Leadership has never been more important in anesthesiology than it is today.  As the specialty demands and takes ownership of increasing levels of responsibility in healthcare reform, the quality of leadership becomes one the fundamental factors that determine success.  Developing the Perioperative Surgical Home (PSH), the most exciting organizational concept to emerge within anesthesiology this century, requires outstanding leaders.  So does maintaining the highest quality of patient care in each anesthesiology department or practice. Recognizing the value of leaders and also their role in enhancing each others’ skills as well as those of the broader community, the Anesthesia Quality Institute (AQI) has created an Anesthesia Leadership Registry, a database of more than 250 ASA members who serve in leadership roles. The purposes of this registry are threefold, according to Richard P. Dutton, MD, MBA, Executive Director of the AQI (“Data, Data, and More Data—Where’s the Value?” Presentation given at the ASA...

1. Senate Passes SGR Repeal BillWe are very happy to advise you that late last night, the Senate passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) 92-8 and did away with the Sustainable Growth Rate (SGR) formula at long last.  Had the Senate not acted, Medicare payments to physicians would have been reduced by 21.2 percent, effective April 1.  Instead, Medicare payments will increase by 0.5 percent for the next five years beginning on July 1, 2015.Claims that Medicare held for services provided between April 1 and April 14, pending Senate action, will now be processed and paid at the rates that were in place during the first quarter. Other changes in the legislation include an extension of the Children's Health Insurance Program by two years as well as a consolidation of Medicare’s quality reporting programs into a single merit-based incentive payment system (MIPS).  The MIPS and the...

Let us begin with the basic answer to the question in the title of this Alert:  anesthesiologists continue to benefit from a specialty-based exemption from the Electronic Health Record (EHR) Incentive Program’s “meaningful use” (MU) requirements, so only those who are have chosen to earn the incentive will be affected directly by the new Stage 3 rules.  Pain physicians may be affected, unless their practice meets the EHR program definition of “hospital-based” or they have been granted a hardship exception (see Alert dated February 16, 2015). The Stage 3 changes to the MU requirements, as described in a proposed rule issued on March 20, are part of what CMS calls its “broader efforts to increase simplicity and flexibility in the program while driving interoperability and a focus on patient outcomes in the meaningful use program.”  The most significant of the changes that would be implemented beginning in 2017, if the Stage...

Once more, the law preventing the Sustainable Growth Rate (SGR) formula from wreaking havoc on Medicare payments to physicians is about to expire. Payments are scheduled to decrease by 21.2 percent on April 1. On Thursday, March 26, the House of Representatives voted overwhelmingly 392-37 in favor of the bipartisan Medicare Access and CHIP Reauthorization Act (H.R. 2), which had already received an enthusiastic response from physician organizations, as well as strong support from President Obama.  On Friday, disappointingly, the Senate recessed without taking action on the bill.  The pressure is on for the Senate to bring the legislation to a vote soon after it reconvenes on April 13, and many observers expect passage.  We at ABC encourage all our readers to contact their Senators during this recess and urge them to support the legislation so that the SGR goes to its grave at long last. In the short term, CMS...

The New York Attorney General announced, on March 11, 2015, that his office had entered into a settlement agreement with EmblemHealth, Inc., requiring the health plan to cover anesthesiology services provided in connection with an in-network preventive colonoscopy, without any cost-sharing by the patient.  The agreement includes a $25,000 penalty and applies not just prospectively but also requires Emblem to send nearly $400,000 of reimbursements to 255 patients who were inappropriately charged co-payments. The Affordable Care Act (ACA) requires health plans to provide first-dollar coverage for colorectal cancer screening tests and certain other preventive care services, waiving any patient co-insurance, co-payments or deductible amounts.  The Emblem agreement expressly extends the requirement to anesthesia for screening colonoscopies:  “Because colonoscopies necessitate the administration of anesthesia, anesthesia services provided in connection with preventive colonoscopies should likewise be covered without member cost-sharing.” In the final Physician Fee Schedule rule for 2015, the Centers for Medicare...