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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Robo-Anesthesia?
May 20, 2013
With remarkable timing, news of a lawsuit brought by the parents of a teenager left in a permanent vegetative state after a routine endoscopy coincides with the announcement that the Food and Drug Administration (FDA) has granted Premarket Approval for the SEDASYS® system, a computer-assisted personalized sedation system.
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Anesthesia Practices Can File Claims for Repayment under MasterCard and Visa Class Action Settlement
May 15, 2013
Anesthesia practices that accept Visa and MasterCard payments are among the “merchants” that may be able to collect a portion of the fees paid to the card issuers under the proposed settlement in the Payment Card Interchange Fee and Merchant Discount Antitrust Litigation pending in federal District Court in New York.
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When is an Anesthesiologist “Immediately Available?”
May 13, 2013
Astonishingly, after decades of discussion, there is still a lot of uncertainty as to what the anesthesia medical direction rules mean by the requirement that the medically-directing anesthesiologist be “immediately available.”
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Anesthesiologist Compensation
May 6, 2013
What do orthopedic surgery, cardiology, radiology, gastroenterology and urology have in common? Compensation in all five specialties is higher, on average, than it is for anesthesiology, according to Medscape’s Physician Compensation Report: 2013.
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Insights for Anesthesiologists: Participating in Hospitals’ New Strategies
April 29, 2013
The American Hospital Association (AHA) has just released a report that describes the strategies that will help its nearly 5,000 member hospitals succeed in the value-based healthcare environment. This report, Metrics for the Second Curve of Health Care, will be of interest to all anesthesiologists who want to understand and meet their hospitals’ needs—and that should include all anesthesiologists who work in a hospital. Whether you have held the anesthesia franchise at your institution for decades with no competition, or whether you are seeking ways to improve or even launch a relationship with a hospital, you will benefit from knowing administration’s goals.
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Anesthesiologists and Pain Physicians: Make Sure You are Enrolled in PECOS Now
April 22, 2013
Physicians who refer or order services for Medicare patients must be enrolled in PECOS, the Medicare Provider Enrollment, Chain, and Ownership System database, and physicians who bill Medicare are required to list the name and National Provider Identifier (NPI) of the ordering/referring physician on their claims in order to be paid. The source of these requirements is Section 6405 of the Affordable Care Act.
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Hospitals May Pay for Anesthesia and Pain Medicine EHRs without Violating the Self-Referral or Anti-Kickback Laws
April 15, 2013
The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services Office of the Inspector General (OIG) last week published parallel proposed rules that would remove certain obstacles to hospitals’ paying for the electronic health record (EHR) technologies used by anesthesiologists, pain specialists and other physicians.
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Proposed “Medical Necessity” Restrictions on Post-Anesthesia Pain Blocks
April 8, 2013
One of the Medicare Administrative Contractors (MACs), Noridian Administrative Services LLC, has published a proposed policy that would bar payment for peripheral nerve blocks placed pre-operatively for the management of post-operative pain. According to the draft policy, entitled Nerve Blockade: Somatic, Selective Nerve Root, and Epidural.
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PQRS, The Value-Based Payment Modifier and Large Anesthesia Groups
April 1, 2013
In last week’s Alert, we summarized the requirements for participating in Medicare’s Physician Quality Reporting System (PQRS) in 2013. One of the major changes to the PQRS program—which we deferred until this week—is the implementation of the Value-Based Payment Modifier (VBM) for groups of 100 or more eligible professionals (EPs), consisting of physicians and CRNAs and others described in detail below.
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PQRS Refresher for Anesthesiologists, CRNAs and Pain Physicians
March 25, 2013
Participating in Medicare’s Physician Quality Reporting System (PQRS) has taken on a new flavor this year. While until now participating has meant a potential annual bonus of several thousand dollars, not reporting in 2013 will entail a penalty in 2015. Losing out on a bonus is less galling than forfeiting a percentage of each remittance. No anesthesiologist, CRNA or pain physician is doomed to lose money for failing to report the applicable PQRS measure(s). This Alert will provide a reminder of the steps you need to take to earn the bonus and to avoid future penalties..
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ACOs, Antitrust and Anesthesiologists
March 18, 2013
The Centers for Medicare and Medicaid Services (CMS) has been encouraging the growth of accountable care organizations (ACOs) and other integrated models under the impetus of the Affordable Care Act (ACA). The Federal Trade Commission (FTC), on the other hand, remains fiercely protective of competition. If competitors coalesce into a single large organization, there will be fewer competitors.
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New Ways for Anesthesiologists to Add Value to the Management of their O.R.s
March 11, 2013
Several recent publications have described strategies for hospitals and ambulatory surgical centers to improve their operational health—their profitability, to be blunt. Anesthesiologists are well aware of the role that they can play in O.R. management and of the need to assume O.R. leadership responsibilities in order to remain competitive. There are some valuable ideas to be gleaned from articles and presentations directed to O.R. managers. Anesthesiologists can take charge of most, if not all, of the processes described below.
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Do ACOs Matter to Anesthesiologists and Pain Physicians Yet?
March 4, 2013
In meetings and conferences where the presenter asks anesthesiologists and pain physicians whether they are participating in—or negotiating with—an Accountable Care Organization (ACO), very few, if any, of the doctors raise their hands. Everyone is aware of the concept of ACOs, but almost no one has any experience with them yet. Nevertheless, there are significant ACO developments across the country.
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How Safe Are Anesthesia Practices From a RAC Attack?
