CMS released the Final Medicare Fee Schedule Rule for 2016  on October 30, 2015.  The November 9th issue of F1RSTNews discussed the conversion factors for anesthesia ($22.4426) and for other services ($35.8279) and some of the changes to the measures and registry options for the Physician Quality Reporting System (PQRS).  The final rule addresses a number of other matters of interest to anesthesiologists and pain physicians.  In this issue, we will summarize developments concerning the Value Based Payment Modifier (VM). The VM adjusts Medicare fee-for-service payments either upward or downward by assessing both the quality of care and the cost of the care provided, as explained in our November 3, 2014 Alert What Anesthesiologists Need to Know about the Value-Based Payment Modifier.  It is an adjustment made on a per claim basis to Medicare payments for physician services.  It is applied at the Taxpayer Identification Number (TIN) level to physicians (and beginning...

Sometimes those of us in the healthcare industry become so immersed in the multitude of applicable regulations, and their evolution and ambiguities, that we need to take a step back and be reminded of the basics. So for a few moments, let’s push aside the status of healthcare reform, the future of independent anesthesiology practices, the abstract and sometimes conflicting guidance governing anesthesia joint ventures and the nuances of ICD-10. Let’s refresh our recollection regarding a federal law that has been with us in various forms for about 25 years and that continues to impact us each day. This is a broad overview of the federal Stark law1 in 10 quick bullet points. It’s important to understand what Stark is and what it is not. It is relatively common for healthcare attorneys to receive calls from clients requesting a Stark review of a relationship when the Stark law is not even...

CMS has now finalized its proposal to cover total joint replacement (TJR) procedures through a bundled payment methodology.  Under the Final Rule issued on November 16, 2015, some 800 hospitals across the country will be financially responsible for all of the inpatient and postoperative care of patients undergoing total knee or hip replacements from admission until 90 days after discharge.  CMS estimates that the new bundled-payment test will cover about 23 percent of TJR surgeries for which Medicare pays and save Medicare $343 million over the five performance years of the model. Through the Comprehensive Care for Joint Replacement (CJR) payment model, hospitals in 67 Metropolitan Statistical Areas (MSAs) will receive additional payments if quality and spending performance are strong or, if not, potentially have to repay Medicare for a portion of the spending for care surrounding a lower extremity joint replacement procedure.  The goal of the CJR model, according to...

particular, the ever-growing complexity of the Physician Quality Reporting Program (PQRS) and the newer Value Based Payment Modifier seems more likely to generate frustration than to lead to major improvements in healthcare safety and outcomes. As noted in last week’s Announcement (The Anesthesia Conversion Factor and PQRS Changes in the Final Medicare Fee Schedule Rule for 2016), CMS is adding five items advocated by ASA to the list of PQRS measures that can be reported to a registry: Measure # 404:  Anesthesiology Smoking Abstinence; Measure # 424:  Perioperative Temperature Management  (which revises and replaces Measure # 193); Measure # 426:  Post-Anesthetic Transfer of Care Measure: Procedure Room to a Post Anesthesia Care Unit (PACU) (using a checklist or protocol); Measure # 427:  Post-Anesthetic Transfer of Care: Use of Checklist or Protocol for Direct Transfer of Care from Procedure Room to Intensive Care Unit (ICU), and Measure # 430:  Prevention of Post-Operative...

Anesthesia practice management used to be relatively simple. Bill correctly, collect aggressively, and everyone is happy. It is true that Medicare and managed care made getting paid a little more challenging, but a good day’s work in most facilities generally resulted in enough revenue to cover the cost of the providers, and when it didn’t most hospitals have been willing to make up the difference with some level of stipend or revenue guarantee. Most anesthesia providers would argue that for all the payment challenges created by diverse payer rules, fee for service medicine is still the preferred system. They like the fact that you get paid to provide services. What they don’t like are the increasing layers of complexity being imposed by efforts to measure quality and appropriateness of care. Especially concerning is the perception that what started as a trickle of inconvenient reporting requirements is gaining momentum to form a...