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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Getting Paid for All Your Anesthesia Time

October 20, 2014

Anesthesia time “starts when the anesthesia practitioner begins to prepare the patient for anesthesia services in the operating room or an equivalent area,” according to the Medicare regulations and the ASA Relative Value Guide®, or “begins to prepare the patient for the induction of anesthesia” as stated in the CPT® Anesthesia Guidelines.  What do those words mean—and can there be any remaining controversies after all these years?

Restrictions on Billing Anesthesia Patients Who Go Out of Network

October 13, 2014

Anesthesiologists are wondering how to respond to questions about an article that appeared in the New York Times on September 20, 2014, reporting on a $117,000 bill received by a spinal fusion patient from a neurosurgeon who had assisted in his procedure.

Anesthesiologists Need to Understand Hospital Readmission Penalties

October 6, 2014

On October 1, 2014, the start of the fiscal year for hospitals, Medicare’s maximum penalties for “preventable” readmissions increased from two percent to three percent.  At the same time, CMS added three new conditions, including two frequently performed orthopedic procedures, to the list of conditions for which readmissions are deemed preventable, which now consists of the following:

Can A Computer Replace Your Anesthesiologist?

September 29, 2014

An article in the September 21 New York Times Sunday Review asked the question Can a Computer Replace Your Doctor?  The author, Elisabeth Rosenthal (who identified herself as a “former physician”)  opened with the following:

Anesthesiologists Ask: How Are ACOs Doing?

September 22, 2014

According to recent estimates, there are some 500 ACOs operating in the US today.  More than 360 Medicare ACOs have been established, serving over 5.6 million Medicare beneficiaries, since passage of the Affordable Care Act in March 2010.  There are two distinct categories of Medicare ACO:  the Pioneer Model ACOs, which are on a faster track toward value- and population-based payment, with higher levels of shared savings and risk, and the ACOs participating in the Medicare Shared Savings Program (MSSP).  Together, the ACOs reduced Medicare spending by approximately $817 million in 2013.

New “Distinct Procedural Service” (-59) Modifiers on the Way–Anesthesia and Pain Management Practices Take Note

September 15, 2014

Many medical services and procedures can be performed either on their own or in conjunction with another service or procedure.  The National Correct Coding Initiative (CCI) identifies pairs of services that a physician cannot normally report for the same patient on the same date of service.  The two services may be mutually exclusive, as when one is performed only on female patients and the other only on males.  Most commonly, the reason for the linkage—the CCI “edit” that bundles the two services and prevents separate payment—is that the second service in the pair is a component of the more extensive service performed by the same physician for the same patient at the same encounter.  An example familiar to anesthesiologists is the bundling of postoperative pain management procedures with an anesthetic delivered through the same catheter.

Are Anesthesia Group-Hospital Gainsharing Agreements Legal?

September 9, 2014

"Properly structured, arrangements that compensate physicians for achieving hospital cost savings can serve legitimate business and medical purposes. Specifically, properly structured arrangements may increase efficiency and reduce waste, thereby potentially increasing a hospital’s profitability."  (Office of the Inspector General, Advisory Opinion No. 07-22, December 28, 2007.)

Should Anesthesia Practices Be Concerned about Phase 2 of the Government HIPAA Audit Program?

September 2, 2014

HHS’ Office for Civil Rights (OCR) is about to begin a new round of audits to determine the extent of providers’ and their business associates’ compliance with the HIPAA privacy, security and breach notification rules.

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.