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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Effective Hospital-Anesthesia Group Contracting: Understanding the Relationships Between Finance, Operations and Compliance
August 20, 2012
Preparing for negotiations requires an appreciation of the other side’s needs, wants, values and constraints. Anesthesiologists who have contracts with their hospitals or surgery centers are in a continuous cycle of negotiations—as soon as one contract is signed, it is time to start working toward the next agreement. One good place to start in understanding the facility’s position is to look at the advice hospitals are receiving from their consultants. Below is an article recently written for that audience by ABC Vice President for Regulatory Affairs & Research Joette Derricks, CPC, CHC, CMPE, CSSGB. This article addresses hospital employment of physicians who bill using RBRVS Relative Value Units, and of course anesthesiologists use the Relative Value Guide’s Base and Time Unit methodology and typically have group exclusive contracts to provide services to the hospital’s patients, but the discussion below can be read with the differences in mind. It is important to know that hospitals may not even realize that anesthesia services have a unique relative value system. Relative Value Units are billed for pain medicine, critical care, and invasive monitoring lines.
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When Negotiations with Carriers Force Anesthesiologists to Go Out of Network
August 13, 2012
Patients who go out of network can present serious collections problems for the physicians who do not participate in the network. Managed care organizations (MCOs) often send the check to the patient in order to pressure physicians to sign participation agreements, leading to the necessity for practices to collect directly from the patients, something that is especially challenging for hospital-based anesthesiologists and other physicians who do not have ongoing relationships with their patients.
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Anesthesiologists’ Investments in ASCs
August 6, 2012
Many, if not most, anesthesia practices provide services at ambulatory surgical centers (ASCs) as well as at hospitals. Some 11 percent of anesthesiologists have invested in the ASC as part owners, according to Medscape’s Anesthesiology Compensation Report: 2011 Results. Others invest their energy in contracts to staff ASCs. In either case, it is important to know the economic condition and value of one’s ASC.
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Proposed Changes for Anesthesiologists and Pain Physicians Who Report Measures to the PQRS
July 30, 2012
Anesthesiologists and pain physicians who have been receiving bonuses for participating in Medicare’s Physician Quality Reporting System (PQRS) should continue to do what they have been doing. The proposed Fee Schedule rule (NPRM) for 2013 does not contain any new requirements affecting those who are already successfully participating, as we noted summarily in last week’s Alert.
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Payment and Quality Changes Affecting Anesthesiologists in the 2013 Proposed Fee Schedule Rule
July 23, 2012
It comes as no surprise that the 27 percent cut mandated by the Sustainable Growth Rate (SGR) formula remains in place for now and will take effect on January 1, 2013, if Congress fails to act. Fear of the economic cliff that the entire country faces with mandatory spending reductions and the expiration of tax cuts early next year will undoubtedly affect how Congress deals with the SGR for 2013; what we cannot predict now is how.
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CMS Proposes to Pay Nurse Anesthetists for Chronic Pain Procedures
July 16, 2012
CMS has proposed to begin paying certified registered nurse anesthetists (CRNAs) for providing certain pain management procedures on a nationwide basis. The discussion in the proposed rule on the Medicare Physician Fee Schedule for calendar year 2013, issued on July 6, 2012, sets forth the history and the considerations in expanding the types of services for which CRNAs may bill Medicare.
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What Anesthesia Practices Should Do With Unclaimed Funds Belonging to Patients
July 9, 2012
State governments are under severe financial pressure. In the last few years, many of them have stepped up their efforts to collect unclaimed property held by private entities such as medical practices. Every state has an “escheat” or unclaimed property statute that places the burden on those holding such property to deliver it to the treasury or commerce department if the owner cannot be found. Escheatment is the general rule that abandoned or unclaimed property (of all kinds) becomes the property of the state.
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After the Supreme Court Decision: Anesthesiologists Must Proceed With a Perioperative Care Model
July 2, 2012
The Supreme Court’s decision on the fate of the Patient Protection and Affordable Care Act (PPACA or, more commonly, ACA) is due to be announced at 10:15 on Thursday morning, June 28. We are not jumping the gun by beginning to write this Alert ahead of the decision – the take-away message is that whether the ACA stands or falls, in whole or in part, anesthesiologists need to continue developing their role in perioperative care.
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What Does Medicare’s 3-Day Payment Rule Mean for Anesthesia and Pain Practices?
June 25, 2012
Another Medicare compliance deadline approaches, and it has attracted a fair amount of attention. The good news is that it will apply to few pain physicians and even fewer anesthesiologists. Sometimes it is necessary to explain a new rule or requirement just so that our readers know not to worry. This is one of those times.
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Tips for Anesthesia Practices to Get the Surgeons to the OR on Time
June 18, 2012
On-time case starts can make the difference between profitable and unprofitable operating rooms. There are multiple causes for late starts, among them clinical complications, unavailable instruments or supplies, unavailable laboratory reports or other paperwork, delays in room turnover and late arrivals on the part of surgeons, patients, and yes, anesthesiologists and nurse anesthetists.
