December 26, 2017

We close the year with a glance back at some of the most significant healthcare- and anesthesia-related developments of 2017.  The word of the year in health law and bioethics was “uncertainty,” Carmel Schacar and I. Glenn Cohen of Harvard Law School proclaimed on Health Affairs’ blog.  The same might well be said of the healthcare sector as a whole as well as of anesthesia, which experienced a few glitches of its own.  The current climate of changeability reminds anesthesia professionals of the importance of doing all within their power to remain targeted, resilient, compliant and value-driven.

Some—not all—predicted that the Affordable Care Act would be repealed and replaced in 2017.  After several attempts by a Republican Congress, that didn’t happen.  Much remains to be seen now that the House and Senate have passed the Tax Cuts and Jobs Act of 2017, which calls for elimination of the individual mandate and gives more Medicaid decision-making authority to the states.  In the meantime, the ACA remains the law of the land and we continue to abide by its provisions.

The transition to value-based payment and the federal government’s emphasis on quality reporting stayed essentially intact, although the Centers for Medicare and Medicaid Services (CMS) raised the low-volume threshold for exclusion for year two of the Quality Payment Program from $30,000 to $90,000 in annual Medicare billings, reducing the number of anesthesiologists and nurse anesthetists required to participate in 2018 without facing a penalty in 2020. 

Still, as former CMS acting administrator Andy Slavitt predicted a year ago, the shift toward a value-based system that rewards clinicians for the quality, safety and cost-effectiveness of their care continues.  To support the specialty, the CMS-approved anesthesia Quality Clinical Data Registries (QCDRs), including ABC’s QCDR, joined forces this past fall with the American Society of Anesthesiologists to form a QCDR Roundtable with the goal of harmonizing quality measures in keeping with CMS policy.

It was a record-breaking year for natural and man-made disasters and mass casualty events.  The costliest wildfire season and the worst mass shooting in United States history, three Category 4 hurricanes, and at least 16 natural disasters that caused more than $1 billion in damage each reiterated, more powerfully than ever, the need for hospital—and anesthesia department—emergency preparedness, and, by extension, careful documentation when disaster strikes.  With climate change patterns and evidence of a copycat effect among perpetrators of mass shootings, the message for anesthesia providers is clear:  be prepared.  Our communities depend on you for it.

Disasters and potential disasters involving electronic protected health information (PHI) also loomed large this year, as the WannaCry and other ransomware viruses demonstrated the vulnerability of our hospital and office IT systems.

Balance or “surprise” billing remained a major issue for consumers and advocacy groups, with several states introducing legislation designed to protect patients.  We saw anesthesia practices cope with the controversy by, among other things, entering into contract negotiations with the insurance carriers with whom they have previously been out of network, and aligning themselves with the contracting strategies and in-network profiles of the facilities they serve. 

The total number of opioid prescriptions may have been declining since 2010, but prescribing remained high, and the opioid crisis continued to rage, with numbers reported in 2017 showing that more Americans died of drug overdoses (most of which were opioid-related) in 2016 than were killed in the Vietnam War.  President Trump officially declared the opioid epidemic a national public health emergency, the Administration’s opioid commission released its recommendations for combatting the crisis, and public health experts and advocacy groups called for rapid increases in government funding for prevention, education and medication-assisted treatment.

At the same time, the Department of Justice and the Office of Inspector General zeroed in on opioid-related fraud and abuse, with pain specialists and prescribing practices becoming more frequent targets of investigations.  Clinicians explored opioid-sparing perioperative pain management techniques and continued the complex balancing act of prescribing narcotics judiciously, at the lowest effective doses, for the smallest number of days, seeking alternatives first, while advocating for continued access to therapy including opioids for chronic pain patients who truly benefit and are not at risk of addiction.

The latter part of the year brought publication of the 2018 Medicare Physician Fee Schedule, which, as feared, included sizable reductions in anesthesia payments for such services as screening colonoscopies.  Despite a slight increase in the anesthesia conversion factor, these changes are expected to have a significant impact on many practices.  We will be monitoring and reporting on that impact in 2018.  

The level of unpredictability, uncertainty and change that characterizes modern healthcare and that distinguished 2017 has contributed to physician burnout rates that are at an all-time high, with 51 percent of anesthesiologists reporting burnout in the most recent Medscape survey.  Anesthesia practitioners might take a cue from the inspiration medical student, Erin Barnes, writing in Stat, received from a physician mentor who said that he is terrible at “work-life balance” but copes by keeping a binder of his successes.  “When you see it all there you really can’t help but be proud of the career you chose, the work you’re doing, and the difference you are making in patients’ lives,” he said.  Indeed.  Thank you for all you do.

With best wishes for a happy, healthy and productive new year,

Tony Mira
President and CEO