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The specialty of anesthesiology, and indeed all of health care, is somewhere in the middle of its long transition away from a volume-driven cottage industry. Details of the destination are not yet clear, but one change of which we can be confident is the shift away from in-hospital care toward outpatient settings. Nearly two-thirds of procedures are now performed on an ambulatory basis. With the advent of more and more minimally invasive techniques— not to mention ever-safer anesthesia—that proportion will continue to grow. Stanford Plavin, MD gives us a window into the mindset necessary for anesthesiologists to succeed in the ambulatory surgical center (ASC) environment, where “the microscope is powerful and the lights are bright” and where even the identity of our customers is changing. “What do the ASC’s customers want?” he asks in Anesthesiologists and the World of ASCs: A Different Value Proposition. Dr. Plavin recommends surveys to identify their...
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.Some 6.4 million Americans were at risk of losing their “Obamacare” health insurance coverage had the Court invalidated the ACA and eliminated the subsidies that made the insurance affordable.  The cost of insurance was predicted to rise dramatically for millions of others as the pool of participants in the individual markets shrank.Six words provided the basis for the challenge brought by four individual plaintiffs in Virginia:  “an Exchange established by the State.”  The statute provides for a premium tax credit (i.e., a subsidy) for “health plans offered in the individual market within a State which cover the taxpayer, the taxpayer’s spouse, or any dependent (as defined in section 152) of the taxpayer and which were enrolled in through an Exchange established...
Anesthesia Business Consultants (ABC), is pleased to announce its latest partnership with Virginia Commonwealth University, (VCU) Department of Anesthesiology to provide integrated practice management billing services.ABC entered into discussions with VCU to explore options to integrate VCU’s billing information into ABC’s proprietary practice management software, F1RSTAnesthesia.  Effective September 1, 2015, ABC will begin receiving charge information from VCU.  This data will be processed via F1RSTAnesthesia with its very sophisticated concurrency and reporting modules and returned to VCU’s GE-IDX system through a secure HL7 interface.  The data will then be finalized via VCU’s GE-IDX system, allowing VCU to bill claims out of their historical system, maintaining the look and feel of an internal process.ABC is very excited to be working with VCU on this exciting, new project.  We see the integration of F1RSTAnesthesia into VCU's billing process as an excellent way to allow them to provide the level of service they are...
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. We last wrote about company model-like behavior in our Alert dated November 18, 2013 (The OIG Rejects Another Attempt to Take a Franchise Fee from Anesthesiologists), and some of our readers have asked us to address the issue again. Third parties have continued to seek to enter into company model arrangements.  In February 2014, the American Society of Anesthesiologists (ASA) renewed its request that the OIG amend several of the anti-kickback statute safe...
In today’s anesthesiology environment, all groups are trying to size up their best option to survive and thrive into the future. Some try to go it alone and others sell out to practice management firms, while others seek or are forced into hospital employment. Another option that many groups are considering is merging with other anesthesiology groups. Why are anesthesiology groups considering mergers? Mergers: Allow them to maintain a higher level of autonomy than any other option, Prevent the groups from being played off against each other by hospitals or managed care companies, Build clout, Create the ability to hire needed management expertise, and Allow them to move towards economies of scale. In addition, today’s healthcare environment is influencing many hospitals to merge or join systems. When hospitals integrate they often want to work with a single anesthesiology group to cover all their facilities. When this happens, many anesthesiology groups consider...
Note: ABC encourages all anesthesiology groups to participate in ASA’s 13th survey of commercial payment rates, launched on June 9th.  The results will be published in the ASA Newsletter later this year and obviously they will be more meaningful if there are many responses.  For further information go to http://www.asahq.org/advocacy/fda-and-washington-alerts/washington-alerts/2015/06/please-participate-in-2015-survey-of-commercial-payment-rates. Many anesthesiologists serve as the paid medical director of their operating room suite or ambulatory surgical center (ASC).  Many others would like to receive compensation for medical director services.  The Health and Human Services Office of the Inspector General (OIG) has just issued a Fraud Alert entitled Physician Compensation Arrangements May Result in Significant Liability, of which they should all be aware. The Anti-Kickback Statute As the OIG has stated in numerous Advisory Opinions, The anti-kickback statute makes it a criminal offense knowingly and willfully to offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or...
What is your succession plan? Oh, you don’t have one! Why not? Maybe you don’t think you need one. Or maybe you figure you will manage a change in leadership the way you manage anesthesia in the Operating Room; when the need arises you will figure it out. If this describes your practice you are not alone. If so, it may be time to think about what this says about your practice. The Significance of a Strong Leader The reality of most private practice anesthesia groups is that the strength of the contract with the hospital or facility depends heavily on the relationship between a key member of the practice and the administration. This can be a good thing when the leader speaks for the interests of the membership but what happens when he or she steps down? It is an unknown, but this is an inevitable development for every practice....
