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Anesthesia Business Consultants (ABC), a leading provider in billing and practice management for the anesthesia and pain management specialty, is pleased to announce its latest partnership with Stat-App. Developed and piloted by Anaesthesia Associates of Massachusetts, the largest private anesthesia practice in New England, Stat-App focuses on improving the efficiencies of anesthesia practices to better serve the facilities they work in.The Stat-App infrastructure is designed to allow clinical providers to securely communicate with their colleagues, and to better understand who is available presently within their own facility utilizing GPS technologies. Leveraging devices that are already utilized today, the Stat-App brings a new capability to an anesthesia practice to better manage schedules, utilization and costs."The profitability, and even survival, of an independent multi-facility practice group depends upon correctly aligning valuable clinicians with an appropriate workload. Stat-App exists to optimize multi-facility practices, open lines of communication and to equalize provider workload," said Christopher...
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. For 2015, Modern Healthcare reports an average salary for anesthesiologists of $384,290, which comes from...
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.This announcement makes it seem less likely than ever that there will be a delay in CMS’s implementation of ICD-10 coding.  CMS’s new set of Frequently Asked Questions (FAQs) entitled “CMS and AMA Announce Efforts to Help Providers Get Ready for ICD-10” stated clearly and in boldface type “a valid ICD-10 code will be required on all claims starting on October 1.”  (CMS, of course, does not have the discretion to put off the deadline, for which Congressional action would be required.)  The AMA’s participation in the final set of educational programs and...
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.Background Whether a patient is admitted as an inpatient or treated as an outpatient has a considerable impact on hospital payment and on patient cost sharing.  Medicare covers inpatient admissions under Part A and pays $3,100 more on average for an inpatient stay than for an outpatient observation stay, which is paid under Part B, according to claims data reviewed by the Medicare Payment Advisory Commission (MedPAC).By 2012 the Medicare Recovery Audit Contractors (RACs) had become so aggressive in pursuing medically unnecessary hospital admissions that hospitals started keeping patients for extended outpatient...
Anesthesia Business Consultants (ABC) is pleased to announce Anesthesia Valet™, an exciting, new platform to support the quality reporting programs designed to enable the anesthesia specialty and as mandated by the Centers for Medicare and  Medicaid Services (CMS).Anesthesia Valet is an easy, streamlined solution developed exclusively for the anesthesia specialty to document, analyze and submit quality data to the Anesthesia Quality Institute’s (AQI) Qualified Clinical Data Registry (QCDR) database.  ABC has been a preferred vendor of the AQI since 2010; the AQI was founded by the American Society of Anesthesiologists (ASA) in 2008.  The AQI established the National Anesthesia Clinical Outcomes Registry (NACOR) for the collection and reporting of anesthesia quality metrics.Starting in 2015, Eligible Professionals need to report quality data to a designated QCDR or potentially face reimbursement penalties from CMS.  “NACOR not only meets CMS’ reporting requirements as a designated QCDR, but provides the anesthesia speciality a valuable resource...
“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.”This case was noteworthy not merely for the contempt with which the doctor talked about her patient, but also for the fact that the conversation in the procedure room was recorded by the patient’s smartphone, which neither he nor the medical team realized had been left on.  The patient claimed he had inadvertently left his phone in the room, set to record, having neglected to turn...
“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.”This case was noteworthy not merely for the contempt with which the doctor talked about her patient, but also for the fact that the conversation in the procedure room was recorded by the patient’s smartphone, which neither he nor the medical team realized had been left on.  The patient claimed he had inadvertently left his phone in the room, set to record, having neglected to turn...

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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...