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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ICD-10 Delay Will Benefit Anesthesia and Pain Medicine Practices
March 26, 2012
Another dragon is slinking away, although it isn’t yet slain. On February 15, 2012, Health and Human Services Secretary Kathleen G. Sebelius announced that “HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).” In other words, medical practices no longer need to ensure that they will be ready for ICD-10 by October 2013.
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Medicare Updates of Interest to Anesthesiologists and Pain Physicians
March 19, 2012
CMS has just updated the Medicare conversion factors (CFs) for anesthesia services. The new national, unadjusted CF is $21.52, up from $21.41 for the first two months of 2012. Download the list of locality-adjusted CFs here.
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The IPAB Threatens Anesthesia and Pain Medicine Practices
March 12, 2012
Last week saw the launch of the latest version of the iPad—and the beginning of the end, perhaps, of the IPAB.
The Independent Payment Advisory Board (IPAB) was created by the Patient Protection and Affordable Care Act (ACA) in 2010. IPAB is responsible for recommending specific proposals to contain the growth rate of Medicare spending if spending per capita is projected to exceed targets also established by the ACA. From 2015 through 2019, that target is based on measures of inflation. Starting in 2020, the target is based on the growth of the gross domestic product plus one percentage point.
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Electronic Health Records – Proposed Stage 2 Meaningful Use Requirements Still Not Relevant to Anesthesiologists
March 5, 2012
The Centers for Medicare and Medicaid Services (CMS) has just issued a proposed rule that will make it more difficult than ever for anesthesiologists and pain physicians to qualify for the Medicare or Medicaid electronic health records (EHR) incentive. There will be a 60-day comment period, after which CMS will review the feedback and publish a final rule this summer.
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Practice Management Companies’ Acquisitions of Anesthesia Practices
February 27, 2012
Every private anesthesia group in the United States knows that practice management companies (PMCs) in the business of acquiring and operating anesthesia practices are growing rapidly. This is part of a general acceleration in health care merger and acquisition activity driven by healthcare reform and by the economic uncertainty of the last few years. Physician practices have become one of the fastest-growing targets; larger entities such as health systems, insurance companies and PMCs are buying up hospital-based specialties with a view toward participating in accountable care organizations (ACOs) and receiving bonuses for improving quality and decreasing costs.
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Protecting Your Anesthesia Practice from a Patient Privacy Breach
February 20, 2012
Have you heard about the federal privacy and security compliance audit pilot program? The Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of the 2009 stimulus package, requires the Department of Health and Human Services (HHS) to conduct periodic audits to ensure covered entities and business associates are complying with the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules and Breach Notification standards. To implement this mandate, the HHS Office of Civil Rights (OCR) is piloting a program to perform up to 150 audits of covered entities to assess privacy and security compliance. The pilot phase began in November 2011 and will conclude by December 2012.
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What Anesthesiologists Should Know about Medicare Prepayment Reviews
February 13, 2012
In any financial transaction, the person holding the money is at an advantage. Getting money back from someone who should not have been paid is harder than not making the payment in the first place. CMS knows this, and that is why it is placing a new emphasis on prepayment review of claims. Originally slated to begin on January 1, 2012 the prepayment review initiative will now formally launch in June. The number of prepayment reviews is going to increase from 1.2 million to 2.7 million claims per year.
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Performance Based Compensation: Benchmarking, Monitoring and Improving Quality
February 6, 2012
Last week’s Alert discussed the growing trend toward including performance measures in contracts between hospitals and anesthesia groups. We identified clinical quality, efficiency and patient satisfaction measures developed by the Surgical Care Improvement Project (SCIP), the Medicare Physician Quality Reporting System (PQRS), the American Society of Anesthesiologists (ASA), the Anesthesia Quality Institute (AQI), Press-Ganey and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). All of these measures can be the basis of hospital or ambulatory surgery center contracts for performance-based payment.
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Performance-Based Compensation in Contracts between Hospitals and Anesthesia Groups: Measures
January 30, 2012
Contracts between hospitals and anesthesia groups frequently include provisions for compensation for the anesthesiologists’ services to their institutions. Estimates by speakers at this past weekend’s ASA Practice Management Conference ranged from 70 to 81 percent of anesthesia groups receiving payments from their hospitals. The amount of compensation varies widely, depending on different factors such as payer and patient mix, size of the group, subspecialization, number of other anesthesia groups in the geographic area, salary costs, OR utilization rates and number and spread of anesthetizing locations outside the OR.
