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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eAlerts

Ealerts

The Two-Midnight Rule and the Anesthesia Department

August 25, 2014

The “two-midnight rule” was established by the 2014 Medicare inpatient prospective payment rule. According to the policy, inpatient admissions extending through at least two midnights generally qualify for Medicare Part A payments. Surgical procedures, diagnostic tests and other services are presumptively appropriate for inpatient hospital admission and payment when (1) the physician “reasonably” expects the patient to require a stay that crosses at least two midnights and (2) admits the patient to the hospital based upon that expectation. Inpatient stays lasting fewer than two midnights are considered and should be billed as outpatient or observation services under Medicare Part B.

Physician Payments Sunshine Act: Anesthesiologists Should Register and Review Their Information

August 18, 2014

One of our readers asked us recently what his group needed to report under the Physician Payments Sunshine Act.  The answer:  nothing.  The Sunshine Act, which is part of the Affordable Care Act, requires pharmaceutical and medical device manufacturers to report payments and other items of value worth more than $10, as well as certain ownership interests held by physicians and immediate family members.  (See our Alert of August 5, 2013, Drug Manufacturers’ Payments to Anesthesiologists Are Now Reportable under the Sunshine Act.)  It does not impose any tasks on physicians.

What the Surgeon Wants from the Anesthesiologist and Nurse Anesthetist

August 11, 2014

We recently had the opportunity to talk with one of our favorite surgeons about what she wants from her anesthesiologist or care team.  Some of the items on the list below will be very familiar—so much so that it’s surprising that the issue still comes up.  Others are specific to our surgeon’s specialty, otolaryngology, they may sensitize readers to analogous concerns affecting other specialties.

Some Financial and Strategic Challenges Facing ASCs: What Anesthesiologists Should Understand

August 4, 2014

Ambulatory or outpatient anesthesia accounts for approximately 60 percent of surgeries in the U.S. today.  The majority of anesthesia practices provide services at one or more of the 5,300 Medicare-certified ambulatory surgical centers (ASCs).  The challenges faced by ASCs—whether hospital-owned or independent—affect us all.  In order to be your ASCs’ valued partners, anesthesiologists and nurse anesthetists need to understand how healthcare’s challenges in general and ASC’s challenges in particular affect your facilities.

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.