February 25, 2013
CMS’ Medicare Recovery Audit Contractor (RAC) Program has now been in effect in all 50 states for three years. The RACs, readers will recall, are contractors who are compensated on a contingency fee basis for finding and recouping overpayments made by Medicare to physicians, hospitals and other providers. Each of the four RACs is responsible for identifying overpayments—and underpayments—“in a geographically defined area that is roughly one-quarter of the country. In addition, [they] are responsible for highlighting to CMS common billing errors, trends, and other Medicare payment issues,” according to a report from CMS to Congress released earlier this month and entitled Recovery Auditing in the Medicare and Medicaid Programs.
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The Sun Shines on Payments from Drug Companies to Anesthesiologists and other Physicians
February 18, 2013
"Physicians’ relationships with the pharmaceutical industry should be transparent and focused on benefits to patients." (Jeremy A. Lazarus, MD, President, American Medical Association, Statement on Final Physician Payment Sunshine Act Rule, February 1, 2013.)
“You should know when your doctor has a financial relationship with the companies that manufacture or supply the medicines or medical devices you may need. Disclosure of these relationships allows patients to have more informed discussions with their doctors.” (Peter Budetti, MD, JD, CMS Deputy Administrator for Program Integrity, quoted in Rule Increases Transparency in Health Care, press release, February 1, 2013.)
Have you ever received a consulting fee, a meal, a textbook, a mug or a pen set from a drug company or a device manufacturer? If the value of the item was more than $10, it would likely be reportable to a new registry under the Physician Payment Sunshine Act and the final regulations (“Final Rule”) published by CMS on February 1, 2013. The Final Rule was published after a lengthy delay to allow CMS to analyze more than 350 comments it received in response to the Proposed Rule, which was published in December 2011.
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What Anesthesiologists and Pain Physicians Should Know about Health Insurance Exchanges
February 11, 2013
The creation of Health Insurance Exchanges (HIEs) is among the most important changes to the health care system made by the Affordable Care Act (ACA). The HIEs are marketplaces where consumers and small businesses can shop for private health insurance plans. Many anesthesia and pain medicine patients will be covered by health plans participating in HIEs beginning as soon as October 2013. Payment rates under such plans have the potential to make or break providers. Additionally, some group practices may choose to offer coverage through the HIEs. A basic familiarity with HIE structure and operations is therefore in order.
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The Company Model Presents Risks for Anesthesiologists and for ASCs
February 4, 2013
Anesthesia revenue streams are an attractive target for investors of various stripes.
Across the country, ambulatory surgical centers (ASCs) and certain medical specialty groups are looking at beefing up their incomes by sharing in anesthesia profits. At the January 24-26, 2013 ASA Practice Management Conference, Judith Jurin Semo, Esq., who presented an Update on the Company Model, noted that trade press articles encouraging such ventures appear regularly, going back at least to 2004 (Outpatient Surgery). The “company model” arrangement, which allows a third party to use an intermediate corporation to collect the professional fees while paying the anesthesiologists a negotiated rate, has been the object of considerable concern on the part of the ASA and the anesthesia community at large. Polled informally, one-third of anesthesiologists report having been approached about participating in a company model.
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Update Your Anesthesia Compliance Program: The Final HIPAA Privacy, Security and Breach Notification Rules Are Here
January 28, 2013
“Much has changed in health care since HIPAA was enacted over fifteen years ago,” said HHS Secretary Kathleen Sebelius in the Department of Health and Human Services’ January 17th press release announcing the publication of the long-awaited final omnibus rule with Modifications to the HIPAA Privacy, Security, Enforcement and Breach Notification Rules under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act. “The new rule will help protect patient privacy and safeguard patients’ health information in an ever expanding digital age.”
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Anesthesia for GI Endoscopy: An Ongoing Problem of “Medical Necessity”
January 21, 2013
Gastrointestinal endoscopy is one of the safest and most commonly performed adult procedures. The record of safety extends to the sedation or anesthesia for both upper and lower GI endoscopy. Because of both the safety and the frequency of the procedure, anesthesia for GI endoscopy has been under scrutiny by health plans for a decade or more. Lately, the number of claims denied for lack of “medical necessity” for endoscopic anesthesia services have once again been growing. Without taking any position on the merits of anesthesia vs. moderate sedation in connection with endoscopies and especially colonoscopies, we would like to remind our audience of the principles followed by payers in evaluating the medical necessity of anesthesia for these procedures.
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Medicare Locality Conversion Factors for Anesthesia Services Through 2013
January 14, 2013
As happens every year, Congress stepped in at the last minute and blocked the Sustainable Growth Rate (SGR) cuts in Medicare payments to physicians. On the afternoon of January 1, 2013, the House of Representatives adopted legislation passed earlier that day by the Senate, the "American Taxpayer Relief Act of 2012.” The bill prevented a plunge over the “fiscal cliff” by postponing across-the-board spending reductions and also overrode the 26.5 percent Medicare fee schedule cut that technically had already gone into effect on the morning of passage.
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2013 CPT Coding Changes Pain Management and Anesthesia
January 7, 2013
The 2013 CPT® Changes and Codebook are now available to health care providers. Overall, the 2013 changes include 186 new codes, 119 deleted codes, and 263 revised codes. In addition CPT revised 18 modifiers and updated 150 guidelines. The very good news for anesthesia and pain management providers is only a small handful of these changes directly impact the services they routinely provide. Following are general comments regarding the 2013 changes:
