Anesthesia Industry and Market News: eAlerts

eAlerts are the latest industry information regarding regulatory changes, helpful compliance reminders, or any number of relevant topics in the fast-paced, ever-evolving speciality of anesthesia.

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Latest Obamacare Litigation—A Summary for Anesthesiologists

July 28, 2014

Some of the most controversial provisions of the Affordable Care Act (ACA) are those that require individuals to either sign up for health insurance or to pay a tax.  Differing interpretations of the statutory language regarding the tax credit or “subsidy” that would enable lower-income individuals to afford coverage have given opponents of ACA a hook on which to hang a small but powerful legal weapon.  Contrary to the claims (and hopes) of some observers, recent federal Appeals Courts decisions are not the death knell for Obamacare, however.

What Do Narrow Networks Imply for Anesthesia?

July 21, 2014

In a health plan featuring a “narrow network” (NN), the carrier substantially reduces the number of participating physicians, hospitals and other providers.  Limiting the panel to providers offering lower prices is nothing new.  In the mid-1990s, HMOs and PPOs sparked a backlash from patients and a multitude of state laws requiring that insurers include any willing provider in their networks. The dynamic has changed since the Affordable Care Act (ACA) went into effect, however.

The Proposed Fee Schedule Rule Contains Some Important Developments for Anesthesia

July 14, 2014

The Proposed Rule for the 2015 Medicare Fee Schedule would eliminate the PQRS antibiotic prophylaxis measure, would reinstate the 2014 values for the laminar epidural injections, and would revise the definition of “screening colonoscopy” in recognition of the role of anesthesia—among numerous other changes.

It’s Vacation Time. Does Your Anesthesia Group Have the Right Coverage Using Locum Tenens?

July 7, 2014

Medicare and most commercial payers will pay anesthesia practices for locum tenens physicians who temporarily substitute for regular physicians.  Know your carriers’ rules and make sure that you don’t forfeit any payments for services provided.

Do You Know Where Your Anesthesia Practice’s Patient Records Are Tonight?

June 30, 2014

Keeping patient information confidential has become a major challenge since we all began storing so much of it in electronic form.  Computers, tablets and smart phones containing unsecured electronic Protected Health Information (ePHI) go missing and are reported in the press on at least a weekly basis.

Value in Anesthesia and Price Transparency

June 23, 2014

Two recent Alerts focused on the growing movement toward transparency of medical prices.  (How Much Did Medicare Pay Each of 32,641 Anesthesiologists in 2012?, April 21, 2014 and Private Payer Information on Anesthesia and Other Services: Claims Data to Be Available Next Year, May 19, 2014.)  The first of these discussed CMS’ April 9th release of a massive database with information on the approximately $77 billion that Medicare paid out to more than 800,000 physicians and other non-hospital providers in 2012.  The May Alert examined three large insurers’ announcement that they were establishing an online database of paid claims that would provide public information about the price and quality of healthcare services.

Reporting PQRS Measures: Anesthesiology’s Own Quality Clinical Data Registry (QCDR)

June 16, 2014

Until now, claims-based reporting has been the only Physician Quality Reporting System (PQRS) option for most anesthesiologists.  While the method of reporting, inserting the five-digit PQRS codes for the PQRS measures on one’s Medicare claims, has been easy enough, finding enough quality measures that apply to anesthesia practices has been more of a challenge.

Anesthesiologists as Operating Room Directors: The Advantages

June 9, 2014

For the first time, we are using an issue of the Alert to reproduce a third-party article in full.  Dr. Steven Boggs’s thoughts on “anesthesiologists as operating room directors” add such a lot to the concept of “anesthesiologists as medical directors” that they deserve to be read unabridged, undiluted and unencumbered by extraneous ideas.  We are grateful to Dr. Boggs and to PhySynergy for granting us permission to publish this article, which appeared on PhySynergy’s AnesthesiaReviews Blog on March 10, 2014.

Meaningful Use Stage 2 Reprieve Helps Anesthesia Practices

June 2, 2014

Under CMS’ current Medicare and Medicaid electronic health record (EHR) incentive program regulations, eligible professionals (EPs) must use 2014 edition certified EHR technology (CEHRT) to demonstrate meaningful use for either Stage 1 or Stage 2 in 2014.  Many EHR vendors have not yet met the criteria to obtain certification for the 2014 edition, or they have too large a backlog of installations to comply with the timeline, however.  On May 20th, CMS issued a proposed rule that would push back the deadlines for implementation of 2014 edition systems for the Medicare program.

Anesthesia Patient Satisfaction Surveys

May 27, 2014

Are there any anesthesia or pain medicine practices that have not yet implemented a patient satisfaction survey?

