SUMMARY The misuse and abuse of prescription opioids has become a serious public health problem in the United States and is a major factor in the recent increase in heroin addiction. Practices can help to curtail this problem by staying abreast of new developments and guidelines stressing the prudent use of narcotics. The death in April of the musician Prince from an accidental overdose of fentanyl is only one of the more highly publicized instances of a public health problem in the United States that has reached epidemic scale.  According to the Department of Health and Human Services (HHS), 44 people die every day in the U.S. from an overdose of prescription painkillers. A recent analysis of more than 800,000 prescriptions written in 2013 showed that pain specialists and anesthesiologists wrote the most opioid prescriptions of any group of healthcare professionals—an average per physician of 900 - 1,100 and 500 prescriptions,...

SUMMARY The U.S. Department of Veterans Affairs (VA) has issued a proposed rule to allow advanced practice registered nurses to practice within their full authority at veterans’ hospitals across the country, preempting certain State laws prohibiting the practice. Although certified registered nurse anesthetists (CRNAs) have not yet been given the green light to furnish anesthetics, the VA continues to consider this issue. Introduction Few are unfamiliar with the general state of veterans and healthcare in our country. According to statistics recently released by the VA, an average of 20 veterans died from suicide in 2014. 1 Further, there is a backlog of nearly 500,000 veterans waiting 30 days or longer to receive care at VA facilities across the U.S. This is higher than the numbers from one year ago when reports were released that showed veterans dying while waiting for care as a result of the backlog. 2 In an...

Introduction To hospitals, the Centers for Medicaid & Medicare Services (CMS) is acting like the terrible Wicked Witch of the West from the movie the Wizard of Oz because of their proposed plans for site-neutral rate reductions. The proposed modifications in reimbursement are included in the 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System (CMS-1656-P) proposal submitted on July 6, 2016. The law provides for payment system policy changes, quality reporting provisions, and reduced pay rates that many hospitals would prefer to douse with water and have them disappear like the Wicked Witch rather than have payments reduced at their off-campus facilities. CMS is proposing a number of policies they believe will improve the quality of care Medicare patients receive. A key piece of the 2017 proposed legislation is the implementation of Section 603 of the Bipartisan Budget Act of 2015, which will affect how...

Prior to addressing the main topic of today’s alert, we felt it necessary to inform our readership of the recent proposed changes made by the Centers for Medicare and Medicaid Services (CMS) in its CY 2017 Proposed Physician Fee Schedule (PPFS). In the CY 2016 PPFS, CMS proposed reexamining the anesthesia codes reported in conjunction with colonoscopy procedures (i.e., 00740 and 00810) as potentially misvalued. In the CY 2017 PPFS, CMS continues to maintain that 00740 and 00810 are misvalued and it “look[s] forward to receiving input from interested parties and specialty societies for consideration during future notice and comment rulemaking.” Moreover, CMS notes that although sedation services are included in certain endoscopic procedures, that anesthesia is being separately reported. As such, “[i]n the CY 2017 PFS proposed rule, CMS is proposing values for the new CPT moderate sedation codes and proposing a uniform methodology for valuation of the procedural codes...

The transition to the International Classification of Diseases and Related Health Problems 10th revision (ICD-10) appears to have gone well so far, despite widespread anxiety that it would wreak havoc across healthcare as providers struggled to comply with the new coding structure, heightened specificity and documentation requirements.  The Centers for Medicare and Medicaid Services (CMS) reports that total claims denials and other claims metrics remained essentially unchanged from the historical baseline to the fourth quarter of calendar year 2015. In a blog post, Andy Slavitt, CMS acting administrator, likened the healthcare industry’s anticipatory concerns surrounding ICD-10 to the Y2K information technology disaster that never took place.  “With preparation, planning, a focus on the customer, collaboration, clear accountability, and metrics, the dire Y2K fears didn’t come to pass.  Instead, ICD-10 became like what actually occurred on Y2K, an implementation and transition most people never heard about,” he said. So far, so good. Nonetheless,...