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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First Look at Proposed Medicare Fee Schedule for 2024
July 18, 2023
The 2024 Proposed Medicare Fee Schedule has been released, and it’s not looking good for anesthesia, chronic pain management and several other specialties. Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that lists changes for Medicare payments under the Medicare Physician Fee Schedule (PFS), effective on or after January 1, 2024.
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Anesthesia Flat Fees: The New Frontier
July 17, 2023
All charges for anesthesia services can be lumped into three categories based on how they are paid. The majority of charges are time-based surgical charges where the charges and payments are calculated on the base value plus time and modifier units multiplied by a conversion factor. Obstetric charges involve a value based on the outcome of the delivery plus time, which may be calculated based on a number of different methodologies. Because payment methodologies vary considerably, it is always useful to analyze labor epidural payments as a separate category of services. The third category includes all the non-time-based services and procedures that are typically paid from a fee schedule that has nothing to do with the values in the Relative Value Guide (RVG), published by the American Society of Anesthesiologists (ASA). This third category includes charges for invasive monitoring, nerve blocks for acute pain management, ultrasonic guidance and a variety of other services such as Evaluation and Management (E/M) services.
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Viral Vids and Other Distractions: When Anesthesiologists’ Attention Gets Diverted
July 10, 2023
It’s not unheard of. In fact, it’s human nature. Sometimes, we just take our eyes off the ball. Like the napping sentry on night watch or the student who doodles and dawdles in class, there are times when we fail to keep our minds on the task at hand. While occasionally harmless, in the context of anesthesia this failure can lead to significant consequences.
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Monitored Anesthesia Care: The Rest of the Story
July 3, 2023
While anesthesia providers may employ a wide variety of techniques to induce anesthesia from a coding and billing perspective, every case must be reported as only one of three modes of anesthesia: general anesthesia (GA), monitored anesthesia care (MAC) and regional anesthesia. The predominant mode for surgical cases is GA, and regional is the typical mode for obstetrics. It is MAC that seems to cause some confusion. Given the history of the term and the evolution of the specialty, this confusion is clearly understandable. The purpose of the following discussion is to put the reporting of anesthesia technique into perspective.
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Rejected: The Ever-Rising Rate of Claim Denials
June 26, 2023
Rejection hurts. And for those who have experienced the rejection of a job application, a turn down after a tryout, or the rebuff of a romantic overture, the feelings of failure and inadequacy can be hard to overcome. No one likes to be rejected! And that is especially true when it comes to having your own insurance company—to whom you have been faithful in paying those monthly premiums—reject your claim for coverage of a necessary and legitimate medical procedure.
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Medicaid Coverage Trends: Impact on Anesthesia
June 19, 2023
There are a number of public payers that have a material impact on all anesthesia practices for two reasons. First, the rates for Medicare, Medicaid, Champus, Tricare and workers compensation are set by government agencies and are non-negotiable. In addition, the rates that have been set for federal and state insurance programs are significantly discounted as compared to the average commercial payment rate in every part of the country. Because of this reality, we often track what we refer to as the PPP—the public payer percentage—because it has such a dramatic impact on the overall average yield a practice can achieve per billed ASA unit.
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Something in the Wind: Renewed Hope for Better Reimbursement
June 12, 2023
It’s just a feeling you have. You can’t put your finger on it, but you know something’s afoot; something’s in the wind; something significant could be coming your way. For those in the medical community who have been disappointed time and again with annual announcements of reduced Medicare payments, there is news coming out of our nation’s capital that may provide renewed hope.
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Assessing the Migration of Surgical Cases: From Inpatient to Outpatient
June 5, 2023
Over the past decades, anesthesia providers have noticed a dramatic migration of surgical cases from traditional inpatient venues to a variety of outpatient venues—including outpatient facilities at hospitals, free-standing ASCs and doctor’s offices. Strategically, this has created some interesting opportunities, especially in certain markets. Our data reflects a simple reality: the larger the practice and the more facilities it covers, the larger the percentage of outpatient cases. Some of our largest clients see as many as 75 percent of all surgical procedures performed in outpatient venues.
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Anesthesia Technique and Postoperative Pain: Examining the Available Options
May 30, 2023
I can still remember that line from the classic comedic film, The Blues Brothers. When asked by the blues band’s front man what type of music is usually performed at this particular venue, the bar owner’s wife says with an assuring smile and a cosmopolitan confidence, “Oh, we have both kinds—country AND western!” The band knew they were in for a long night.
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What Anesthesia Providers Should Know about Their Surgeons
May 22, 2023
In the current environment, many of the managers and directors of most anesthesia practices are increasingly concerned about the revenue potential of their practices. An increasing Medicare population is just one of the potential challenges placing downward pressure on a practice’s revenue potential. Most practices must rely on the financial support of their primary facilities to generate enough income to recruit and retain an appropriate team of qualified providers. While many hospital administrators recognize the importance and value of a strong anesthesia department, even their resources are not unlimited. These challenges are forcing most practices to perform a deeper dive into the factors that determine their income and lifestyle.
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In Hot Water: Cautionary Tales for Pain Providers
May 15, 2023
According to a source on the history of idioms, there was a custom in ancient times of pouring a cauldron of boiling water onto unwelcome intruders or enemy soldiers from an upper window or castle wall to encourage their retreat. From at least the 1600s, to be “in hot water” meant to find oneself in some measure of trouble—usually as a result of your own ill-considered actions.
