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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December 2, 2013
One of the longest-running Medicare whistleblower lawsuits, U.S. ex rel. El-Amin v. George Washington University (D.D.C. November 25, 2013), has apparently come to an end, without a trial. Late last month, the United States District Court granted the defendant’s motion for summary judgment, which means that even if the plaintiff’s factual allegations were true, the defendant would prevail as a matter of law.
November 25, 2013
One way in which anesthesiologists can add value to their hospitals’ bottom line is by assuming responsibility for the cost of the drugs they order and administer. The U.S. general anesthesia market size was approximately $2 billion in 2011 and is expected to grow at a moderate rate of 4% annually from 2011 to 2015, according to a Markets and Markets report. In addition, intravenous anesthetic drugs accounted for the largest share—65%—of the U.S. general anesthetics drugs market in 2011. Individual anesthesiology practitioners and groups have little control over total spending on drugs, just as they have little control over annual national spending on anesthesia services, but they can involve themselves in cost management locally, within their own institutions. As with most activities, success starts with knowledge.
November 18, 2013
Most practicing anesthesiologists know that the federal anti-kickback statute prohibits hospitals, ambulatory surgical centers and others from asking for something of value in exchange for the referral of patients for anesthesia services. Paying for the anesthesia franchise violates the statute. So does soliciting payment for the franchise.
The Relative Value Update Committee: The Process for Valuing Anesthesia, Pain Medicine and Other Services
November 11, 2013
The Centers for Medicare and Medicaid Services (CMS) does not conjure up the relative value units (RVUs) on which payment for individual procedures is based, although it may sometimes seem that way. A consensus group of physicians representing all the major specialties, convened by the American Medical Association (AMA), meets three times a year to develop recommendations for RVU adjustments. The recommendations from the consensus group (the Relative Value Scale Update Committee, or RUC) are sent on to CMS, which considers the information as it prepares its annual update to the Physician Fee Schedule. In recent years, CMS has adopted between 87.4 and 95 percent of the RUC’s recommendations, depending on which source you accept, Health Affairs or the RUC, respectively. The former figure represents 2,419 out of 2,768 recommendations that the RUC proposed between 1994 and 2010.
November 4, 2013
Most anesthesiology practices provide services in ambulatory surgical centers (ASCs), and quite a few anesthesiologists have investment interests in ASCs. With more than 5,400 Medicare-certified ASCs in the United States, 1.8 percent more than in 2012, a look at the characteristics of successful facilities and at the challenges they face should be worthwhile.
October 28, 2013
Last spring, we alerted readers to a proposed payment policy (“Local Coverage Determination,” or “LCD”) under which Noridian Administrative Services, LLC, the Medicare Administrative Contractor (“MAC”) for nine Western states, would have denied coverage for blocks and epidurals placed pre-operatively for the management of post-operative pain. In Proposed "Medical Necessity" Restrictions on Post-Anesthesia Pain Blocks, we criticized the proposed LCD for confusing the timing and the purpose of post-operative pain procedures and explained the process by which MACs propose, revise and finalize LCDs. We encouraged readers to use the process, and their representatives on the Carrier Advisory Committees of practicing physicians, to speak up for patients and help prevent undue restrictions on the availability of post-operative pain management services.
October 21, 2013
As both colonoscopy rates and use of anesthesia during gastrointestinal endoscopies are projected to increase in the coming years, the overall cost of colonoscopy screening programs will be closely scrutinized by payers and policy makers.
October 14, 2013
The most authoritative information on managed care (commercial) contract rates for anesthesia services has just been updated. The ASA Survey Results for Commercial Fees Paid for Anesthesia Services -2013 appears in the October issue of the ASA Newsletter.
How Not to Structure Hospital-Physician Compensation Arrangements (A Stark Law Refresher for Anesthesiologists)
October 7, 2013
The latest court decision in the eight-year whistleblower litigation against Tuomey Healthcare System in Sumter, South Carolina, giving rise to perhaps the largest amount of damages—$276,767,260—ever awarded against a community hospital, provides an opportunity to review some Stark law. The September 30 order and opinion from the federal district court also demonstrates some compliance strategies to be avoided, notably shopping around for the most obliging legal advice.
September 30, 2013
With the ICD-10-CM conversion deadline one year away, many professional organizations and industry experts are warning of a lack of preparation and the serious adverse effects on practice revenues. The level of alarm and doom is not realistic nor a given outcome for the majority of anesthesiologists. With reasonable physician diligence in documenting services completely and accurately, successful conversion is likely. Groups should make sure that their billing companies are preparing them to meet the new documentation requirements—as ABC will do—to avoid claim processing delays or denials beginning on October 1, 2014.
