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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When the Mode Gets Murky: A Review of Multi-anesthetic Scenarios
March 22, 2021
Determining the anesthesia mode can occasionally get complicated—both for the provider and the billing staff. Some situations can lead to unintended consequences, especially where a combined anesthetic is involved. It is important, then, for our readers to recognize the principles for correctly discerning and documenting the anesthesia technique where more than one may be in play.
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Anesthesia Business Consultants’ Spring 2021 Issue of Communiqué—Current News for the Anesthesia Specialty— Available Now
March 18, 2021
As loyal readers know, Communiqué is a complimentary publication with articles strictly relating to topics of anesthesia and pain management billing and practice management concerns. The content is carefully considered to ensure it is relevant and practical. You will not have to weed through articles that speak generally or don’t pertain to your specialty, because our entire newsletter is devoted to anesthesia and pain management. Communiqué will help you stay current and informed on topics relating to the management of your practice.
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The Cost of Anesthesia Care
March 15, 2021
There are two common misconceptions that hospital administrators frequently use to taunt their anesthesia practices during contract negotiations. The first is that anesthesia practices can use standard business strategies to reduce the cost of the care they provide without compromising the quality of the care provided. The second is that anesthesia practices can play a much more important role in optimizing the efficiency and cost effectiveness of the operating rooms they support. The reality is that while not all anesthesia practices are managed as well as others, their ability to manage their costs and impact the behavior of the operating room staff is minimal. Essentially, anesthesia practices are quintessential service organizations and at the mercy of the environments in which they operate. Many have even suggested that anesthesia practices occupy the bottom rung of the medical food chain—captive to every other department for their income and lifestyle.
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Anesthesia à la Mode
March 8, 2021
Learning the etymology behind certain phrases and words can be most enlightening. Studying the development of, and relationship between, certain words in the English language, or any other language, can assist us in better overall comprehension. Take the phrase, “‘a la mode,” for example. In American English, that phrase has come to mean “with ice cream.” Originally, however, it was a French phrase roughly meaning “in the fashion of” or simply “in fashion.” It is not surprising, then, that the English word “mode,” might be defined as something akin to form or fashion. So, when looking at the title of today’s article, the focus is not on flavorful dessert toppings—as delightful as that would be—but rather on the form and fashion of the anesthesia service. Today, we’re discussing the mode of anesthesia.
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Imagining Uberism in Anesthesia
March 1, 2021
Uber has dramatically transformed the taxi business. We no longer talk of grabbing a cab; we “Uber” from point A to B. Airports now send us to ride-sharing pickup points where we see dozens of people staring at their phones trying to find their rides. For many of us, the Uber and Lyft apps are the most used on our phones. Some of us have even given up our cars because it is so much easier to pay for the ride than to incur the costs of ownership.
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The Great Anesthesia Migration: Increased Inpatient Procedures to ASCs
February 22, 2021
On the move—that’s the story of mankind, isn’t it? From primitive times to the digital age, people groups from around the world have gathered their possessions and hit the road, looking for new vistas and new opportunities. There were great movements of people arriving from Europe to the eastern shores of America in centuries past, and then their descendants migrated further west. It is an inevitability of human society, it seems, that we must eventually transition to new places. We just can’t sit still. The latest evidence of this compulsion can now be seen in the American healthcare sector.
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TEE Documentation Requirements for Anesthesia Providers
February 15, 2021
There was a time, not too long ago, when cardiovascular anesthesiologists relied on three main monitoring devices to manage a patient’s cardiovascular functions during a CABG. The development of transesophageal (TEE) probes to monitor heart function via ultrasound from the esophagus changed that. Many anesthesia providers now find the TEE probe one of the most useful monitors. This diagnostic tool now provides real-time imaging of heart function, especially during critical phases of the procedure.
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Anesthesia’s Path Forward with the Quality Payment Program
February 8, 2021
The new year of quality reporting brings about some changes that may feel a little uncomfortable for the anesthesia specialty. As the Quality Payment Program (QPP) progresses, it will increasingly become harder to comply; however, there may be a light at the end of the tunnel with the MIPS Value Pathways (MVPs) initiative. In this update, we will briefly review what occurred in 2020 with respect to the QPP, as well as what is required for 2021. Lastly, we will provide a glimpse of the soon-coming MVP and what that might look like for anesthesia.
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The True Impact of Covid on the Specialty of Anesthesia in 2020
February 1, 2021
When we started hearing about the coronavirus early last year, most of us assumed it would have a significant impact on all anesthesia practices, but that it would only be an issue for four to six months. Now that we are into the next year, it is clear that while the worst of the storm may have passed, the residual implications may prove to be quite significant. Not all practices are back to 100% of their pre-Covid surgical volumes; many are still down five to ten percent. When it comes to collections, these are still lagging. The question we are all asking is what the new normal will look like.
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2021 PFS Final Rule: More Details for Anesthesia and Chronic Pain
January 25, 2021
In previous weeks, we have attempted to summarize for you some of the key provisions of the 2021 Medicare Physician Fee Schedule (PFS) Final Rule and subsequent legislation (e.g., Consolidated Appropriations Act) that will have a direct impact on anesthesia and chronic pain practices over the course of this year. We’ve brought to the attention of our readers new rules concerning such topics as telehealth, coding and conversion factors. The purpose of today’s article is to share some additional regulatory changes on tap for 2021, based, in part, on a PFS summary issued by the Centers for Medicare and Medicaid Services (CMS).
