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What Is the Value of Data and What Data Has Value? Today’s Anesthesia Management Challenge

What is it that makes today's anesthesia providers so good at managing patients safely through the trauma and discomfort of surgery? While many will cite the value of experience, the most critical factor is the availability of timely and relevant data that facilitates critical management decision making at appropriate junctures in the case.The curi...
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Legal Cases Underscore Compliance Lessons for Anesthesia and Pain Groups: Part 3

SummaryWe review takeaways from the Advanced Institute for Anesthesia Practice Management on recent legal cases of interest to anesthesia and pain practices pertaining to incorrect billing for anesthesia time and violations of the Anti-Kickback Statute. We continue this week with our third eAlert highlighting legal cases related to significant risk...
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What Does “Patient Satisfaction” Mean to and for Anesthesiologists?

​"Patient satisfaction" and the patient experience are considered key measures of quality and performance in our increasingly value-based healthcare system. The American Society of Anesthesiologists' Committee on Performance and Outcomes Measurement (ASACPOM) has acknowledged that "monitoring of patient satisfaction has already been incorporated in...
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A Refresher on Documentation of Anesthesia Postoperative Evaluations

SummaryTo clarify one of the more confusing issues in anesthesia, we offer an overview of the documentation requirements for and distinctions between three types of anesthesia postoperative visits: 1) Conditions of Participation; 2) anesthesia postoperative evaluation; and 3) postoperative pain follow-up evaluation..One of the issues in anesthesia ...
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Anesthesiologists and the Changing Healthcare Landscape

As we noted in our eAlert on the topic, the medical community's transition to the International Classification of Diseases and Related Health Problems 10th revision (ICD-10) has, contrary to expectations, gone fairly well so far. In fact, it has gone much better than anticipated, with rates of claims denials remaining essentially unchanged before a...
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Does Your Anesthesia Billing Partner Have Access to the Details of a Case?

Summary The transition from paper-based anesthesia records to electronic anesthesia records has created new coding and billing challenges for anesthesia groups. Expanded clinical documentation requirements now require coders to access the preoperative note, intraoperative note, operative report and postoperative note. Problems with access to this i...
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On Waivers, ASCs and Independent Anesthesia Practice

The rules pertaining to waivers of copays are certainly worth understanding. "It is an understatement to say the consequences of inappropriate waiver practices are significant," write returning authors Frank Carsonie, JD, and Nathan Sargent, JD, in their lead article for this Communiqué.In the current era of increased federal and state governmental...
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How Are Anesthesia Practitioners Faring With the New GI Codes?

SummaryThe changes in base unit values for anesthesia services for upper and lower endoscopy procedures for 2018, along with the replacement of two endoscopy codes with five more specific codes, were expected to have a negative financial impact on many anesthesia practices. An analysis of data for a representative sample of clients across the count...
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Disrupting the Disruptive Physician

One would think (or hope) that by the time anesthesiologists complete their training and begin practicing, they have mastered not only their clinical field, but also the ability to work well with others and behave appropriately. If you've spent any time as a member of an anesthesia group, however, you know that it is rare for all of the physicians ...
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Legal Cases Underscore Compliance Lessons for Anesthesia and Pain Groups: Part 2

SummaryLegal cases presented at the Advanced Institute for Anesthesia Practice Management offer valuable reminders to anesthesia practitioners and pain specialists regarding the importance of documenting medical necessity for urine drug test screens, including quantitative tests, and compliance with the 60-day overpayments provision of the Affordab...
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Six Years On: The Growing Pains—and Remarkable Growth—of the Perioperative Surgical Home

Roseanne M. Fischoff, MPP Economics and Practice Innovations Executive, American Society of Anesthesiologists•​ One regional medical center saved $1.5 million in the first year.•​ A Midwest academic center reduced average length of stay (LOS) for total joint replacement patients from 4.6 to 2.1 days.•​ A pediatric institution reduced the 30-day rea...
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Legal Cases Underscore Compliance Lessons for Anesthesia and Pain Groups

Summary Anesthesia and pain practices should stay abreast of risk areas not only nationally, but also locally, through their branch office of the U.S. Department of Justice, in order to help ensure compliance and protect their groups. We highlight two cases presented at the Advanced Institute for Anesthesia Practice Management by attorney Vick...
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Ambulatory Anesthesia: Everything You Wanted to Know But Were Afraid to Ask

Howard Greenfield, MD Co-Founder and Principal, Enhance Healthcare Consulting, Aventura, FL Jody Locke, MA Vice President of Anesthesia and Pain Practice Management Services Anesthesia Business Consultants, LLC, Jackson, MI The steady migration of surgical cases from traditional inpatient to non-traditional outpatient and ambulatory venues has req...
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Anesthesia Payment for the Perioperative Surgical Home

Summary A growing body of evidence shows that implementing a perioperative surgical home (PSH) can yield important quality improvements, operational efficiencies and cost savings for hospitals, including reductions in length of stay and readmissions. However, many anesthesia groups have questions regarding the payment aspects of this model. On...
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How Much Call is Too Much?

Anyone who has had to leave in the middle of a family dinner because of a call from labor and delivery or tried to sleep in the call room knowing that a recently completed case is bleeding and likely to come back that night probably also wonders whether they should be working somewhere with less call responsibility.Working on call is part of the re...
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Anesthesia Community Speaks Out Against California Healthcare Bill

Summary The California Health Care Price Relief Act (AB 3087) proposes the creation of an appointed Commission that would "control in-state health care costs and set the amounts accepted as payment by health plans, hospitals, physicians, physician groups, and other health care providers." We offer an overview of the bill as a heads up to anest...
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Anesthesia Services RFPs: Reality, Unicorns and Cognitive Bias

Mark F. Weiss, JD The Mark F. Weiss Law Firm, Dallas, TX, Los Angeles and Santa Barbara, CAThink back in time to a job interview. You dressed for success, put a wide smile on your face, and were on your best behavior.In the advertising world, they call them "reviews." In healthcare, we call them requests for proposal or "RFPs" for short. They're th...
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Anesthesia Groups: Keep HIPAA Compliance on Your Radar

Summary The second round of audits by the Office of Civil Rights of compliance with the Health Insurance Portability and Accountability Act (HIPAA) may be over, but HIPAA enforcement has not subsided. Anesthesia and pain groups, and their business associates, risk exposure to civil or criminal penalties if they don't comply with the administra...
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Independent Anesthesia Group Practice: A Short Manifesto

"Most people will choose unhappiness over uncertainty. -Tim FerrisAnesthesia groups are facing great challenges in today's environment. I am sure you are aware of these various challenges so I won't belabor them.The question is: What do we do now?Some groups are throwing in the towel and selling out. It seems as though every few weeks another indep...
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Lawmakers Take Aim at Opioid Epidemic: What Anesthesia Providers and Pain Specialists Should Know

Summary We provide an overview of recently proposed legislation from the Senate Health, Education, Labor and Pensions Committee (HELP) and the Health Subcommittee of the House Energy and Commerce Committee to address the opioid crisis in the United States, including a large number of bills related to Medicare and Medicaid payment and coverage ...
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