesthesia services for upper and lower endoscopy procedures and screening colonoscopies.  We will explore changes in the conversion factor as well as the broader implications of other anesthesia-related changes in the 2018 PFS in next week’s eAlert.

  • Opioids a National Public Health Emergency: What Does it Mean for Anesthesia Practitioners and Pain Specialists?

    November 6, 2017

    Following on the heels of President Trump’s declaration of the opioid epidemic as a national public health emergency, the president’s commission on the opioid crisis last week issued its final report containing more than 50 recommendations for addressing what has been called the most serious drug problem in U.S. history.  The report, the heightened focus on opioid addiction and overdose deaths spurred by the president’s directive, and actions by the Centers for Medicare and Medicaid Services (CMS) and other agencies are likely to impact pain specialists and anesthesia providers in several spheres, including prescribing, treatment, prevention, documentation and compliance, diversion prevention, fraud and abuse detection, and reimbursement.

  • Three Steps to a High Reliability Anesthesia Drug Delivery System and Medication Safety Improvement: ANESTHESIOLOGY® 2017

    October 30, 2017

    Anesthesiology has a long history of improvements in patient safety, but anesthesia care providers know they can always do better.  As healthcare’s transition to value-based care continues and clinicians are held to increasingly high standards for quality and safety through MACRA’s Merit-Based Incentive Payment System (MIPS) and other programs, anesthesia practices might consider incorporating the innovative safety improvement methodologies of high reliability industries into their practices.

  • A Refresher for Anesthesia Practices on Business Associate Agreements: Are Your Contracts in Order?

    October 23, 2017

    Under the HIPAA Omnibus Rule, failure to have written business associate agreements in place can lead to sizable fines and penalties for covered entities, including anesthesia practices.  In 2015, for example, Raleigh Orthopaedic Clinic, PA, of North Carolina paid $750,000 to settle charges that it potentially violated the HIPAA Privacy Rule by sharing patient protected health information (PHI) with a potential business partner without executing a business associate agreement.  The vendor had agreed to transfer x-ray images to electronic media in exchange for harvesting the silver from the films.

  • ASA, Anesthesia QCDRs Join Forces on MIPS Quality Measures

    October 16, 2017

    When it comes to measuring the quality of anesthesia care—or the quality of care in any medical specialty, for that matter—why not compare apples to apples so that measures are reliable, straightforward, accurate and consistent?

  • What Anesthesia Providers Should Know About Emergency Preparedness, Mass Casualty and Trauma

    October 9, 2017

    The recent mass shooting in Las Vegas that killed 59 people and injured more than 500 others—the largest in United States history—painfully reminds us, again, that large-scale emergencies can happen virtually anywhere, at any time.  Of course, this means anesthesiologists and nurse anesthetists in any hospital and geographic location could be required, on extremely short notice, to deliver emergency anesthesia care for many people with life-threatening and other traumatic injuries.  That did happen to anesthesiologist Dean R. Polce, DO, of Sunrise Hospital and Medical Center in Las Vegas, who reported in an article in the Washington Post that he provided anesthesia for 27 surgeries in the wake of the shooting.  Dr. Polce and anesthesia providers in area hospitals undoubtedly endured one of the harshest tests they’ll ever face of their clinical and crisis management skills.

  • Anesthesia Practitioners: Expand Your Safety Role to Reduce OR Greenhouse Gas Emissions

    October 2, 2017

    Hospitals exist to protect health and treat illness, but healthcare has developed a culture of wasteful, environmentally unsound practices that actually causes harm, according to clinicians and scientists who have pioneered the emerging field of ecological sustainability in healthcare.  “The fundamental tenet of healthcare practice is ‘Do no harm,’ but ironically, the practice of healthcare itself causes significant pollution, and, consequently, indirect adverse effects on public health,” one of these pioneers, Yale University anesthesiologist Jodi Sherman, MD, said.

  • News for Anesthesia Groups: ACA Repeal, ADRs, Opioid Prescribing and Medicare ID Cards

    September 25, 2017

    The current Republican proposal to repeal the Affordable Care Act (ACA), known as Graham-Cassidy for its lead sponsors (Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana), could come up for a Senate vote this week. Essentially, the bill would change or eliminate such major provisions of the ACA as subsidized insurance coverage and Medicaid expansion, and give federal block grants to states to use in large part as they choose.

