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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Peering into the Heart: A Fresh Look at Anesthesia TEE Services
February 17, 2020
Not everyone can look into the human heart and understand its complexities. Who among us can really know what goes on inside another person, or even ourselves? While most us will never be able to plumb the depths of the emotion and intention that reside within the metaphysical heart, there are those who have the capacity to peer into the dark and evaluate its physical counterpart; and they do this through the use of transesophageal echocardiography, or “TEE.” -
Non-O.R. Anesthesia: Challenge and Opportunity
February 10, 2020
Anesthesia services fall into three broad categories from a scheduling perspective: surgical anesthesia, obstetric anesthesia and NORA (non-OR anesthesia). The typical ABC client allocates manpower between the operating rooms and the delivery suites and does its best to accommodate requests for services outside the operating room on an ad hoc basis. Sometimes this works and sometimes it does not. Increasingly, the demands of NORA have become a source of considerable frustration to most practices. For many of our clients, increased demands to cover IR, MRI and other procedural interventions on the floor epitomizes scope creep, that ever-more familiar phenomenon of being asked to do more for less.
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The ABCs of EMRs: Anesthesia in the Electronic Age
February 3, 2020
I can remember when important documents were kept in a paper folder and stuck in a metal file cabinet. Those were the “good old days” when you had to keep folded maps in your glove compartment in order to navigate from state to state, and emergency communication from the road meant heading to the nearest gas station phone booth. My, how times have changed. Yes, in many ways, for the better. Convenience, immediacy, efficiency—that’s what the digital age has brought us! It is no surprise, then, to see that companies, organizations and institutions have widely adopted the use of electronic data storage and transmission capabilities. That includes hospitals.
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Ketamine in an Anesthesia Clinic
January 27, 2020
Ketamine is a powerful anesthetic agent well known to all anesthesia providers. It is widely used in today’s operating rooms. However, there is now growing discussion and serious consideration of using Ketamine outside the operating room and moving it into clinics, with the intention of helping patients suffering from severe depression. The number of such clinics is relatively small at this time, but their existence raises the interesting question as to whether anesthesia practices should consider such an extension of this service line.
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Making the Rounds: A Closer Look at Postoperative Pain Visits
January 20, 2020
Pain rounds may be an overlooked or uncertain part of an anesthesia practice from a billing or compliance perspective. Today’s article seeks to bring clarity to this topic so that anesthesia providers are more informed about how they might be correctly compensated for this important service.
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Anesthesia for Nerve Blocks: Present Picture and Future Outlook
January 13, 2020
We receive a lot of inquiries concerning anesthesia for chronic pain blocks. The question is whether or not this is a worthwhile service to undertake and to what extent does it present concerns. The answer includes both good and bad news. It is a payable service under certain circumstances today, but future reimbursement is very uncertain.
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Twenty for Twenty: The Top 20 Highlights for Anesthesia in 2020
January 6, 2020
With every new year there is the prospect of change. It’s the primary role that January 1 seems to always play: an objective demarcation and psychological delineation between what was and what will be. It’s a time of personal change, with millions making resolutions to lose weight or forgo certain habits. A new year means new laws, as well, with thousands taking effect on the first of January in the several states, as well as nationally. It, therefore, comes as no surprise that each January brings change to the anesthesia specialty, with new codes and new requirements that must be reviewed and implemented.
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The Year in Review: How 2019 Affected Anesthesia Practices
December 30, 2019
As we close out 2019 and prepare ourselves for a new year, it is time to seriously assess the events and developments that impacted the specialty of anesthesiology over the past twelve months. American medicine is in a constant state of evolution; the only constant is change. The key to success lies in knowing which trends to take advantage of and which to avoid. The challenge is that some of these trends, including those that bubbled up in 2019, are more subtle than others. Because of the size and distribution of our client base across the country—especially now that we have joined forces with Medac—our practice managers have been afforded a unique perspective on a wide range of clinical, financial and strategic developments.
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OB Anesthesia: A Special Challenge for Anesthesia Practices
December 16, 2019
Obstetric anesthesia is either a make-or-break service for anesthesia practices. Its unique aspects, including (a) the use of epidurals that don’t require continuous attention, (b) the ability to manage multiple cases simultaneously, and (c) complex, diverse and inconsistent billing rules, make it a subject for special consideration.
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Moving Out of the Hospital: Should Anesthesia Be Worried?
December 9, 2019
The cost of healthcare is slowly overshadowing other considerations in American medicine. Physicians tend to focus their management strategies on ways to enhance practice incomes. As this happens, and as the overall utilization and cost of healthcare continue to rise, payers are always refining their policies to control the cost of healthcare by managing utilization. To date, this objective has resulted in three distinct categories. Providers are most aware of payer efforts to limit contract rates and the tendency to fixate on contract negotiations. The reality is this is just one factor in the equation. From a payer perspective, utilization has become the primary concern. An increase in utilization of a specific service, such as anesthesia for endoscopy, has a multiplier effect and can dramatically impact the overall cost of healthcare.
