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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eAlerts

  • 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 http://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system.

  • 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.

  • 2016 CPT® Coding and Key Reimbursement Changes For Pain Management and Anesthesia

    January 4, 2016

    We begin this new year with a list of the key changes to CPT coding and Medicare payment policies.

  • 2016 Predictions for Anesthesiologists to Ponder

    December 28, 2015

    As we barrel toward the end of 2015, let us stop briefly to consider some predictions for the year ahead in healthcare.  Below is a set of ten predictions that appeared in Fortune magazine earlier this month, along with several comments.

  • Update for Anesthesiologists on the Value Based Payment Modifier

    December 7, 2015

    CMS released the Final Medicare Fee Schedule Rule for 2016  on October 30, 2015.  The November 9th issue of F1RSTNews discussed the conversion factors for anesthesia ($22.4426) and for other services ($35.8279) and some of the changes to the measures and registry options for the Physician Quality Reporting System (PQRS).  The final rule addresses a number of other matters of interest to anesthesiologists and pain physicians.  In this issue, we will summarize developments concerning the Value Based Payment Modifier (VM).

  • Social Media 101 for Anesthesiologists and Pain Physicians

    November 30, 2015

    Are you using social media for professional purposes?  If so, you are in the vanguard of specialist physicians generally, and of anesthesiologists in particular.  Many doctors are still skeptical of the benefits, and leery of the potential to waste a lot of time.

  • Anesthesiologists Should Prepare for the Medicare Comprehensive Care for Joint Replacement (CJR) Payment Model

    November 23, 2015

    CMS has now finalized its proposal to cover total joint replacement (TJR) procedures through a bundled payment methodology.  Under the Final Rule issued on November 16, 2015, some 800 hospitals across the country will be financially responsible for all of the inpatient and postoperative care of patients undergoing total knee or hip replacements from admission until 90 days after discharge.  CMS estimates that the new bundled-payment test will cover about 23 percent of TJR surgeries for which Medicare pays and save Medicare $343 million over the five performance years of the model.

  • How Well Does Measuring Anesthesiologists’ and other Physicians’ Quality Work?

    November 16, 2015

    Studying the 1,400 pages of the Final Fee Schedule Rule for 2016, which CMS released on October 30, has made us stop to think about the status and benefits of quality measurement in healthcare.  In particular, the ever-growing complexity of the Physician Quality Reporting Program (PQRS) and the newer Value Based Payment Modifier seems more likely to generate frustration than to lead to major improvements in healthcare safety and outcomes.

  • Anesthesia Conversion Factors by Medicare Locality

    November 9, 2015

    The national average conversion factor for anesthesia services for 2016 is $22.4426. ABC has just obtained the list of the individual conversion factors for the 90 Medicare geographic localities. The highest conversion factor is $31.10 (Alaska) and the lowest is $18.86 (Puerto Rico). In the continental U.S., the New York City suburbs and San Francisco will see the highest conversion factors. The full list appears below, in state alphabetical order.

  • The Anesthesia Conversion Factor and PQRS Changes in the Final Medicare Fee Schedule Rule for 2016

    November 9, 2015

    The national average Medicare anesthesia conversion factor (CF) effective January 1, 2016 will be $22.4426, down from $22.6093 in 2015, which is a decrease of $0.1667 per anesthesia unit.  Geographically-adjusted CFs for the 90-odd Medicare localities are not yet available.

  • Implications of North Carolina State Board of Dental Examiners v. FTC for Anesthesia and Anesthesiologists

    November 2, 2015

    Early this year, the U.S. Supreme Court ruled that the North Carolina State Board of Dental Examiners (Dental Board) violated the federal antitrust laws by preventing non-dentists from providing teeth whitening services in competition with the state’s licensed dentists in North Carolina State Board of Dental Examiners v. FTC, 135 S. Ct. 1101 (2015). The Dental Board had contended that its activity was immune from antitrust scrutiny under the “state action” doctrine because it was an exercise of the state’s sovereign power. The Court rejected that contention and upheld the Federal Trade Commission’s determination that the Dental Board’s enforcement actions against teeth whitening competitors had illegally restrained trade and did not amount to protected “state action.” To be protected, a state licensing agency such as a board of dentistry or of medicine that is made up of active members of the professions they regulate, such as practicing physicians, must be “actively supervised” by the state.

