Failure of the Joint Select Committee on Deficit Reduction to reach agreement on $1.2 trillion in cuts to federal spending, has triggered automatic Federal budget cuts known as sequestration. The cuts were originally scheduled to go into effect January 2, 2013. Congress delayed implementation until March and President Obama signed the order late Friday evening, March 1.The 2% cut is evenly split between domestic and defense programs, with half affecting defense discretionary spending (weapons purchases, base operations, construction work, etc.) and the rest affecting both mandatory and discretionary domestic spending. Only a few mandatory programs, like the unemployment trust fund and, most notably, Medicare (more specifically—provider and hospital payments) are affected.Last Friday, the White House Budget Office provided an 83-page list identifying for each of 1,200 accounts what amount needed to be chopped. Medicare beneficiaries will not be subject to any reductions in their benefits. Rather, the expected $123 billion cut... 
Noah Rosenberg, M.D.Resident, Department of Family & Community Medicine, University of Massachusetts Memorial Medical Center, Worcester, MA
Fred E. Shapiro, D.O.Assistant Professor of Anesthesia, Harvard Medical School, Boston, ISOBS Founder
The Institute for Safety in Office-Based Surgery (ISOBS), an independent, non-profit 501(c)(3) organization, has developed a safety checklist for use in the office-based setting. A recent study to be published in the journal ePlastydemonstrated a more than 75% reduction in the number of surgical complications with use of the ISOBS Safety Checklist (see below for citation). While this positive effect on surgical complications validates much of the data already collected in the inpatient setting, it also clearly emphasizes the need for a tailored patient safety approach to the office-based setting. For that reason, ISOBS has developed a second checklist for use by patients to engage them in office-based surgical safety.
The ISOBS Patient Checklist (ISOBS PC) contains a number of questions...
Anesthesia revenue streams are an attractive target for investors of various stripes.
Across the country,
ambulatory surgical centers (ASCs) and certain medical specialty groups
are looking at beefing up their incomes by sharing in anesthesia
profits. At the January 24-26, 2013 ASA Practice Management Conference,
Judith Jurin Semo, Esq., who presented an Update on the Company Model,
noted that trade press articles encouraging such ventures appear
regularly, going back at least to 2004 (Outpatient Surgery). The
“company model” arrangement, which allows a third party to use an
intermediate corporation to collect the professional fees while paying
the anesthesiologists a negotiated rate, has been the object of
considerable concern on the part of the ASA and the anesthesia community
at large. Polled informally, one-third of anesthesiologists report
having been approached about participating in a company model.
The company model is becoming familiar, but is it legal?
The Federal Anti-Kickback Statute
The chief...
Christopher Ryan, Esq. Giarmarco, Mullins & Horton, P.C., Troy, MI
Neda M. Ryan, Esq. Clark Hill, PLC, Birmingham, MI
Reporting post-operative pain management procedures often gives rise to questions, especially toward the beginning of the new year when the Centers for Medicare and Medicaid Services (CMS) issues its National Correct Coding Initiative (NCCI) edits. Historically, epidurals and blocks that are placed pre-operatively for the purpose of managing post-operative pain have been, and still are, separately reportable and not bundled into the anesthesia service itself. The exception to this general rule is when the epidural or block is the anesthetic itself. While CMS has not called for significant changes in 2013, anesthesia providers should, nevertheless, be aware of new post-operative pain management coding changes taking effect January 1, 2013.
NCCI Edits
The NCCI edits for 2013 provide, in part, that certain post-operative pain management procedures may only be separately reportable with...
“Much has changed in health
care since HIPAA was enacted over fifteen years ago,” said HHS Secretary
Kathleen Sebelius in the Department of Health and Human Services’
January 17th press release announcing the publication of the
long-awaited final omnibus rule with Modifications to the HIPAA Privacy,
Security, Enforcement and Breach Notification Rules under the Health
Information Technology for Economic and Clinical Health Act and the
Genetic Information Nondiscrimination Act. “The new rule will help
protect patient privacy and safeguard patients’ health information in an
ever expanding digital age.”
The final omnibus rule will
go into effect on March 26, 2013. Covered entities such as anesthesia
and pain medicine practices and billing companies including ABC—and
their business associates—must be in compliance by September 23, 2013.
The final rule changes HIPAA in several important ways:
It toughens the definition and consequences of failure to notify affected parties of security and privacy breaches;It strengthens...