  • CMS Emergency Waivers Help Hospitals and Anesthesia Providers Care for Hurricane-Affected Patients

    September 18, 2017

    Anesthesia care providers, if you serve Medicare, Medicaid and Children’s Health Insurance Program (CHIP) patients in the counties and geographical areas impacted by Hurricane Irma and Hurricane Harvey, or have patients coming into your facilities who have been displaced from their homes and are in need of care, you need to know how government payers are responding to the crises and the compliance implications of these actions for your facilities and groups.

  • A Compliance Reminder for Anesthesia Groups: Check Monthly OIG Work Plan Updates

    September 11, 2017

    Anesthesia practices should be aware that the Health and Human Services Office of Inspector General (OIG) has converted to a "dynamic, web-based” format for its annual Work Plan that now publishes updates monthly rather than once or twice yearly.  The change reflects the agency’s effort to “enhance transparency around OIG's continuous work planning efforts” and more effectively “respond to emerging issues.”

  • Anesthesia Services and ‘Surprise’ Billing Laws: How Are Practices Managing?

    September 5, 2017

    Given the intricacy of the interrelationships among payers, hospitals and clinicians (including anesthesia care providers), the evolving healthcare marketplace and the growing level of outrage among patients and consumer groups, balance (surprise) billing is certain to remain rooted in the spotlight for years.

  • The ACA’s Impact on Anesthesia Practices: What We’ve Learned

    August 28, 2017

    In March 2010, Congress passed and President Obama signed the Patient Protection and Affordable Care Act (ACA).  It would take a number of years for the various provisions of what we now refer to as Obamacare to be implemented.  By 2014, these would include significant protections for patients trying to obtain and maintain health insurance, such as the elimination of pre-existing medical condition limitations, guarantees of key insurance provisions, such as obstetric care, and new ways to obtain health insurance.

  • Anesthesia Groups, Take Note: Data Breach Website Helps Providers Research and Report

    August 21, 2017

    It’s every anesthesia practice’s nightmare, but it happened last year to a large anesthesiology and pain management group in Arizona.  A health data breach from unauthorized access by a third party affected nearly 883,000 patients.  The information included patient names, providers’ names, dates of service, places of treatment, names of health insurers, insurance identification numbers, diagnosis and treatment codes, and, in some cases, Social Security numbers, bank account information, tax information, and more.

  • Anesthesiologist Assistants as Physician Extenders: An Option Whose Time Has Come?

    August 14, 2017

    The use of physician extenders has become commonplace in medicine and anesthesia is no exception.  More than 75 percent of all anesthetics are administered by CRNAs.  Do AAs offer a viable alternative?  Our perception is that most anesthesiologists still know relatively little about this profession, which is understandable given the current state of AA involvement across the country.  Only anesthesiologists in Ohio and Georgia have much experience working with AAs.

  • The Future of Payment for Ultrasonic Guidance: Predictions for Anesthesia Providers

    August 7, 2017

    The use of ultrasonic guidance (USG) in the placement of nerve blocks and catheters for postoperative pain management has become a standard of care for most anesthesia practices.  It is also widely used for confirmation of vascular access, especially for the placement of central venous pressure lines (CVPs).

  • EMRs in Anesthesia: Smart Tips for a Smoother Transition

    July 31, 2017

    Peruse the most recent graph showing electronic health record (EHR) adoption rates among hospitals, and you’ll see a curve sloping steadily and optimistically upward.  In 2015, nearly all reported hospitals (96 percent) possessed certified EHR technology, and 84 percent had adopted EHRs with advanced functionality.  In addition, more than 80 percent of non-federal acute care hospitals had adopted all of the functionalities of a basic EHR—a nine-fold increase since 2008, before passage of the HITECH act of 2009, according to the Office of the National Coordinator for Health Information Technology.

  • On Diversion, Depression and Emergency Department Visits: An Update on Opioids for Pain Specialists and Anesthesia Providers

    July 24, 2017

    Opioid prescribing in the United States quadrupled between 1999 and 2015, the Centers for Disease Control and Prevention (CDC) reports. In that time, more than 183,000 people died from overdoses related to prescription opioids.  These numbers alone point to the need for pain specialists, anesthesiologists and nurse anesthetists to stay abreast of news and research about opioids that can be used to inform and improve their practices.  The eclectic array of items presented here provides a minute sampling of the current information.  Hopefully, it will be useful and spark further thinking and discussion.