Anesthesia Industry eAlerts
Sent to subscribers every Monday morning, our eAlerts deliver timely updates on regulatory, legislative and practice management developments of interest to anesthesia professionals.
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eAlerts
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Demographic Trends that Impact Anesthesia Practices
December 6, 2021
Anesthesia has been undergoing a significant paradigm shift. It used to be that the primary focus and concern of anesthesia providers was what happened within the four walls of the operating room. Successful anesthesia care involved a careful balance of art and science. What mattered was that each and every patient had a safe and comfortable surgical experience. It was all about the outcome. The problem was that outcomes were so consistently good that they became a given. As this occurred, the quality of care became less important than the economics of care. The fact is that, in today’s dynamic healthcare marketplace, what happens outside the O.R. is now the key to a practice’s success. The challenge, of course, is that what happens outside the O.R. and the hospital is almost completely out of the provider’s control, and the tools and strategies that allowed them to be successful clinicians are virtually useless in this new context.
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SPECIAL ALERT: Anesthesia for Epidural Steroid Injections in Jeopardy
December 1, 2021
A few months ago, we published an alert describing new hurdles Medicare put in place for anesthesia providers in connection with facet intervention cases. Now, Medicare is making it more difficult to get paid in epidural steroid injection (ESI) cases. Beginning this month, a new policy will go into effect across the country that will dramatically reduce the circumstances in which anesthesia services can be reimbursed in connection with patients receiving chronic pain epidurals. This includes not only interlaminar ESIs but transforaminal ESIs, as well.
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2022 MPFS Final Rule: Part Two
November 29, 2021
A couple of weeks ago, we reviewed for our readers some of the major provisions of the 2022 Medicare Physician Fee Schedule (MPFS) Final Rule (FR), including a look at the new conversion factors (CFs), evaluation and management (E/M) changes, and modifications to the critical care rules. Today’s article will summarize additional areas of the FR that particularly pertain to our anesthesia and chronic pain clients.
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Anesthesia Practice Size: Is Big Better?
November 22, 2021
As Americans, we have a fascination with bigness. We are raised in the belief that bigger is better, especially when it comes to business. There is a famous joke about an international book competition where the topic was elephants. The American submission was entitled: “How to Make a Bigger and Better Elephant.” The real question is, when is size an advantage in the structure and operation of an anesthesia practice? It is a good question, especially in the current environment where hospitals and health plans keep merging and growing.
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First Look at the Final Rule: Anesthesia Takes Another Hit
November 15, 2021
On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) Final Rule (FR). The rule includes payment and quality provisions that will take effect on January 1, 2022. In addition, CMS produced a fact sheet summarizing the key provisions of the FR. The following will act to highlight some of the more pertinent provisions of the FR from the anesthesia specialty standpoint.
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The Challenge of Succession Planning for Private Anesthesia Practices
November 8, 2021
A critical aspect of any governance model is succession planning. Identifying and developing strong leadership and assuring a peaceful transition of power are items that need to be added to every group’s strategic planning agenda.
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Anesthesia Time in Extended Situations
November 1, 2021
It happens occasionally. A teacher waits for a delayed parent to pick up the last remaining child at the end of a school day. The babysitter demands another ten because you arrived home an hour later than arranged. These temporal disruptions in our otherwise routine schedules are not supposed to occur, but they inevitably do. Now what? That’s what many anesthesiologists and anesthetists would like to know. After all, they, too, are not immune to the caprices of time.
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Anesthesia Negotiation: Who Are the Players?
October 25, 2021
It used to be that when an anesthesia services agreement came due, the head of the group would sit down with the CEO or the CFO of the facility and work out any updates that might be needed. Usually, the corporate attorney would review the agreement, suggest a few modifications, and the deal would be done. Maybe the process was not always so simple for all groups; but, when there was no need for a financial subsidy, it was generally a perfunctory process.
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The Big MAC: Sizing Up Monitored Anesthesia Care
October 18, 2021
Several months ago, we published an article on the three anesthesia techniques available to anesthesiologists and anesthetists from a documentation and billing perspective. Today’s article focuses particular attention on the third of those techniques: monitored anesthesia care (MAC). Unlike general and regional anesthesia, MAC comes with a unique set of nuances for providers to consider. To be more direct, there are potential pitfalls in getting paid unless certain patient circumstances are in play and successfully documented. MAC is not a slam dunk.
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The Importance of Strategic Planning for Anesthesia Practices
October 11, 2021
There is a tendency to think of strategic planning in today’s medical group environment as something limited to overpaid management consultants who are trying to impress their clients with the value of a SWOT analysis. While it is true that most anesthesia practices do not hold regular strategic planning sessions or formally commit time to the future of the practice, such activities can nevertheless be significant to the survival and viability of the practice.
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No Surprise Act Final Rule: What Anesthesia Groups Need to Know
October 4, 2021
On September 30, 2021, the U.S. Department of Health and Human Services (HHS), along with other federal departments and agencies, issued an interim final rule (FR), which fleshes out and acts to implement provisions of the previously passed No Surprises Act (NSA). As you will recall, the NSA represents Congress’s attempt to put an end to certain balance billing practices in out-of-network (OON) cases, with the intent of protecting beneficiaries from unexpectedly high medical bills. The law goes into effect the first of next year. This FR establishes the specific mechanisms by which the NSA will take effect. Among other items, it outlines a new federal independent dispute resolution process, good faith estimate requirements for uninsured (or self-pay) individuals, and a patient-provider dispute resolution process for uninsured individuals. We will provide a summary of each of these provisions, based in part on an interim final rule fact sheet recently released by the Centers for Medicare and Medicaid Services (CMS).