September 23, 2013
Health insurance exchanges (HIEs) will open in every state by October 1, 2013, as mandated by the Affordable Care Act (ACA). Their basic role will be to permit consumers to compare and purchase qualified insurance plans online. Estimates of the numbers of individuals who will enroll in HIE plans during the six-month enrollment period that starts on October 1st vary from seven million (Congressional Budget Office) to four million (Citigroup investor survey released last Monday). Many of these enrollees will be eligible for federal subsidies to help pay for the coverage.
September 18, 2013
Since 1995, the American Society of Anesthesiologists has presented an annual conference on practice management in late January. The conference is now a three-day meeting with multiple tracks, including an all-day program for residents. According to the ASA, “This comprehensive educational event provides up-to-date information about the state of practice management including business and technology trends, changes in regulations and laws, and best practices to manage an anesthesiology practice in today’s environment.” Next year’s meeting will be held in Dallas on January 24-26, and is beneficial for anesthesiologists, practice administrators, allied health professionals, consultants and others. For further information, go to www.ASAhq.org.
September 16, 2013
If you are an anesthesiologist practicing in a group of 100 or more eligible professionals (EPs) and submitting claims to Medicare under a single taxpayer number, you may be subject to the Value Based Payment Modifier (VBPM) in 2015. By 2017, all physicians participating in Fee-for-Service Medicare will be affected by the VBPM. This Alert is intended to help anesthesiologists familiarize themselves with the VBPM.
Before the Shoe Drops: Anesthesiologists Can Help Hospitals Prevent Certain Hospital-Acquired Infections
September 9, 2013
Anesthesiologists increasingly point to their role in driving down the rate of surgical site and other hospital-acquired infections (HAIs). Not only does anesthesiologists’ and nurse anesthetists’ compliance with the relevant quality measures help the hospitals’ quality scores and satisfy PQRS requirements, preventing HAIs is good for patients and saves on health care system costs.
Anesthesia Providers: Make Sure You Continue to Revalidate Your Medicare Enrollment When Medicare Asks
September 4, 2013
Anesthesiologists, nurse anesthetists and anesthesiologist assistants who last validated their enrollment in Medicare prior to March 25, 2011 are going to have to revalidate again by March 23, 2015. This is an update to the previously communicated timeframe of March 23, 2013.
September 3, 2013
The AMA and MGMA offer research-based tools on payer performance that may be helpful to practices negotiating participation contracts.
CERT Errors of Interest to Anesthesiologists and Pain Medicine Providers: Will the New A/B Contractor CERT Task Force Make a Difference?
August 26, 2013
The Centers for Medicare & Medicaid Services (CMS) implemented the Comprehensive Error Rate Testing (CERT) program to measure improper payments in the Medicare Fee-for-Service (FFS) program. CERT is designed to comply with the Improper Payments Information Act (IPIA) of 2002, as amended by the Improper Payments Elimination and Recovery Improvement Act (IPERIA) of 2012. IPIA and IPERIA require the heads of Federal agencies, including the Department of Health and Human Services (HHS), to annually review programs it administers to improve agency efforts to reduce and recover improper payments
August 19, 2013
In May of this year, CMS released information on the average charges for the one hundred most common inpatient services at more than 3,000 hospitals nationwide. The following month, the Agency published average charges for 30 outpatient procedures. Are average charges—or payments—for physicians’ professional services next?
August 12, 2013
Legislation to repeal the Sustainable Growth Rate (SGR) formula is emerging in the House of Representatives. On July 31st, the Energy and Commerce Committee voted unanimously to pass H.R. 2810, the Medicare Patient Access and Quality Improvement Act of 2013. This is the culmination of more than two years of work involving members of both the Energy and Commerce Committee and the House Ways and Means Committee, with feedback from healthcare providers. The bill now advances to the full Ways and Means Committee; the Senate Finance Committee is expected to produce its version in the fall.
August 5, 2013
As of August 1st, certain manufacturers of drugs, medical devices and biologicals are tracking their payments to physicians, as required by the Physician Payments Sunshine Act (Sunshine Act), which is part of the Affordable Care Act. They will report payments and other items of value worth more than $10, as well as certain ownership interests held by physicians and immediate family members, to CMS annually. Reporting may begin immediately, on a voluntary basis, and must begin by next January. CMS will post the information, by physician, on a public, searchable website.
July 29, 2013
The first Alert this month looked at preventable hospital readmissions and ways to attempt to reduce the rate, which was 12.3 percent for Medicare patients in 2011. There is much more to say on the topic, including an interesting study published in the June 2013 issue of Health Affairs, Limits of Readmission Rates in Measuring Hospital Quality Suggest the Need for Added Metrics by Matthew J. Press and colleagues.