More than 14 million screening colonoscopies are performed each year.  Anesthesiologists and nurse anesthetists participate in a large proportion of these procedures.  There are several developments that may bring down the numbers or at least slow the rate of growth of screening colonoscopies that our readers, especially those whose practices include a significant volume of anesthesia for colonoscopy services, should note.   The first of the changes going forward is the reduction of Medicare payments for lower gastrointestinal endoscopies that went into effect on January 1, 2016.  CMS announced, in the Final Fee Schedule Rule issued in November 2015, that it was reducing the relative value units (RVUs) for the physician-work component of the Fee Schedule payment for screening colonoscopies by nine percent, from 3.69 to 3.36 RVUs, the value recommended by the AMA/Specialty Society Relative Value Update Committee (RUC). There were also changes to the RVUs for practice expenses. The...

We begin this new year with a list of the key changes to CPT coding and Medicare payment policies.The 2016 CPT edition had more than 300 changes, including 140 new codes, 132 revised codes and 91 deleted codes. It is important to understand the changes and what should be documented to support the new or revised codes. The majority of changes for 2016 appear in the Pathology/Laboratory section of CPT.  Radiology also had major CPT changes, including several for bundling along with “written report” guidelines. There have been gastrointestinal changes made in both 2014 (upper) and 2015 (lower) and in 2016 there were several additional changes.The Office of the Inspector General (OIG) has included non-covered services under Anesthesia Services to the 2016 Work Plan, stating:  “We will review Medicare Part B claims for anesthesia services to determine whether they were supported in accordance with Medicare requirements.  Specifically, we will review anesthesia...

As we barrel toward the end of 2015, let us stop briefly to consider some predictions for the year ahead in healthcare.  Below is a set of ten predictions that appeared in Fortune magazine earlier this month, along with several comments. The Federal Trade Commission (FTC) will block a major hospital merger based upon data showing clearly that consolidation leads to price increases more than quality gains.  In fact on December 18th the FTC moved to block a proposed mega-merger between Advocate Health Care and NorthShore University HealthSystem in Illinois—the third hospital deal the FTC sought to block in the past seven weeks.  The Illinois Attorney General joined the FTC in filing for a preliminary injunction to halt the merger pending Commission review.  The Illinois systems, which, if the merger went through would have a combined 15 acute-care hospital campuses, a children's hospital and a large group of employed and affiliated...

The late great Yogi Berra was famous for his humorous and wise observations. It is true that “the future ain’t what it used to be.” Until a few years ago, the future did not encompass the perioperative surgical home (PSH), but the potential impact of the PSH model cannot be doubted now. It is hard, if not impossible, to argue with the relevance of the model as value-based purchasing takes hold within the governmental and private payer markets. The lead article in this issue, The Perioperative Surgical Home: “Right for our Group?” by Rick Bushnell, MD, MBA, a private practice anesthesiologist in Southern California, is a shining example of the response that the proponents of the PSH hoped to bring about. The PSH is emphatically “right” for Dr. Bushnell’s group—a single specialty private practice, which, like many others, has been successful at providing traditional surgical anesthesia care but is wondering not...

“Patient satisfaction” and the patient experience are considered key measures of quality and  performance in our increasingly value-based healthcare system.  The American Society of Anesthesiologists’ Committee on Performance and Outcomes Measurement (ASACPOM) has acknowledged that “monitoring of patient satisfaction has already been incorporated into payment for performance plans and will be an important component of other payer, healthcare plan affiliations.  It is a given that this trend will continue and that assessment of patient satisfaction will affect payment for anesthesiologists in the near future.”  (White Paper on Patient Satisfaction and Experience with Anesthesia, as revised June 9, 2014.)  Health plans use patient satisfaction surveys to evaluate physicians and to determine incentive compensation, and consumer web sites such as HealthGrades often report patient satisfaction ratings as the sole physician measure.  Patient satisfaction surveys are also playing a growing role in medical boards’ assessment of physicians’ competency.The ASA-Anesthesia Quality Institute’s Qualified Clinical Data...