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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March 3, 2014
Have you checked how your information appears on Medicare’s Physician Compare website? Is it accurate?
February 24, 2014
There are now more than 500 Accountable Care Organizations (ACOs) up and running in the U.S. Since they first appeared on the health care horizon, interest in their potential to improve quality while reducing or at least holding down costs has continued to grow. Specific approaches and strategies for shifting the quality/cost equation such as ASA’s Perioperative Surgical Home model are developing with a view toward participating in future ACOs. How—and how well—are ACOs working as the health care system’s transition to value-based care proceeds? Overall, the results are a mixed bag.
February 17, 2014
The Office of the Inspector General (OIG) in the Department of Health and Human Services released its Work Plan for 2014 on January 31, several months later than usual in part, at least, because of the sequestration and government shutdown engineered by our dysfunctional Congress last fall.
February 10, 2014
Leaders in medicine and health policy are focusing on a new component of care: appropriateness. Only those medical services and interventions that are likely to help and not harm the patient and that represent value (cost/quality) are appropriate. The real issue is, of course, knowing which services are appropriate.
February 3, 2014
No three-word phrase was heard more frequently than “Perioperative Surgical Home” (PSH) at the ASA Practice Management Conference held in Dallas on January 24-26, 2013.
January 27, 2014
After requesting comments from the public in August 2013 and receiving more than 130 letters, CMS is going forward with modification of its policy on disclosure of physician payment information.
January 21, 2014
Hardly a week goes by without news of the loss of a computer containing thousands of patient records. It is all too easy for medical practices and health systems to suffer data breaches, and the financial consequences can be severe. When a breach of patient data is found and reported, healthcare providers and legal business associates can be liable for penalties of up to $1.5 million for violations of a single HIPAA provision.
January 13, 2014
It is time for us to begin to familiarize ourselves with the role of telemedicine in anesthesiology. The concept is not entirely new; there have been several articles published on preadmission anesthesia or critical care consultations conducted through telemedicine. The results of a Canadian pilot study that appeared in Anesthesiology in 2004 showed “that preadmission anesthesia consultations using telemedicine technology can be successfully performed. Patients and consulting and attending anesthesiologists are very satisfied with telemedicine consultation.”
January 6, 2014
Anesthesiologists and other physicians who provided out-of-network services to Aetna patients for part or all of the period from 2003 to 2013 may be eligible for a share of the $120 million settlement agreement in the Aetna usual-and-customary (UCR) class action lawsuit.
December 30, 2013
Just like the physical universe, the anesthesia practice universe continues to expand with increasing speed—or at least that is how it seems. The number and breadth of the challenges we face are larger than ever. To the familiar concerns such as disappointing payment rates, declining hospital income support and growing service demands, we can add the confusion and worries created by Obamacare and explosion of work occasioned by information technology. In most challenges, we know, there are also opportunities, some more accessible than others, of course.
December 16, 2013
Electronic health records (EHRs) make it easier to document patient care with incorrect information, not just with desirable data. To put it bluntly, as does the Health and Human Services Office of the Inspector General (OIG) in its just-released report Not All Recommended Fraud Safeguards Have Been Implemented in Hospital EHR Technology, “Experts in health information technology caution that EHR technology can make it easier to commit fraud.”
December 9, 2013
The Centers for Medicare and Medicaid Services (CMS) released the 1369-page final regulations containing the changes to the Physician Fee Schedule for 2014 (the “Final Rule”) on the Wednesday before Thanksgiving. Updates and provisions of interest to anesthesiologists include the 2014 conversion factor and changes to the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier requirements.
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.