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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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.
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.
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.
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.
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.
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.
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?
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.
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.