December 31, 2018

As 2018 draws to a close, we take this opportunity to review and distill some of the key takeaways from selected ABC eAlerts and Communiqué articles for the year. We hope the highlights below (with links for easy reference) offer a useful year-end refresher that helps you consolidate your thinking and learning about the practice management issues facing the specialty. 

Anesthesiologist supply and demand:  Two 2018 studies suggest a future shortage of anesthesiologists. The findings translate into job opportunities for some and challenges for practices facing a shrinking pool of clinicians. Use the data cautiously and examine the assumptions before jumping to conclusions for yourself and your practice.

MIPS participation in 2019:  Anesthesia providers are unlikely to earn significant bonuses in performance year 2019 (payment year 2021) of MIPS. However, we recommend continuing to report because: 1) insurance carriers continue to require it; 2) hospitals and facilities continue to request it; and 3) practice trend data is a valuable asset for organizational reviews.

Ambulatory surgery:  The 2019 OPPS/ASC final rule added 12 cardiac catheterization procedures and five additional cardiology procedures to the ASC list of covered procedures. Many anesthesia groups will see a change in the mix of procedures at their ASCs starting in 2019 and should begin planning accordingly.

The future of private anesthesia practice:  To the extent that larger entities can provide a better product cheaper, consolidation will continue. But smaller private practices that provide service tailored to the customer’s needs will always have the edge over large, formula-driven national entities.

Impact of the new GI codes:  An analysis of data for a representative sample of clients across the country reveals that the impact of these changes has not been as extensive as predicted. However, if your practice is considering providing services for endoscopy centers, we recommend weighing the potential case rate in deciding whether to sign an agreement. Volume may be sufficient, but payment will be lower due to the 2018 changes. Also, we are seeing isolated payer policy changes intended to limit utilization of anesthesia services for endoscopy. We predict similar changes from other payers and advise anesthesia practices to closely monitor productivity and reimbursements.

Emerging technologies:  Will artificial intelligence and blockchain technology start to realize their promise in 2019? Will those capabilities begin benefiting anesthesia providers and their patients?  See here and here for more information. 

Concurrency defined:  Concurrency is the number of cases an anesthesia provider is involved in at a given moment.  It applies to all anesthesia cases performed by any type of provider and to all insurance companies. We recommend a single time piece to document anesthesia start and stop times, and consistent use of a 24-hour clock.

Preparing your group for the future:  Developing the nimbleness and responsiveness needed to succeed in today’s market means letting go of the need to personally control almost all aspects of the group’s financial affairs—an outmoded approach that can sabotage your group’s ability to function as a true business.

Payment for the perioperative surgical home:  Co-management agreements between physicians and hospitals show promise as an option. Physicians receive fixed compensation for clinical care management, strategic and budget planning and other duties, and earn variable incentive payments based on how well they meet targets aligned with the hospital’s goals. 

Accurate documentation:  Pay close attention to the following anesthesia documentation troublespots:  1) time; 2) medical direction and concurrency; 3) surgical procedure documentation; 4) specific requirements for postoperative pain blocks and catheters; 5) imaging guidance documentation; 6) cosmetic/insurance split cases; and 7) the endoscopy codes introduced in 2018.

Patient decision aids:  Brochures designed specifically to take patients through the process of deciding whether they would prefer a regional or general anesthetic technique for surgery—when there is no medically “best” option--can help anesthesia providers engage patients in shared decision-making.

Informed consent:  Informed consent is a process, not a form. Anesthesiologists should obtain informed consent in face-to-face communication with patients. This two-way dialogue offers the best way to ensure that patients fully understand the risks, and helps to protect practitioners. 

High-performing teams:  An aligned vision, achievable goals and participative leadership are among the hallmarks of high-performing teams that can help anesthesia departments create a culture of safety. Success is never guaranteed, but high-performing teams rebound more quickly.

Managing waivers of copays and deductibles:  In an era of increased scrutiny, the safest course is to avoid granting copay waivers as a matter of policy, except in cases of well-defined and documented hardship. Still, there are steps anesthesia practices can take to mitigate risk.

Medical necessity:  Issues around documentation of medical necessity are probably the leading cause of anesthesia claim denials. Services may be medically necessary and well documented in the anesthesia record, but does the documentation you send your billing and coding partner reflect it?

OR efficiency:  To improve efficiency in the OR, reduce the hours of over-utilized OR time, increase first-case on-time starts, use an OR manager to drive efficiency with electronic notifications and search the scientific literature to find examples of what works.

Price transparency:  Patients are going to have increasing access to information about the costs of procedures, and this information could influence activity levels and patterns at facilities.

May the ideas and information shared in our 2018 publications continue to enhance and support your anesthesia and pain management practices in the coming year.

We want to hear from you.  Do you have a topic you would like to see covered in an ABC eAlert?  Please send your suggestions to info@anesthesiallc.com.

With best wishes,

Tony Mira
President and CEO