The national average Medicare anesthesia conversion factor (CF) effective January 1, 2016 will be $22.4426, down from $22.6093 in 2015, which is a decrease of $0.1667 per anesthesia unit.  Geographically-adjusted CFs for the 90-odd Medicare localities are not yet available. The general Medicare physician fee schedule CF, which is used to calculate payments for visit services and pain medicine and other non-anesthesia procedures, will be $35.8279, a decrease of 10.56 cents per relative value unit (RVU).  CMS announced the new CFs in the Final Rule containing Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016, released on October 30.After the elimination of the Sustainable Growth Rate (SGR) formula in last spring’s Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), we had hoped to see the last of the “negative updates” or cuts in Medicare payment rates.  MACRA replaced the SGR with...

The Centers for Medicare and Medicaid Services (CMS) Bundled Payments for Care Improvement (BPCI) initiative is comprised of four broadly defined models of care, which link payments for the multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. The intent is for these models to lead to higher quality and more coordinated care at a lower cost to Medicare. Traditional Medicare reimburses physicians on a fee-for-service (FFS) system, through Part B, and hospitals under an inpatient prospective payment system (IPPS) through Part A. Both systems are triggered by individual services being provided to beneficiaries for a discrete illness or course of treatment. Various studies have demonstrated that this approach can result in fragmented care with minimal coordination across providers and healthcare settings. As we have heard many times, the payment systems are geared...

Telemedicine, in one form or another, is going to be part of most physician practices within the next decade.  For many doctors, it will arrive sooner, if it is not already here.  Five years ago, Dr. Girish Joshi wrote in the ASA Newsletter (Global Patient Perioperative Care through Clinical Pathways, ASA Newsletter. 2010; 74(8):10-12):Telemedicine is a term used to describe health care provided by a practitioner at a remote location with the help of advanced technologies.  Telemedicine is expected to play an increasingly important role in outpatient settings (e.g., home health care, remote patient monitoring, chronic disease management and rural health care) as well as in hospital settings (e.g., emergency department and ICU). Other applications of telemedicine include battlefield medicine, maritime medicine and aviation health care.  Telemedicine provided in the critical care setting is commonly referred to as e-ICU.  e-ICU has been proposed as a potential means of bringing the expertise...

The third-party medical payment system is so complicated that incorrect payments are not uncommon.  Sometimes the error is in the provider’s favor.  The health insurer may ask the provider—in this instance, the anesthesia practice—to refund an alleged overpayment.  How should the practice handle such requests?  The American Medical Association (AMA) has published an excellent Overpayment Recovery Toolkit, which we summarize in this Alert while referring readers to the 14-page Toolkit for more detailed information. When do payers request refunds of overpayments?Managed care contracts typically permit the payer to recover alleged overpayments by reducing or “offsetting” overpaid amounts from pending or future claims payments.  The problem does not generally arise with non-contracted payers since they are apt to reimburse the patient instead of the practice. Payers request refunds—or offset overpaid amounts against other payments to the physicians—when any of the following occur:Duplicate paymentsAnother insurer is responsible (coordination of benefits problem)Patient’s coverage has...

One feature of the Affordable Care Act (ACA) that has received limited attention is the high-cost plan tax (HCPT), aka the “Cadillac plan” tax.  Beginning in 2018, employer health benefit plans with a value exceeding certain thresholds will be subject to an excise tax of 40 percent on the incremental costs of those benefits.  This tax is likely to affect anesthesia practices in two ways:  (1) in many instances, patients with employer-provided insurance may be responsible for a greater share of their health costs and (2) practices that offer relatively rich health benefits may themselves owe the excise tax. In 2018, the thresholds for the tax are $10,200 for individual coverage and $27,500 for family coverage.  They will increase annually based on the general rate of inflation.   The Kaiser Family Foundation (KFF) published a report on August 25, 2015 (How Many Employers Could be Affected by the Cadillac Plan Tax?) in...