The National Practitioner Data Bank (NPDB) was established under Title IV of the Health Care Quality Improvement Act of 1986 and has been operational since September of 1990. The NPDB impacts both anesthesiologists and certified registered nurse anesthetists (CRNAs) as certain entities are required to report adverse actions taken against their licenses, clinical privileges and professional society memberships. The issue of the NPDB most commonly arises under scenarios involving medical malpractice claims as, often, any and all payments made—regardless of whether those payments are made to dispose of a claim or to satisfy a judgment—must be reported to the NPDB. The Data Bank According to the NPDB Guidebook, The intent of [the NPDB] is to improve the quality of health care by encouraging State licensing boards, hospitals and other health care entities, and professional societies to identify and discipline those who engage in unprofessional behavior; and to restrict the ability of...

Using a cloud-based Meaningful Use Electronic Health Record (EHR) like F1RSTUse enables anesthesiologists to participate in either the Medicare or Medicaid EHR Incentive Programs. For those of us who have been doing this for the last few years, the incentive payments have been quite substantial. While data entry does require some time and commitment, the process is straightforward and provides additional non-financial rewards to the physician and patient. As physicians, we have the ability to document patient encounters, review patient records, generate patient lists and securely message our patients. In addition, there is now technology to securely message the growing number of other healthcare providers in the Direct Protocol messaging trust bundle. Historically, anesthesiologists have been the unseen doctors behind the mask. Patients may be grateful for good care, but they may not remember much about the experience due to the amnestic effects of our medications and the fact that much...

I. Background The medical specialty of anesthesiology is recognized for being in the forefront of adopting technology to enhance patient safety. The rapid dissemination of pulse oximetry and capnonography in anesthetic practice are two classic examples of early adoption of technology by the medical community to make our practice safer. The creation of the Anesthesia Patient Safety Foundation (APSF) further exemplifies our specialty’s commitment to both patient welfare and technological progress. Over the past few decades, a new factor has prominently inserted itself into the equation, influencing the introduction of new technology. That is cost-effectiveness. In evaluating a new product, whether it provides ideal patient care or cost-effective care may give different answers. The professional cost of anesthesia services is only a small percentage of total physician services (three percent of Medicare spending in 2010). Yet, the increase in spending on monitored anesthesia care (MAC) for esophagogastroduodenoscopy (EGD) and for colonoscopy...

Is your anesthesia or pain medicine practice participating in any bundled payment programs?  Bundled payments are single payments to providers or health care facilities (or to a combination of both) for all services furnished during an episode of care or over a certain time period.  Distribution of the single payment among the providers often entails a gainsharing and/or pay-for-performance arrangement to incentivize cost reduction and improve quality of care.  With many bundled payment packages including orthopedic, spine or cardiovascular service lines, it is almost certain that some anesthesiologists are involved. More than 243 providers had entered into bundled payment contracts with CMS under Phase II of the Medicare Bundled Payments for Care Improvement (BPCI) Initiative as of July 2014.  More than 6,400 providers participated in Phase I.  According to CMS, some 6,500 providers are analyzing Medicare spending data to decide whether to apply to enter into BPCI contracts.  Although the ability...

By now, many readers of the ABC Communiqué will have heard about the Qualified Clinical Data Registry (QCDR) and will be wondering (or dreading) what this means for them and their practice. This article will lay out the basic definitions and requirements. The QCDR is a new mechanism for eligible professionals (EPs) to report data on their performance to the Centers for Medicare and Medicaid Services (CMS). CMS currently reimburses about one-third of anesthesia care in the United States, and almost every practice derives a portion of its income from CMS. As a federal agency, CMS has been at the forefront of responding to public demand for transparent reporting of healthcare quality from both hospitals and providers. This has led to a steadily escalating requirement for performance reporting. Under the QCDR, EPs contributing data to a clinical registry can get credit for meeting the requirements of the Physician Quality Reporting System...