One especially alarming artifact of the Patient Protection and Affordable Care Act (ACA) is the Independent Payment Advisory Board (IPAB). The IPAB is a 15-member panel charged with making proposals to “reduce cost growth” and “improve quality of care for Medicare beneficiaries.” It is required to recommend cost-saving initiatives in any year in which per capita spending exceeds a threshold determined by the government. In addition, the Commission is authorized to make recommendations to “constrain the rate of growth in the private sector.”
Right now, the IPAB is also a phantom. Although the ACA called for the Commission to be in place and to make its first set of recommendations by January 2014, no members have ever been appointed and no nominations are even in the works.
Nevertheless, opposition to the IPAB is as strong today as when the draft that became the ACA first appeared. Senator John Cornyn (R-TX) reintroduced... 
By:
Michael R. Hicks, MD, MBA, MHCM, FACHE Physician Executive, Dallas, TX
Joe Laden Louisville, KY
Background of the Authors:
National anesthesia management companies increase revenue for acquired groups....or do they? This article presents pros and cons for both viewpoints with discussion by two leaders in the field of anesthesia practice management, Michael R. Hicks, MD, MBA, MHCM, FACHE, a physician executive from Dallas, TX and Joe Laden, a practice manager based in Louisville, KY.
Mr. Laden
Over the past several years, anesthesiologists have been increasingly willing to sell their practices to acquiring firms. In a typical transaction, the anesthesiologist practice owners agree to reduce their incomes in return for the purchase of their stock in their practice. The stock payment is usually several times the annual salary reduction. The anesthesiologists benefit by receiving funds now rather than in the future, and this money is taxed at the capital gains rate... 
Anesthesiologists’ role in perioperative medicine is rapidly expanding. It is now sufficiently visible that some surgeons are concerned about turf; see Brian Dunleavy’s article Perioperative Surgical Home Promotes Perioperativists in the February issue of General Surgery News online.
While much of the attention has focused on the services that anesthesiologists might provide in the pre-operative phase of surgical care, some anesthesiologists are providing care after discharge for a period of up to 30 days—and are being paid directly for some of that post-operative care. Medicare has recognized two transitional care management (TCM) codes (CPT™ codes 99495 and 99496) since January 1, 2013. Private payers may cover the service, but few, if any, have chosen to do so.
This year, the national unadjusted Medicare payment amounts for services provided in the facility setting are $111.91 (99495) and $161.25 (99496). For some anesthesiology practices, it makes financial as well as clinical sense to provide...
The compliance deadline for ICD-10, as you have read many times, is October 1, 2015. After three delays since the deadline was originally set for 2011, there may be some doubt—not to say cynicism—about whether the October 1st date will slip too. It may—but the majority of viewers believe that the transition to ICD-10 codes will occur as scheduled.
On February 11, 2015, the U.S. House Energy and Commerce Subcommittee on Health held a hearing entitled "Examining ICD-10 Implementation.” The seven witnesses who testified were health industry professionals representing such major players as the American Health Information Management Association (AHIMA), Athena Health, America’s Health Insurance Plans (the commercial payers’ lobby) and 3M Health Information Systems. Six of the seven witnesses adamantly supported October 1st implementation. The seventh, William Jefferson Terry, MD, of the Mobile Urology Group and American Urology Association, made the usual arguments that ICD-10 coding will interfere with treating...
If you have not spent much time thinking about the impact of the Exchange plans now being offered under Obamacare, you are not alone. For many anesthesia providers and their administrative staff, the specific implications of the Patient Protection and Affordable Care Act (ACA) passed in March 2010 are more or less a black box. As is true of so many issues in healthcare, the devil is in the details; unfortunately this is just one more complicated issue that merits special management focus.
So what are Exchange plans and how do they work? It is important to understand that Exchange plan options are offered in every state. These insurance options are available through the Health Insurance Marketplace at Healthcare.gov. Essentially this provides options for those who are not covered through their employer. In each state where they are offered, private, commercial insurers have contracted to provide coverage at discounted rates. For...