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The Ongoing Impact of Medicare on Anesthesia Practices
January 19, 2021
Baby boomers are increasingly entering the rolls of Medicare. While many of them lead healthy and active lives, this swelling of subscribers is having a profound impact on the Medicare program. It is this inevitable growth in beneficiaries and health care utilization that has led to the recent reduction in the Medicare rate for anesthesia services, which we now anticipate will be about 3 percent less in 2021 than it was in 2020. While many practice managers use this 3 percent rate drop to do a quick napkin calculation of the financial impact of the change, there is more to an assessment of Medicare rate changes than one might initially consider.
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Anesthesia Gets Some Relief: Conversion Factor Reductions Modified
January 11, 2021
Over the last several months, the American people have become quite accustomed to fast-moving and life-altering change. Often that change has involved financial and other setbacks that have been hard to endure. How refreshing it is, then, to see a change that actually involves some positive news—especially for our anesthesia and chronic pain providers. That news is outlined in the following sections.
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2021 CPT Coding Changes: Relevance for Anesthesia and Chronic Pain
January 4, 2021
With every new year, there arises within us the hope of better days ahead—a certain optimism fostered by a clean slate and a wide-ranging set of possibilities. New Year is a time of change. That holds true for the individual who resolves to make improvements in diet or lifestyle, and it’s often true in areas of business and government. New laws or policies go into effect with the coming of every January 1, and thus we are all programmed to prepare for annual change.
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Virtual Visits for 2021: Telehealth Rules Refined
December 28, 2020
During the course of this year, the Centers for Medicare and Medicaid Services (CMS) produced a number of rule changes concerning the utilization of telehealth services. Generally, these services describe a remote patient encounter with a clinician by means of both (as opposed to either) audio and visual technologies. Such encounters became all the more mainstream in 2020, given the concerns regarding physical interactions in this age of COVID. Many of our readers—to include both anesthesiologists and interventional pain physicians—have asked about or actively utilized telehealth in connection with their practices. Just as providers were getting used to the latest iteration of telehealth do’s and don’ts, the government is readjusting the goal posts once more.
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2021 PFS Final Rule: Financial Impact on Anesthesia
December 14, 2020
The Centers for Medicare and Medicaid Services (CMS) has released its Medicare Physician Fee Schedule (PFS) Final Rule for 2021. The document includes over 2,100 pages of provisions that address a myriad of topics, and it will take some time to review and process the voluminous information. Thankfully, CMS has already provided a summary of many of the more important components of the Rule. Until we are able to undertake a more comprehensive review of the Rule, itself, we want to provide you with an analysis of what appears to be its most impactful component—at least as it concerns the anesthesia specialty.
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The Value of Updating Your Practice on Anesthesia Documentation
December 7, 2020
As your billing partner, we encourage all our clients to participate in documentation in-services on an annual basis. We believe these are an important component of an effective compliance plan. Unfortunately, participation in such scheduled sessions is sometimes less than optimal. Based on this reality, it is worth reviewing the rationale and intent of such sessions and the careful consideration that has gone into their preparation.
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In Stark Contrast: Viewing the Stark Law from a New Lens
November 30, 2020
In the ancient past, stargazers assumed that the celestial bodies visible at night numbered a little over a thousand. This was due in part to Ptolemy’s highly-regarded catalogue of stars, published in the second century. He had meticulously counted the lights in the night sky that he could visualize at his level of latitude, using only his naked eye. Fast forward a couple of millennia and, using the orbiting Hubble telescope, we’re now able to view innumerable galaxies—each containing billions of stars.
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Nerve Blocks for Acute Pain Management: The Main Coding Challenge
November 23, 2020
The use of nerve blocks for acute pain management has undergone a dramatic transformation over the past ten years. Not only has the number of blocks performed by our clients increased significantly, especially for the management of orthopedic procedures, but providers have introduced new and refined techniques and approaches. Three main codes have generally served the needs of most providers. They are 64415 for interscalene blocks, 64447 for femoral nerve blocks and 64445 for sciatic block—all of which are paid from a surgical fee schedule and not ASA units, as would be the case for anesthesia services. There are a number of variations on the theme that have been sanctioned by CPT, the definitive coding reference guide. For example, adductor canal blocks are billed as femoral blocks and popliteal blocks are billed as sciatic blocks.
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When Uncertainty Abounds: Anesthesia Providers Wait and Wonder
November 16, 2020
There is nothing more unsettling than not knowing. That is especially true where the information being withheld is critical to your interests, to your wellbeing. It’s one thing to be unable to find the box scores relating to your favorite sports team or to be forced to wait until next season to see what happens in the most binge-worthy television series (think Stranger Things). These are reasons for nervous impatience, to be sure. However, it’s a whole other matter to spend weeks or months worrying about whether you’re going to lose ground as it pertains to your financial security. Real life involving real uncertainties—that’s the state that anesthesiologists and anesthetists find themselves in mid-autumn 2020.
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Opioid-Free Anesthesia
November 9, 2020
At a recent documentation in-service session for one of our clients, the question was asked if there was a modifier for opioid-free anesthesia. The short answer to the question is no; there is no billing modifier that would enhance the payment opportunity for a case that did not involve the administration of opioids, nor would we expect there to be. In American medicine, providers get payment for services they provide, not for services they do not provide—regardless of the social value of a given clinical strategy in the eyes of many. Some contracts have a quality metric based on the minimization of opioid use, but this should not be confused with payment opportunities.
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The Clinical Classroom: Specific Scenarios for the Anesthesia Teacher
November 2, 2020
Two weeks ago, we presented the first in a two-part series of articles devoted to the intricacies and oddities of billing while teaching. We learned that an anesthesiologist can get paid at the personally performed rate, even when running two resident cases. We discussed the two-case principle and the meaning of “resident,” from a Medicare perspective. Finally, we looked at some historical changes in the billing rules for cases involving residents and student nurses.