Private Payer Information on Anesthesia and Other Services: Claims Data to Be Available Next Year

May 19, 2014

Aetna, Humana and UnitedHealthcare have announced plans to establish an online database of paid claims that will give consumers, employers and federal and state governments information about the price and quality of healthcare services

Meaningful Use of Electronic Health Records by Anesthesiologists and Pain Physicians – 2014

May 12, 2014

Anesthesiologists are automatically exempt from the meaningful use requirement and from penalties in 2015 as long as they have registered in the Provider, Enrollment, Chain and Ownership System (PECOS) using anesthesiology’s specialty designation (05).  Any anesthesiologist who is at all unsure should check that he or she has created an account in PECOS and that the information is correct—also before July 1, 2014.  Hospital-based anesthesiologists are not merely excepted; they are excluded from the EHR incentive program altogether and can neither earn the bonus nor be subjected to penalties.  “Hospital-based” is defined narrowly under the program’s rules, however:  the EP must provide 90 percent or more of his or her covered services in a hospital inpatient or emergency room setting.  Most anesthesiologists do not provide anything like 90 percent of their covered services in the hospital inpatient or ER setting unless their practice is limited to cardiac, transplant or critical care work.

The Distracted Anesthesiologist

May 5, 2014

When is it acceptable for anesthesiologists, or nurse anesthetists or anesthesiologist assistants, to use their smart phones in the OR?

Anesthesiologist Compensation Surveys

April 28, 2014

Anesthesiologists, once the third most highly-paid specialists, have dropped to sixth place in Medscape’s latest survey of physician compensation.  The 2014 report, based on 2013 data, shows an average income from patient care activities of $338,000 for anesthesiologists, compared to $413,000 for orthopedic surgeons, who are at the top of the list.

How Much Did Medicare Pay Each of 32,641 Anesthesiologists in 2012?

April 21, 2014

Interested parties can now look up how much Medicare paid each of more than 880,000 providers, including 32,641 anesthesiologists, 1,856 interventional pain physicians, 2,999 pain physicians, 30,160 nurse anesthetists and 881 anesthesiologist assistants individually by name.

Securing Anesthesiology’s Future, and Safeguarding its Present: Thoughts From the Advanced Institute for Anesthesia Practice Management

April 14, 2014

While we are all trying to understand how the landscape is evolving for anesthesiologists, nurse anesthetists and anesthesia groups, keeping our eyes on traditional practice management issues such as compliance remains as important as ever.  Similarly, we must maintain a dual focus on the big picture of system and organizational changes, on the one hand, and on the day-to-day requirements of providing and being paid for anesthesia and pain medicine services, on the other.  Our field of vision has to be both longitudinal and latitudinal.

Healthcare Industry Trends for Anesthesiologists to Ponder

April 7, 2014

When it comes to Medicare payments to physicians, plus ça change, plus c’est la même chose.  Last week Congress adopted the 17th “patch” to prevent the huge cut mandated by the Sustainable Growth Rate (SGR) formula from going into effect for another year.  The legislation also kept in place the antiquated ICD-9 coding system until at least October 1, 2015.

ICD-10 Diagnosis Coding and Anesthesiologists’ New Documentation Responsibilities

March 31, 2014

ICD-10 is coming, as we have all heard many times.  Will full implementation be here on October 1, 2014, though, or on October 1, 2015?  As of the time this is written, the Senate is expected quickly to take up the House-passed Protecting Access to Medicare Act of 2014 (H.R. 4302), legislation that will prevent Medicare payment cuts from going into effect on April 1st—and that contains a provision delaying the implementation of ICD-10 for a year.  Whether we are six months or 18 months from the start date, however, it is none too early for clinicians to gain an understanding of what ICD-10 will require of them, as well as to practice meeting the new requirements.

How Does the ACA “Grace Period” Affect Anesthesia Practices?

March 24, 2014

Patients who receive an advance premium tax credit under the Affordable Care Act (ACA) may lose their insurance coverage if they fail to pay their premiums—and leave their providers holding the bag.  With more than 4.2 million individuals now signed up for policies through the ACA health insurance exchanges, every provider is at some risk of loss.  There are steps that anesthesia practices can take to avoid such losses.

Beyond the Anesthesia Component of Bundled Payments for Surgery

March 17, 2014

More than one-third of the total cost of a hip or knee replacement can be attributable to the cost of the implantable device used in the procedure.  In some cases, the device may account for up to 87 percent of the cost, according to a recent Health Affairs article that has attracted a good deal of attention (Okike K., O’Toole RV, Pollak AN, Bishop JA, McAndrew CM, Mehta S, Cross WW, Garrigues GE, Harris MB, Lebrun CT.  Survey Finds Few Orthopedic Surgeons Know the Costs of the Devices They Implant.  Health Aff (Millwood). 2014; 33(1):103-109.  DOI: 10.1377/hlthaff.2013.0453).

Hospital-Physician Integration, Antitrust and Anesthesia Groups

March 10, 2014

The Affordable Care Act, which last week was the object of a fiftieth attempt at repeal in Congress, is moving the healthcare system toward greater integration of providers.  Classic antitrust law, however, aims to increase competition and the number of competitors.  The conflict between the two values finds it most recent expression in the January 24, 2014 decision in the St. Luke’s antitrust litigation in Boise.