Anesthesia Business Consultants (ABC) is pleased to announce its latest partnership with the Louisiana State University Health Science Center Shreveport Department of Anesthesiology (LSUHSC – Shreveport).  The Department of Anesthesiology at LSUHSC – Shreveport is a part of a world class university and thriving medical school that is committed to being a center of excellence in educational training in anesthesiology, critical care medicine and interventional pain management along with providing innovative programs to develop management skills and future leaders in the specialty of anesthesiology.  ABC is thrilled to support LSUHSC – Shreveport Department of Anesthesiology with their billing operations, as well as other programs, into the future.“The Louisiana State University Health Science Center, Shreveport Department of Anesthesiology is excited about the ability to work with the premier anesthesia billing and consulting company for our specialty. They possess a wealth of experience and expertise which will provide a multitude of benefits for...
Are the standard measures of health care quality—structure, process and even outcomes—all that good? A generation ago, many observers doubted that the tools of quality measurement could be applied at all in healthcare.  Now we have moved beyond the belief that “we know quality when we see it.”  We have acknowledged the limitations of structure (e.g., clinician training) and process (e.g., maintenance of normothermia in anesthetized patients) measures.  We have placed the emphasis on outcomes and have created considerable numbers of performance measures to assess clinical outcomes.  Yet, when we examine and compare performance scores across providers, the information is not always convincing.  Varying definitions of outcomes, and the underdeveloped state of risk adjustment methodologies are just some of the factors that make quality data unreliable in many cases.  Quality measurement in healthcare has come a considerable distance, but it still has a long way to go. That may be the reason for...
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. The Medicare Physician Fee Schedule provides for payment at a higher rate for services performed in doctors’ private offices (the “nonfacility” rate) than for the same services performed in a “facility” such as a hospital or ambulatory surgical center (ASC).  The difference accounts for the increased practice expense that physicians generally incur by providing care in their offices and other nonfacility locations, including private clinics.  When a physician provides...
The Comprehensive Error Rate Testing (CERT) Program is designed to measure improper payments in the Medicare Fee for Service Program (FFS), as required by the Improper Payments Information Act of 2002. The Program was initiated by Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) to achieve the agency’s mission to emphasize accountability and to pay claims appropriately. The Program produces national, contractor-specific and service-specific paid claim error rates, as well as a provider compliance error rate. The improper paid claim error rate is a measure of the extent to which the Medicare program is paying claims correctly. The provider compliance improper error rate is a measure of the extent to which providers are submitting claims correctly. The fiscal year (FY) 2014 Medicare FFS program improper payment rate is 12.7 percent, representing $45.8 billion in improper payments, compared to the FY 2013 improper payment rate of 10.1 percent...
On June 30, CMS is going to release information on payments made to physicians during 2014 by pharmaceutical, device and other manufacturers.  This will be an update to the information made public for the first time in September, 2014.  The current database is available at https://openpaymentsdata.cms.gov/. Open Payments is a national program that promotes transparency by publishing data on the financial relationships between the health care industry (applicable manufacturers and group purchasing organizations, or GPOs) and health care providers (physicians and teaching hospitals).  In 2014, CMS published 4.45 million payment records, transfers of value, or instances of ownership/investment interest that occurred over the last five months of 2013. These financial transactions totaled nearly $3.7 billion.  (CMS, Annual Report to Congress on the Open Payments Program for Fiscal Year 2014.) The program requires “applicable” manufacturers and GPOs to report payments of $10 or more, or of $100 or more per year in...
When one reviews the Current Procedural Terminology (CPT®) changes for 2015, a recurrent theme throughout is the consolidation of code combinations. The American Medical Association/ Specialty Society Relative Value Update Committee (RUC) identifies codes that are regularly reported together more than 75 percent of the time. The identified codes are then considered by the CPT Editorial Panel for bundling. The CPT Editorial Panel consists of physicians representing all specialties and other stakeholders who are all users of the CPT code set and thus have a practical perspective on the changes presented. It is the intention of the RUC, when presenting these code combinations, to provide the logic, rationale and function of these CPT changes. The following paragraphs will explore the rationale behind the bundled codes that are related to anesthesia and pain management. Ultrasound is often utilized to improve the accuracy of intra-articular placement of the needle for safety and better...
Post-acute care services are a major driver of spending, particularly for the Medicare population.  Nationwide, one in seven surgical patients is readmitted within 30 days, stated Michael Schweitzer, MD, MBA, who chairs ASA’s Future Models of Anesthesia Practice task force and who gave a very thought-provoking talk on “The Future of Anesthesia Practice” at the MGMA Anesthesia Conference in Chicago on May 1, 2015. Such readmissions are difficult for patients—and they are costly.  In 2009, the average cost of a total hip replacement readmission was $12,300, with an 8.2 percent readmission rate.  (Rizzo E. 6 Stats of the Cost of Readmission for CMS-Tracked Conditions.  Becker’s Hospital Review, December 12, 2013.)  Dr. Schweitzer cited a study published in Health Affairs in 2012 showing that surgical complications could increase the costs of care up to $58,000 per case. One out of every six Medicare fee-for-service program dollars goes to care provided in rehabilitation...