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What Makes for an Ideal Relationship Between an Anesthesia Practice and the Hospital Administration?
May 1, 2023
Too many anesthesia practices are experiencing a less than collaborative relationship with the administration of the facility where they provide services. Given what an important role anesthesia plays in the management of the operating rooms, this can be a particularly troubling state of affairs. Anesthesia services bring such value to the facility. The anesthesia provider does more to enhance the patient’s overall surgical experience than the surgeon, leading many to wonder why the relationship is not more compatible. Obviously, part of the explanation is historical. In many facilities the anesthesia providers were the masked men about whom little was known. More recently, many in the administration see them as the annoying providers who are always asking for a bigger subsidy or other forms of financial support.
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Determining A Fair Compensation Package for Anesthesia Providers
April 24, 2023
One of the most perplexing challenges in the current anesthesia market is determining what is a fair and reasonable compensation package for the physicians and CRNAs in the practice. Because the cost of providers is the biggest item in the budget, it plays a critical role in any request for a subsidy from the hospital. While there is some national data based on surveys of anesthesia practices, the data is not always useful or relevant in setting compensation levels. Because of the national anesthesia manpower shortage, we are seeing more movement of anesthesia providers from one practice to another than at any time in the past. It is relatively easy for providers to jump from one practice to another, and many factors come to bear on their level of satisfaction and their willingness to change. A client practice in the West noted that, after twelve years of relative stability among the team, they have now lost seven providers over the preceding 10 months.
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Sacroiliac Joint Injections: New Headache for Chronic Pain Practices
April 17, 2023
Nobody said the practice of medicine would be easy. The clinical challenges are difficult enough, but providers must also contend with roadblocks to reimbursement that continue to be placed in their path by expanded rulemaking on the part of federal and commercial payers.
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The Evolving Importance of Cardiovascular Anesthesia
April 10, 2023
There was a time, not too long ago, when cardiovascular anesthesiologists were the most respected members of anesthesia practices. Their specialized training and complexity of cases distinguished them both in terms of clinical skills and compensation. It was not uncommon for the cardiovascular surgeons to only allow certain members of the anesthesia practice into the heart room. Although these anesthesiologists rarely performed the greatest number of cases, the acuity of care inherent within their casework was often intense as most patients had advanced stages of coronary artery disease.
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Impediments to Payment: Payer Policies Targeting Anesthesia in GI Cases
April 3, 2023
Is it just paranoia or are you really being picked on? That’s what some anesthesia providers may be wondering when it comes to their attempted forays into gastrointestinal-related cases. For some time now, it has become increasingly difficult to get paid in the GI context as a growing number of payers have been putting up roadblocks to reimbursement.
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Collecting Anesthesia Charges from Patients
March 27, 2023
Most patients have insurance for their medical expenses. Conventional insurance plans determine the value of services submitted on a claim, which they define as the allowable. Plans that emulate the original Blue Shield policy then pay the provider 80 percent of the allowable, unless there is an applicable unmet deductible. The result is typically a patient responsibility of 20 percent for the allowable. This, of course, only applies to patients who actually have insurance. When it comes to self-pay or no-insurance patients, they are technically responsible for the entire charge (although, given actual experience, it is highly unlikely that the provider will collect anything close to the actual charge).
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Winding It Down: Anesthesia and the End of the PHE
March 20, 2023
World War II, which began on September 1, 1939, raged in Europe for nearly 6 years, ravaging ancient cities and decimating much of the population. It officially ended on May 8, 1945, known in the West as VE (victory in Europe) Day. But months before the German surrender, the leaders of the principal allied nations were already meeting to plan out the post-war world. The great ordeal that had burst upon the European continent was finally winding down, and the time had come to look to the future.
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The Value of an Anesthesia SWOT Analysis
March 13, 2023
Management consultants like to advise their clients to perform a SWOT analysis on a regular basis, because it is an effective tool for strategic planning. In the current environment, it is especially important to honestly identify internal strengths and weaknesses and external opportunities and threats. Successful practices use this tool to constantly fine-tune their goals and objectives to anticipate changing market conditions. The concept of such an analysis should seem very familiar to anesthesia providers who must assess each patient’s anesthetic requirements as they prepare the anesthesia plan. The difference is simply that this applies to the practice as a whole and not just a given patient.
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A Change in the Wind: New Policy Further Complicates Anesthesia Practices
March 6, 2023
You just know it when it happens. It is that sudden shift in events that eerily presages a change in one’s fortunes—and not necessarily for the better.
For decades now, anesthesia practices have been able to rely on certain unchanging rules when it comes to the reimbursement of the providers’ services. This includes those groups that utilize certified registered nurse anesthetists (CRNAs). For the most part, payers have followed Medicare’s lead in reimbursing CRNA services at the same level as the anesthesiologist. While there is the occasional odd outlier, this equality of payment has been the industry norm. That may be coming to an end.
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Mining the Potential of the Anesthesia Database
February 27, 2023
It goes without saying that hospitals could not run their operating room suites without anesthesia. It has been said that the two most significant advances in medicine have been antibiotics and anesthesia. While surgeons appreciate and their patients benefit from the services anesthesia providers perform, few realize just what a powerful database is being created as the details of each case are being captured by billing companies and clinical record systems. Too often. the focus of this database is the financial potential of the practice; but, in the current environment, the focus has shifted from productivity to profitability.