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Flip Rooms: Impact on Anesthesia Staffing
December 2, 2019
Traditionally, anesthesia staffing has involved the assignment of a provider—either a physician or a CRNA—to an anesthetizing location for a line-up of cases. The assumption is that a surgeon performs all his or her cases in one room. Increasingly, though, anesthesia practices are being confronted with the challenge of “flip rooms,” where a very productive surgeon will require two operating rooms (ORs) so as to allow the surgeon to quickly jump from one room to the other at the conclusion of each case. As a result, two separate anesthesia providers must be assigned to a single surgeon; and this, in turn, may lead to less than optimal outcomes, depending on how many cases are involved in the day’s line-up.
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Anesthesia and Invasive Line Ultrasound: A Fresh Look at Billing and Documentation
November 25, 2019
Opportunities for billing ultrasound were expanded for anesthesia providers in 2019—specifically in connection with invasive line placement. This article seeks to provide helpful guidance on payment issues and documentation requirements.
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The Evolving Quality Payment Program
November 18, 2019
On November 1, 2019, CMS released the 2020 Quality Payment Program (QPP) Final Rule under the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) law. This update for the 2020 reporting year is the next step in applying pressure to clinicians on public reporting of relevant quality metrics. Thankfully, there are few surprises in the final rule (which you can read here) but we will target those changes and offer our recommendations on how to best navigate this regulatory program.
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The First Word on the Final Rule: Anesthesia Takes an Unexpected Hit
November 11, 2019
Do you ever get the feeling that things are going along a little too well? At least as it concerns your own personal situation, do you sometimes think: “Wow, I’m living the dream! I’m healthy, I’m happy, I’m prospering;” but in the back of your mind, you’re wondering if bad news is just around the corner. That is undoubtedly a normal human experience, and sometimes that gnawing feeling of looming letdown is justified. Recent information emanating from the Centers for Medicare and Medicaid Services (CMS) may serve as the source for such a letdown for millions of anesthesia providers across the country.
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How is NORA Affecting Your Anesthesia Practice?
November 4, 2019
Anesthesia groups are increasingly providing services outside of standard anesthetizing locations. They need to do more to properly track these services so that they can have a more accurate assessment of their manpower needs and overall financial standing.
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Pressed for Time: New Deadlines for Filing Anesthesia Claims
October 28, 2019
Time marches on. The clock is ticking and the days are flying. Though, at times, we would like nothing more than to slow things down, the passage of time propels us into the maelstrom and compels us to take action. Who among us has not experienced the stress of having to meet toxic timetables and dreaded deadlines? It’s just part of our daily reality. In 1895, H. G. Wells published a novella about an inventor who built a machine to master time; but, by the end of the story, time had gotten the better of the inventor. Despite all attempts to tame it and control it, time tends to have the last word.
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The Role of the Anesthesia Medical Director
October 21, 2019
Virtually every anesthesia service agreement with a facility includes a section entitled, “Medical Director.” This is nothing new. While such language has typically referred to either the chairman of the department or the head of the anesthesia group, its intent was merely to indicate that the department or group should have a clearly defined point person. Such a perfunctory definition of this role made it a rather benign and non-controversial aspect of the contract during contract negotiations but this is clearly changing. Indeed, today’s group practices should pay very close attention to the hospital’s expectations of this now critical role because this could become their Achilles’ heel. A practice with weak or indecisive leadership is a practice doomed to fail.
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Ultrasound for Blocks: What Anesthesiologists Should Know
October 14, 2019
If you had mentioned the word “ultrasound” to teenagers back in the 1960s, I suspect they would have thought you were referring to the psychedelic grooves of Jimi Hendrix or the loud guitars of Jefferson Airplane. Mention the same term to today’s anesthesia providers and you are likely to get a clear and rational description of one of their oft-used medical techniques.
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ON THE WAY OUT: Analyzing the Trend Toward Outpatient Anesthesia
October 7, 2019
Conventional wisdom holds that the better-paying cases are migrating from the traditional inpatient setting to outpatient venues. This explains why today’s larger practices are so focused on growing their surgicenter business. They view it as a matter of financial survival. Many surgeons will bring their older, sicker Medicare patients to the hospital, while they book their younger, healthier patients at an ambulatory surgical center (ASC). As is so often the case in today’s complex medical market, the conventional wisdom is not wrong; but there is more to the story. As practices consider their expansion options, they need to pay special attention to some rather interesting developments.
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Deterrents and Detours: Anesthesia’s Pathway to Pain Payment
September 30, 2019
On a recent trip through the Ozarks, attempting to reach a trout-filled river, our caravan of two vehicles was being guided by a GPS device that began to dole out dubious directions. All of a sudden, we found ourselves on a rut-filled gravel road that promised to go on for miles. The lead car kept going, though now at a snail’s pace. The driver of the rear vehicle, however, was having none of it. He had just purchased a customized sportster and was not about to get it banged or dinged on the increasingly sketchy cow path. After turning around and getting back on the main road, we wound up getting to our destination at the same time as those taking the AI-inspired “fastest route.”
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What are the Limits to Your Acute Pain Practice?
September 23, 2019
The management of acute post-operative pain has become an exciting new frontier for anesthesia. New techniques and the use of ultrasonic guidance make it ever more feasible for anesthesia to implement pain management strategies that minimize the need for opioids. The question is, are you taking maximum advantage of this opportunity in your practice? Here are some critical issues for you to consider.