Medscape is one of the very few organizations that surveys physicians on compensation and practice patterns, breaks out the specialty of anesthesiology and publishes the results for free.  The Medscape Anesthesiologist Compensation Report also has one of the larger absolute response rates; in the most recent survey, reported in March 2015, 1179 responses were received from anesthesiologists during the period December 30, 2014 – March 11, 2015.  For those reasons alone, it behooves anesthesiology practices to be familiar with the Medscape data.  The sample is small.  It is probably not representative.  As science, the survey does not pass muster.  But since there is so little information of any better quality available, the Medscape compensation surveys are being used, usually in conjunction with other surveys such as those published (and sold) by the Medical Group Management Association (MGMA) and American Medical Group Association. The weakness of the information is slightly mitigated by...
The term “Enhanced Recovery After Surgery” and the acronym ERAS are familiar to most anesthesiologists and to other clinicians.  Anesthesia administrators and non-physician advisors may not have encountered the ERAS concept yet.  Because of burgeoning interest in better evidence-based perioperative care protocols leading to improved patient outcomes in this era of value-based payment, administrators and practice management staff should acquire a basic understanding of the ERAS concept. “Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the profound stress response following surgery.  The key elements of ERAS protocols include preoperative counselling, optimization of nutrition, standardized analgesic and anesthetic regimens and early mobilization.”  (M. Melnyk, RG Casey, P. Black, A.J. Koupparis. Enhanced recovery after surgery (ERAS) protocols: Time to change practice? Can Urol Assoc J. 2011 Oct; 5(5): 342–348).   Also referred to as “optimized patient...
Anesthesia Business Consultants (ABC) is pleased to announce its latest partnership with the University of California at Irvine (UC Irvine).  The anesthesia department at UC Irvine has long been a leader in various projects designed to promote the alignment of Anesthesiologists with their perioperative colleagues; to further the goal of supporting the entire perioperative process.  ABC is thrilled to support UC Irvine with their billing operations as well as other programs into the future.“The anesthesia department at University of California, Irvine looks forward to working with Anesthesia Business Consultants.  Their approach to comprehensive billing and technology platforms matches our organization's needs and strategic initiatives,” said Dr. Zeev Kain, Chancellor's Professor & Chair of the UC Irvine Department of Anesthesiology and Perioperative Care.  “UC Irvine is at the forefront of improving hospital-based care with projects such as the Perioperative Surgical Home (PSH) and quality initiatives and ABC’s commitment to this specialty will...
Anesthesia Business Consultants (ABC), a leading provider in billing and practice management for the anesthesia and pain management specialty, is pleased to announce the release of its new client portal and included analytics desktop and mobile access products aimed at anesthesia practices to increase access and visibility of their practice data.ABC’s new portal, F1RSTClient™, is now available and delivers secure, seamless single-sign-on (SSO) access in a fully integrated system utilizing the powerful F1RSTAnesthesia™ and the flexibility of the F1RSTAnalytics™ series of dashboards—now available on desktops as well as mobile access.F1RSTAnesthesia is ABC's proprietary software that gives clients a powerful tool to convert clinical information into claims for reimbursement.  The software supports electronic claims editing to ensure consistently high billing acceptance rates, and minimizes manual intervention in payment posting through direct remittance processing.  Clients are able to access the details of their practice and to view trends securely online.F1RSTAnalytics is ABC’s Big...
The Anesthesia Quality Institute’s Qualified Data Clinical Registry (AQI QCDR) became even more valuable with the recent addition of 16 new measures bringing the total number of measures adopted by the AQI for use in its QCDR to 27.  With the nine official Medicare Physician Quality Reporting System (PQRS) measures that can also be reported to the QCDR, the combined total of 36 measures will give most anesthesiologists, nurse anesthetists and anesthesiologist assistants ample opportunity to satisfy the PQRS requirements for 2015.  The array of available measures should also provide practices with sound choices for their own quality measurement and improvement programs. PQRS Reporting via the QCDR Eligible professionals (EPs) must successfully participate in the PQRS in 2015 in order to avoid a two-percent negative payment adjustment in 2017.  Successful participation means reporting on a total of nine measures from three different National Quality Strategy (NQS) domains for at least 50...
Anesthesia Business Consultants is pleased to announce the success of the 2nd annual Advanced Institute for Anesthesia Practice Management (AIAPM).  The AIAPM was held at the Cosmopolitan Hotel in Las Vegas on April 17-19, 2015 and attracted 340 participants, an increase of nearly 10 percent over the 2014 inaugural AIAPM.During three days of plenary and breakout sessions, attendees heard presentations by 16 speakers including chief executives of national anesthesia practice management companies, private equity firm principals, academic anesthesiologists, compliance and health information technology experts and lawyers and consultants.  Roundtable discussions, meals and refreshment breaks sponsored by some of the 35 exhibitors provided ample opportunity for participants to share information.The participants—practicing anesthesiologists and nurse anesthetists, anesthesia group managers and billing professionals—were highly enthusiastic about the program.  Comments received on the evaluation forms included the following:Excellent conference.  The topics should be mandatory education for every anesthesia provider. Appreciate the expertise of the presenters.Great...