Most anesthesiologists know in general fashion that there are "compliance" issues with professional courtesy, co-payment waivers and discounts for cash payments.  Yet confusion persists about exactly how to handle these situations. The legal principles have not changed in the nearly two decades since the HHS Office of the Inspector General (OIG) issued its Compliance Program for Individual and Small Group Physician Practices.  The basic standards are still as spelled out by the OIG: In general, whether a professional courtesy arrangement runs afoul of the fraud and abuse laws is determined by two factors:  (i) How the recipients of the professional courtesy are selected; and (ii) how the professional courtesy is extended.  If recipients are selected in a manner that directly or indirectly takes into account their ability to affect past or future referrals, the anti-kickback statute—which prohibits giving anything of value to generate Federal health care program business—may be implicated.  If...

Given the heightened level of interest in acquisitions of independent anesthesiology groups, physician shareholders are being confronted with a myriad of questions. Many are finding that anesthesiology groups in the local region are being acquired by larger medical groups. What should their practice do? What would be the value of their practice if they sought to be acquired? What does the acquisition process look like and how could maintaining a steady course of non-action not result in the best long term outcome? Your Practice has Equity Value Over the years, long-standing relationships have been developed with other healthcare providers and service contracts have been established with medical facilities, securing work for all the practice-employed physicians. A practice will accumulate a substantial amount of sweat equity, which has an equally substantial amount of economic value associated with it. Opportunity currently exists to monetize the value of this equity, and depending on regional...

For patients who undergo a surgical procedure, the anesthesiologist’s bill sometimes comes as a surprise.  If the hospital and the surgeon are participating in the patient’s health plan but the anesthesiologist is not in the network and bills the difference between his or her full charge and what the health plan paid, the amount that the patient owes can be a nasty shock.  Large balance bills are often stressful for patients and are a major source of medical debt. Balance billing is a significant issue across the U.S.  As insurance companies have narrowed provider networks to keep premiums down, the number of patients who inadvertently receive out-of-network care has jumped at hospitals, particularly with regard to contracted physicians such as anesthesiologists. In March 2015, the Consumer Reports National Research Center conducted a survey of 2,200 adults that revealed that nearly one third of privately insured Americans received a surprise medical bill...

Computers and improvements in modern anesthesia delivery have gone hand-in-hand. In 1952 Himmelstein and Scheiner reported that they began using an instrument called the cardiotachoscope and found it useful during surgery. In 1958 Ben Ettelson and James Reeves started Spacelabs to develop systems for the United States Air Force for monitoring vital signs of U.S. astronauts.1 This technology returned to earth, with the 1970s witnessing the expansion of digital electronics in operating rooms (ORs) and critical care units (CCUs). The 1980s saw clinical penetration of modularity and utilization of saturation and end-tidal carbon dioxide monitoring. As pharmaceuticals developed shorter and shorter clinical half-lives and microprocessor technology continued to improve, the concepts of closed-loop (CL) anesthesia, targeted-controlled infusion (TCI) devices and other computer controlled delivery systems moved from theoretical possibilities to clinically relevant systems.2 In the late 1990s Dr. Randy Hinkle, an anesthesiologist, formulated the initial concept that ultimately became Computer- Assisted...

“Transparency” is a word that you will encounter more and more frequently in health policy articles, including ABC’s publications.  Information transparency is a key for enabling healthcare purchasers to make value-based decisions concerning the quality and price of services.  Those data are slowly becoming more available, but they remain largely inaccessible to most potential users. CMS recently released the third year of information from the Medicare Provider Utilization and Payment Data: Physician and Other Supplier database.  The database is comprehensive and offers the following information for every physician or Part B supplier who submitted claims in 2014:  name, address, gender, specialty, procedure (by HCPCS/CPT™ code), place of service, number of services, number of Medicare beneficiaries, average payment amount, average allowed charge and average submitted charge.  What is missing is any information on patients or on outcomes.  This being a Medicare database, it excludes the two-thirds of patients who are not in...