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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What Makes Anesthesia Billing So Complicated?
May 2, 2022
The once renowned Harvard economist, John Kenneth Galbraith, wrote that anyone who thinks writing is easy is either a terrible writer or a terrible liar. It is our considered opinion that the same could be said of anesthesia billing. Anyone who thinks it is easy to navigate the plethora of payer policy issues that impact so many anesthesia claims probably does not really understand their subtleties and nuances. Not only is anesthesia a dynamic specialty but payer responses to the changing scope of professional services are in a constant state of evolution. Only committed students of the specialty and payer policy have a fighting chance of keeping up and optimizing their clients’ collections and cash flow.
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Out Of Network Anesthesia Services: Payment Dispute Process Begins
April 25, 2022
‘‘We were eyeball to eyeball, and I think the other fellow just blinked.’’ This was US Secretary of State Dean Rusk’s exclamation to President Kennedy and other onlookers after it was learned that Russian ships bound for Cuba had just turned away from the US-imposed quarantine line during the beginning days of the Cuban Missile Crisis. This was the beginning of a successful strategy on the part of the administration to save the world from nuclear annihilation. Much later, we learned that part of the resolution of the crisis involved the dismantling of our missiles in Turkey in exchange for the removal of Soviet missiles from Cuba.
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Why Scope Creep Is Today’s Most Pressing Anesthesia Management Challenge
April 18, 2022
The vocabulary of anesthesia practice management is now focused on two new terms: scope and creep. They are especially relevant to the negotiation of anesthesia service agreements. It used to be that the objective of each negotiation was to establish a reasonable subsidy, but it turns out there is more to the establishment of a reasonable subsidy than hospital administrators are often willing to admit. As has been said many times, anyone can get the number right today, but will it be right tomorrow?
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Anesthesia and the ASC: A Perfect Partnership?
April 11, 2022
In 1994, country singer Neal McCoy had a number-one hit on his hands. It was a song about finding the perfect match in a lifetime mate. The lyrical theme of the song is summed up in the concluding lines of the chorus: “We were meant to be together, no doubt about it.” Sometimes, you just know when a relationship is right. There is a silent recognition and a mutual understanding of a deep connection. It’s like it was meant to be.
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Anesthesia and the ICU
April 4, 2022
While academic anesthesia departments often provide services in the Intensive Care Unit (ICU), this is quite rare among private practices. Hence the question, why more private practices don’t want to take responsibility for the care of post-surgical patients in the ICU? It would seem that covering the ICU was a logical line extension and entirely consistent with the concept of the peri-operative surgical home. Isn’t the cardiovascular anesthesiologist who managed the patient through a CABG or mitral valve repair the ideal person to ensure that the patient recovers well in the ICU? As is true of so many aspects of medical care, the answer to the question involves tradition, politics and economics.
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A Little More Paperwork: Medicare Refines Neurostimulator Policy
March 28, 2022
In the Cold War spy thriller, Firefox, Clint Eastwood’s character is in the Soviet Union on a clandestine mission for the American government. He is approached by a representative of the feared KGB, who demands: “Your papers, please.” Nervously, the American hands his passport and other identifying documents over. After a few seconds, he hears to his horror the dreaded words from the KGB enforcer: “Your papers are not in order.”
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What is the Value of Chronic Pain to an Anesthesia Practice?
March 21, 2022
Some of our anesthesia clients are actively involved in the provision of chronic pain management services. Usually, the chronic pain physicians are a small subset of the practice. The scope and focus of these services can vary considerably from one practice to another. It used to be that some physicians would perform a limited number of epidural steroid injections in a procedure room, while others were part of a formal pain clinic. The specialty has evolved. Some have even established free-standing pain clinics. In many ways, chronic pain management represents a logical line extension for anesthesiologists who are so inclined. The fact is that the management of a hospital-based anesthesia practice is materially different from the management of a chronic pain practice. While there may be some financial and strategic advantages for an anesthesia group to provide chronic pain services, there are also many challenges; and many practices find chronic pain a loss leader. In the current environment where revenue is contracting and practices are looking for new lines of business, the discussion often includes consideration of chronic pain. The issue is what is involved and whether it is worth the investment.
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Addressing Pain: Anesthesia Considers Best Practices
March 14, 2022
The second law of thermodynamics, which is an axiom of accepted science, says that, over time, things tend to break down, to degenerate, to become more chaotic. And, yet, when it comes to humankind, we see continual improvement in living conditions, technology and processes. We’re always learning—finding new ways to build a better mouse trap, as it were. We may take a few steps back every now and then (anyone remember the Dark Ages?); but, on the whole, there has been a general upward trajectory in our ability to improve upon the status quo.
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The Effect of the No Surprises Act Court Decision on the Specialty of Anesthesia
March 7, 2022
As of February 22, at least six lawsuits have been filed opposing certain regulations arising from the No Surprises Act. A recent ruling in one of these cases has just changed the legal landscape in favor of anesthesia providers.
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The 2022 OIG Work Plan: Implications for Anesthesia Practices
February 28, 2022
Every year, the government’s watchdog agency produces a list of healthcare services and procedures they plan to scrutinize for the purpose of determining the potential for significant abuse by the provider community. The 2022 list contains a few items that will be of interest to anesthesia and chronic pain providers.
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Managing Risk in an Anesthesia Practice
February 21, 2022
Anesthesia providers have been trained to manage the risks associated with a patient’s response to the trauma of surgery. They are familiar with virtually all the decision trees necessary to guide them safely through both anticipated and unanticipated physiologic responses to the entire surgical experience. It is because of this training and the timely and reliable data provided by all the monitors, that morbidity and mortality is so low in the United States. Many providers even like to remind patients that they are at greater risk driving to the facility than undergoing anesthesia. The problem is that the same tools and skills that allow for consistent management of surgical and obstetric patients do not ensure consistent management of the practice as a whole.