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Demystifying “Meaningful Use” for Anesthesiologists
January 23, 2012
The new calendar year is the last year in which “eligible professionals” (EPs) can begin to participate in the Medicare incentive program for electronic health records (EHRs) and receive the maximum available bonus payment, $44,000 over a five-year period. Although the final regulations on the EHR program appeared in mid-2010, there is still a fair amount of confusion over whether anesthesiologists can qualify for the bonus. In this Alert, we will review the cumulative requirements for participation in a program whose summary is deceptively simple.
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The Anesthesia Conversion Factor and the Medicare Fee Schedule, 20 Years Later
January 17, 2012
Do you realize that we have just passed the 20th anniversary of the Medicare Fee Schedule? A product of 1989 legislation, the Physician Fee Schedule went into effect on January 1, 1992. (And William Hsiao, PhD, whose study of Resource-Based Relative Value Systems was the basis for the change from charge-based payment methodology, is still teaching at the Harvard School of Public Health today.)
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Postoperative Pain Management Procedures Can Still Be Reported Separately from the Anesthesia Service
January 9, 2012
A change to some language in the Anesthesia Services chapter of the Medicare National Correct Coding Initiative (NCCI) manual recently created considerable confusion among participants in the on-line discussion maintained by the Medical Group Management Association (MGMA) for the Anesthesia Administration Assembly (AAA).
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Hospital Value-Based Purchasing Program: An Introduction for Anesthesiologists
January 3, 2012
Medicare’s Value-Based Purchasing (VBP) program for hospitals, mandated by the Affordable Care Act, took off upon the release of final regulations on April 29, 2011. VBP marks the start of true pay-for-performance, as opposed to pay-for-reporting, at the hospital level. The intent is to pay for better value, patient outcomes and innovations, and not simply to reward volume of services. As we enter 2012, we are halfway through the first performance period. Anesthesiologists should begin analyzing and planning how they might partner with their hospitals in achieving the scores necessary to earn VBP incentives.
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2011 Medicare Rates for Anesthesia and Other Services Extended Through February
December 27, 2011
On Friday, December 23, President Obama signed legislation extending 2011 Medicare Fee Schedule payment rates for two months. The final bill that passed the House of Representatives, the same day, was virtually identical to the bill approved by the Senate a week earlier, with the Democrats conceding little more than a commitment to continue negotiations on a one-year deal when Congress returns to Washington.
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Texas Statute Requires Anesthesia Informed Consent
December 19, 2011
Texas has revised its statute on medical informed consent, 25 Texas Administrative Code, Chapter 601, effective January 16, 2012. The new rules, adopted by the Texas Medical Disclosure Panel, require physicians to inform patients of the risks of anesthesia and/or perioperative pain management and to obtain their signed consent for these procedures.
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Results of Survey Regarding a Network of Anesthesia Practices
December 12, 2011
ABC recently conducted a survey of clients and others to assess the anesthesiology community’s level of interest in a network of independent practices participating in joint quality improvement and cost-effectiveness initiatives.
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PQRS 2012 for Anesthesiologists and Pain Specialists
December 5, 2011
The end of the year is a good time to review Medicare’s Physician Quality Reporting System (PQRS). Several clients have recently raised questions about the PQRS program and it is likely that a number of other readers could use a refresher course.
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Anesthesia and the Version 5010 Standard
November 28, 2011
In just under five weeks, on January 1, 2012, physicians, hospitals, health plans and claims clearinghouses will be required to be in compliance with the ASC X12 Version 5010 HIPAA standard for the electronic transmission of healthcare claims and other administrative communications such as claims, remittance, eligibility, claims status requests and responses.
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How Will the Affordable Care Act Affect Anesthesiologists After the Supreme Court Rules?
November 21, 2011
Several readers have asked how to plan for the next few years now that the United States Supreme Court has announced that it will review the constitutionality of the Affordable Care Act (the “ACA”) next year. The answer depends on whether the Supreme Court’s decision, which is expected by early summer, upholds the ACA, invalidates it in part, or decides that the entire statute must fail.
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Health Information Technology, Patient Safety and Anesthesia Practice
November 14, 2011
More than 750 companies offering some form of electronic health record solution have entered the market within the last few years, according to a report entitled "US Markets for Electronic Medical Records in 2012" by the Millennium Research Group. Millennium predicts that the EHR industry will continue to grow at least twelve percent per year through 2016. Other observers consider the market already saturated.
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The Impact of the Final Medicare Fee Schedule Rule for 2012 on Anesthesiologists
November 7, 2011
Every November, the Centers for Medicare and Medicaid Services (CMS) issues a final version of the regulation updating the Physician Fee Schedule – and for the past eleven years, the update announced by CMS has been a decrease in payment rates, thanks to the Sustainable Growth Rate (SGR) formula. This year is no exception.