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Articulating the Anesthesia Value Proposition
September 27, 2021
We all know that anesthesia is an essential element in the running of an operating room. It is the anesthesia provider who makes it possible for the surgeon to successfully perform the procedure. Patients must remain motionless, be pain free and not have any unexpected reactions to the trauma of the surgery. Many would even say that anesthesia providers do more to determine the quality of a patient’s overall surgical experience than the surgeon. Then, again, this is what anesthesiologists and CRNAs have been trained to do; so, this is what is expected of them. The fact is that most patients are at greater risk driving to the hospital than undergoing anesthesia for surgery. So, what is the big deal?
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An Early End: Anesthesia Considers Canceled Cases
September 20, 2021
All good things must come to an end, or so the saying goes. The problem arises when they come to an end too soon—suddenly and unexpectedly. Often times, there is little consolation for the rainout of a barbecue or the cancelation of a concert or the sudden loss of a once beautiful relationship. Abrupt endings are rarely desirable; but, every now and then, they can come with a slice of solace. That circumstance particularly applies where the anesthesia provider finds him or herself faced with a canceled case.
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What Hospitals Want from Anesthesia Providers
September 13, 2021
Traditionally, hospital administrators have had three kinds of expectations of anesthesia providers. Many used to refer to them as the three A’s: ability, affability and availability. Providers were assumed to be competent to perform any kind of surgical or obstetric case. Quality of care was considered a given. With regard to the relationship with the OR staff and surgeons, anesthesia providers are expected to be affable and accommodating even when surgeons are being unreasonable. Most important of all, though, someone from anesthesia should always be available for every case the staff wants to book. As if this weren’t a tall enough order, there is now a fourth A: affordability. In this era of hospital subsidies and financial support, what used to be a free good now has a serious cost, and this has changed everything.
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Breaking Down the Back End: Anesthesia in the Postoperative Period
September 7, 2021
It’s all in how you finish. Sprinting out of the gates at the sound of the starting gun during a local marathon will put you in the lead for a while. You’ll look pretty good in comparison to all your competitors, at least for a short time; but, because you expended so much energy at the outset, you’re likely to quickly tire and wind up finishing dead last. In any endeavor we undertake, the ideal is to maintain excellence from beginning to end. That is, we should not flag or let up just because we’re nearing the time of completion. We should finish strong.
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The Value of the Anesthesia Database
August 30, 2021
Historically, revenue cycle management companies have developed their software to navigate the intricacies and exigencies of billing. The idea was to ensure that claims could be coded and calculated correctly. The software included all the claim formatting requirements for each distinct plan. One of the primary challenges of today’s anesthesia billing is that the way charges are calculated does not always conform to the way payers calculate payment. Billing software used to serve an important editing function to ensure prompt and accurate claim submission and payment verification. Management reporting tended to focus on the financial and provide industry standard views and metrics so that clients could monitor collections, evaluate revenue cycle performance and track key trends, such as evolution of payer mix.
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Exceptions to the Rule: What Anesthesiologists Can Do During Medical Direction
August 23, 2021
There is always, it seems, an exception to every rule—an “exception that proves the rule.” It’s always “i” before “e,” except after “c,” right? You can turn right on red, except in those jurisdictions that don’t allow it. Exceptions to rules are pervasive throughout our daily life, and they exist in the anesthesia world, as well.
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Anesthesia Manpower Update
August 16, 2021
The hot topic of the day is the shortage in anesthesia manpower. Not since the 1990s with the publication of the Abt Corporation report has there been such concern about the dwindling supply of anesthesia providers. Some of us remember the publication of that report and its claim that there would be a surplus of anesthesia providers in the coming years. This belief led many second- and third-year residents at that time to opt for other specialties. It took the anesthesia specialty quite a number of years to recover. Now we are experiencing another shortage, and many people are asking if it’s real and, if so, why is it happening.
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2022 Proposed Medicare Fee Schedule: Additional Provisions for Anesthesia and Pain
August 9, 2021
Last month, we published an alert outlining the provisions of the 2022 Medicare Physician Fee Schedule (PFS) Proposed Rule (PR) that were most pertinent to the practice of anesthesia. As promised in that alert, this article will act to provide further details arising from the PR that may impact our readers’ practices—including those in the chronic pain specialty. Again, this material is based on a summary of the 2022 PFS PR provided by the Centers for Medicare and Medicaid Services (CMS) and the PR itself.
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The Future of Independent Anesthesia Practice
August 2, 2021
The specialty of anesthesiology appears to be at a crossroads. Historically, anesthesia providers have prided themselves on their independence and autonomy. In private practice, providers have always preferred a single specialty group, even though most academic practices are part of a multi-specialty faculty practice model. This preference appears to be the result of at least three factors. Anesthesia providers see themselves as a quintessential service specialty committed to enhancing the safety and comfort of surgical and obstetric patients. It is also true that anesthesia billing is unlike that of any other specialty; surgeons don’t have to worry about the time they spend performing procedures, nor do they have such an arcane billing formula to contend with. All they need are CPT and ICD-10 codes to get paid. And then there is the question of the revenue potential of the specialty. Anesthesia providers dread the thought that their revenue will be used to support less profitable specialties such as internal medicine. These strongly held positions notwithstanding, the world is changing. Increasingly, hospitals and healthcare organizations prefer the idea of a collaborative approach to the provision of healthcare.
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The Challenge of Anesthesia Contracting
July 26, 2021
The traditional view of effective practice management considered aggressive payer contracting essential to optimizing practice finances. Conventional wisdom has always held that it is easier to get money from insurance plans than from patients. The problem is that public payer rates for Medicare, Medicaid and workers compensation are non-negotiable. This has meant that anesthesia practices have had to focus their negotiations on an ever-shrinking percentage of commercial payers such as the Blues, Aetna, Cigna and United.
