Anesthesia Industry eAlerts
Sent to subscribers every Monday morning, our eAlerts deliver timely updates on regulatory, legislative and practice management developments of interest to anesthesia professionals.
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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):
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.
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.
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.
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?
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?
September 8, 2015
In last week’s Alert, we looked at Medicare’s Value-Based Modifier (VM) and the Quality and Resource Use Reports (QRURs) that will explain how the VM will affect individual payments. This week we will take a closer look at where Medicare’s move from volume to value will be heading after the VM system sunsets at the end of 2018, as laid out in the payment reform legislation (H.R. 2) that did away with the Sustainable Growth Rate (SGR) methodology in April of this year:
August 31, 2015
Next year, all physicians in groups of ten or more eligible professionals (EPs) will be subject to the Medicare Value-Based Payment Modifier (VM). Larger groups with 100 or more EPs are already seeing VM adjustments based on their 2013 performance.
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.