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...

“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...

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...