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OIG to Anesthesia Practices: Think Again Before You Pay Your ASC for the “Franchise”
June 11, 2012
Owners of ambulatory surgical centers (ASCs) often wish to receive a share of the professional fees paid to their anesthesiologists and nurse anesthetists. ASC owners and anesthesiologists and CRNAs have adopted—or at least proposed—numerous corporate and contractual structures over the last few decades to accomplish this transfer of revenues. The federal Anti-Kickback Statute (AKS), which prohibits a broad range of payments for referrals, has generally caused conservative lawyers to advise against such arrangements. Some attorneys and other advisors who are less risk-averse have helped their clients to go ahead.
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Latest Government Fraud Reports and How They Affect Anesthesiologists and Pain Physicians
June 4, 2012
Inspector General Daniel Levinson of the Department of Health and Human Services has stated in his Spring 2012 Semiannual Report to Congress that his office expects to recover $1.2 billion from audits ($483 million) and investigations ($748 million) concluded during the first half of 2012. Between October 2011 and March of this year, the OIG also brought 346 new criminal cases and 138 civil actions.
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As an Anesthesiologist, What Should I Do About Meaningful Use if I am a Medicaid Provider?
May 28, 2012
The EHR Incentive Program, often dubbed “Meaningful Use” (MU), has been surrounded by questions and confusion among anesthesiologists and practice administrators since its inception. Currently, the majority of anesthesiologists and pain physicians are classified as an Eligible Professional (EP) under the Medicare portion of Meaningful Use and most of the public conversation is centered on that program. However, the Medicaid option offers more flexibility and financial incentive which raises the question, “How does the Medicaid EHR Incentive Program differ from the Medicare portion?”
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Collecting Payments from Anesthesia and Pain Medicine Patients
May 21, 2012
Patient AB underwent a rotator cuff reconstruction in January, more than four months ago. You billed the health plan that Mr. AB’s hospital record indicated. The health plan denied the claim on the ground that Mr. AB was not enrolled. You then billed Mr. AB directly for $1072.50 your usual and customary charges for anesthesia for a 120-minute open procedure on the shoulder joint (CPT™ code 01630, 15 units x $75 conversion factor) and an epidural for post-operative pain (CPT™ code 64415, $97.50).
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Anesthesiology Plays a Role in Coordinating Management of Knee Replacement Patients, Contributing to Better Outcomes
May 14, 2012
“Coordinated care” is one of the key concepts in health system reform. It is central to the cost savings and quality improvements expected from Accountable Care Organizations, value-based purchasing and the medical home. It is also the basis of the American Society of Anesthesiologists’ model, the perioperative surgical home.
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What the Proposed 60-Day Overpayment Refund Rule Means for Anesthesia Practices
May 7, 2012
The Affordable Care Act (ACA) requires providers including physicians to report and refund known overpayments within 60 days, or, for providers that submit cost reports, by the date the corresponding cost report is due. The parameters of this mandate are unclear, but the duty to refund overpayments exists regardless. After summarizing some of the problems with the ACA provision and with CMS’ proposed regulations implementing the statute, we will offer some practical suggestions on compliance.
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A New Quality Tool for Anesthesia Departments
April 30, 2012
Do you check your professional association’s web site regularly? There is more practice-related information there than you may realize. One recent addition to the resources on the American Society of Anesthesiologists web site (www.asahq.org) is worth your special attention. The ASA Committee on Quality Management and Departmental Administration (QMDA) has produced a comprehensive set of questions for anesthesiologists and others involved in perioperative patient care that can guide the development of a quality program tailored to your own department.
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Managing Compensation for Anesthesiologists, CRNAs and AAs
April 23, 2012
About 60 individuals attended the discussion of compensation strategies moderated by Stephen E. Comess, Executive Director, United Anesthesia Services, P.C. Mr. Comess got the ball rolling on responses to twelve prepared compensation management scenario questions by giving each member of the audience a playing card; if the card matched another one drawn by Mr. Comess, that member provided the first response to the next question.
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Medicare ACOs Are Blooming (With or Without Anesthesiologists)
April 16, 2012
CMS has announced the selection of the first 27 Accountable Care Organizations (ACOs) to participate in the Medicare Shared Saving Program. The 27 organizations have agreed to be responsible for improving care for nearly 375,000 beneficiaries in 18 states through better coordination of services among hospitals, physicians and other providers.
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A Brake on Hospital Mergers – A Breather for Anesthesia Groups?
April 9, 2012
Consolidation in the hospital sector has proceeded at a rapid pace in the last few years. Hospitals, like anesthesiologists and other health care professionals and organizations, are seeking the advantages of combined size to secure their future in a marketplace undergoing a revolution with an unknown outcome. Oral argument before the Supreme Court on the constitutionality of the Affordable Care Act, discussed in our Alert of April 2nd, did nothing to mitigate the uncertainty.
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The Affordable Care Act, the Supreme Court and Anesthesiologists – Just the Facts, Please
April 2, 2012
The United States Supreme Court allocated more time to oral argument on the constitutionality of the Affordable Care Act (ACA) last week than it had to any other case in the past 50 years. Four distinct questions were before the Court during six hours of argument spread over three days.