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Anesthesia in the Crosshairs: Surviving a Payer Audit
February 14, 2022
Don’t think they’re not out there. They are . . . just around the corner, looking over your shoulder and ready to pounce. No, we’re not referring to a 150-pound panther hiding in the rocky crags of a Western reserve just waiting on some unsuspecting hiker to stroll by, or a 12-foot alligator in a Louisiana lake grinning at the guy who has just taken a tumble while water skiing. No, it’s another sort of predator with which we're concerned: the medical auditor.
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What is the Optimal Size for an Anesthesia Practice?
February 7, 2022
Is big really better? Many a practice has dedicated considerable time and energy to the discussion of merger and expansion options. Some have been successful in their quest to build a significant market footprint, while others have seen their hopes dashed unceremoniously by unappreciative administrations. The fact is that the question is more relevant now than ever; the specialty is more at effect of dramatic and dynamic market forces than few ever anticipated. Plotting a secure and financially viable path to the future has never been so challenging or perilous.
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Through the Looking Glass: Anesthesia and 3D Technology
January 31, 2022
One of the more recent topics discussed and debated among theoretical physicists involves the nature and number of dimensions. In classical terms, there are three spatial dimensions: up and down, forward and back, and side to side; or, to put it briefly: height, depth and width. Time is considered the fourth dimension. With the publication of Albert Einstein’s general theory of relativity, the world was introduced to the concept of “space-time” as a combined phenomenon. When the fabric of space-time is curved due to the intervening presence of celestial bodies, gravity results.
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HHS Distributing $2 Billion in Provider Relief Fund Payments to Additional Health Care Providers Impacted by the COVID-19 Pandemic
January 26, 2022
In December 2021, Health Resources and Services Administration (HRSA), began releasing Provider Relief Fund (PRF) Phase 4 General Distribution payments to providers and suppliers. Phase 4 payments included new elements specifically focused on equity, including reimbursing smaller providers for their changes in operating revenues and expenses at a higher rate compared to larger providers, and bonus payments based on the amount of services providers furnish to Medicaid/Children’s Health Insurance Program (CHIP) and Medicare beneficiaries.
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Anesthesia and the Current Opioid Crisis
January 24, 2022
A new book has brought one of the nation’s most serious health crises into clear focus. Empire of Pain: The Secret History of the Sackler Dynasty by Patrick Radden Keefe traces the rise of the Sackler empire and how its production and promotion of OxyContin fueled the current opioid crisis. In addition, a recently released Hulu series called Dopesick traces the efforts of the Justice Department to reveal the inner workings of the Sackler family’s marketing and sales strategy for OxyContin.
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Surprise Billing Regulations: A Surprise Attack on Anesthesia?
January 18, 2022
As most of our readers know, federal law now protects insured patients from receiving surprisingly high medical bills from ancillary providers, such as anesthesiologists, who do not participate with the patient’s insurance. This protection is extended to such patients in connection with emergency department services—whether the ED participates with the patient’s health plan or not—as well as services provided in healthcare facilities, such as hospitals, that participate with the patient’s health insurance. The idea is that a patient who is having a procedure performed by a participating surgeon in a participating facility should not be blindsided by an inordinately high bill coming from a non-participating anesthesia provider—especially where the patient had no idea the anesthetist or anesthesiologist was not a participant with the patient’s insurance plan.
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2021: An Anesthesia Retrospective
January 10, 2022
By all accounts, 2021 was a challenging year for American medicine. The pandemic, which we all thought would abate as more Americans got vaccinated, just kept morphing from one variant to another like the cancer that keeps metastasizing from one part of the body to another. Every time we thought we were out of the woods, new case rates started to rise again. For the most part, anesthesia practices were immune to these spikes and appeared to be profiting from strong case volumes; and yet the impact of the virus was so extensive and pervasive that ultimately every practice was impacted in many ways.
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Anesthesia Braces for a New Era: Surprise Billing Prohibition Begins
January 3, 2022
Starting with the first day of this new year, out-of-network (OON) anesthesia providers are prohibited from the age-old practice of balance billing—at least in most cases. For example, if a patient is seeking a surgical service in a facility that participates with the patient’s insurance plan, and an OON practitioner provides the anesthesia in that surgical session, the OON provider cannot bill the patient the difference between what the insurance pays and the provider’s “full charge,” i.e., group rate. Rather, a reduced rate that is more in line with an “in-network” charge is what the group can expect to collect from the patient.
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Impact of Orthopedics on Anesthesia Practices: Review and Analysis
December 28, 2021
Over the past months, we have tended to focus on policy updates and practice trends that have, or have the potential to, impact our clients negatively. We believe that such updates are critical to effective strategic planning for all practices in an ever-changing environment. It is important to note that not all practice developments threaten to undermine the potential financial viability of each practice. For example, the administration of anesthesia for orthopedic cases appears to have been and continues to be one of those bedrock services that has remained fairly constant. Obviously, not all practices benefit equally, which may be an indication that orthopedics is a preferred and desirable line of business to pursue.
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2022 MPFS Final Rule: Part 3 Final Highlights for Anesthesia and Pain Providers
December 13, 2021
In our first two alerts dealing with last month’s release of the 2022 Medicare Physician Fee Schedule (PFS) Final Rule (FR), we provided details that would be of particular interest to anesthesia and chronic pain providers. Today’s alert reflects the final highlights arising from the FR that may have some pertinence to these specialties.