  • CMS Releases Final Electronic Health Record Incentive Program Stage 3 Rules – Anesthesiologists Retain Exemption

    October 26, 2015

    CMS released the long-awaited final rule on the Electronic Health Record Incentive Program-Stage 3 and Modifications to Meaningful Use in 2015 through 2017 (Final Rule) on October 6, 2015. In this rule, CMS made significant changes to current “Meaningful Use” (MU) requirements with the intent to ease the reporting burden for physicians and other providers and to support interoperability. The Electronic Health Record (EHR) Incentive Program was established by the American Recovery and Reinvestment Act of 2009. Separate Medicare and Medicaid programs provide for incentive payments to eligible professionals (EPs) who are meaningful users of certified EHR technology. The last year in which EPs could earn a Medicare incentive payment was 2014; the Medicaid program provides for incentives through 2016. Starting on January 1, 2015, EPs who do not demonstrate MU under either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program are subject to a payment “adjustment” or penalty—unless they benefit from an exception. The penalty for not demonstrating MU in 2015 is one percent of the EP’s fee schedule payments. It will grow to two percent in 2016 and to three percent in 2017 and 2018.

  • Telemedicine Is in Anesthesiologists’ Future

    October 19, 2015

    Telemedicine, in one form or another, is going to be part of most physician practices within the next decade.  For many doctors, it will arrive sooner, if it is not already here.  Five years ago, Dr. Girish Joshi wrote in the ASA Newsletter (Global Patient Perioperative Care through Clinical Pathways, ASA Newsletter. 2010; 74(8):10-12):

  • When Payers Ask Anesthesiologists to Refund Overpayments

    October 12, 2015

    The third-party medical payment system is so complicated that incorrect payments are not uncommon.  Sometimes the error is in the provider’s favor.  The health insurer may ask the provider—in this instance, the anesthesia practice—to refund an alleged overpayment.  How should the practice handle such requests?  The American Medical Association (AMA) has published an excellent Overpayment Recovery Toolkit, which we summarize in this Alert while referring readers to the 14-page Toolkit for more detailed information.

  • Cadillacs in Anesthesia Practices

    October 5, 2015

    One feature of the Affordable Care Act (ACA) that has received limited attention is the high-cost plan tax (HCPT), aka the “Cadillac plan” tax.  Beginning in 2018, employer health benefit plans with a value exceeding certain thresholds will be subject to an excise tax of 40 percent on the incremental costs of those benefits.  This tax is likely to affect anesthesia practices in two ways:  (1) in many instances, patients with employer-provided insurance may be responsible for a greater share of their health costs and (2) practices that offer relatively rich health benefits may themselves owe the excise tax.

  • Aligning Anesthesiologists’ Interests with Those of Their Ambulatory Surgical Centers

    September 28, 2015

    There are more than 5,400 Medicare-certified ambulatory surgical centers (ASCs) in the US today.  Ten more opened within the last month, not an unusual number, according to the latest issue of Becker’s ASC Review.  The Anesthesia Quality Institute’s Anesthesia in the U.S. 2015 shows that the number of cases performed in freestanding surgery centers reported to the National Anesthesia Clinical Outcomes Registry has gone from under 40,000 in 2010 to more than 80,000 in 2014.  Certainly a significant proportion of the anesthesia workforce—anesthesiologists, nurse anesthetists and anesthesiologist assistants—provides services in independent ASCs.  ASCs are even more vital to the practice of pain medicine, which is one of the big four ASC specialties, along with ophthalmology, orthopedics and gastroenterology.

  • What is a Valid Anesthesiologist’s Signature on a Medical Record, and What Does it Mean?

    September 21, 2015

    What does it mean when an anesthesiologist signs a patient’s medical record?  What happens if the anesthesiologist’s signature is missing?

  • HIPAA Privacy Breach Penalties: Don’t Let Them Happen to Your Anesthesiology Practice

    September 14, 2015

    Have you conducted an enterprise-wide analysis of the risk of a loss of unsecured electronic protected health information (ePHI)?  Do you have in place a written policy specific to the removal of hardware and electronic media containing ePHI into and out of your office or OR suite?