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Why Report? The 2018 Anesthesia Quality Measures: Key Considerations for Groups

Summary Though the low-volume threshold for the 2018 Quality Payment Program has been raised, loosening the requirement for participation by anesthesiologists and nurse anesthetists, anesthesia groups that continue to report quality data through a Qualified Clinical Data Registry can reap some important benefits. We present the anesthesia qual...
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HIPAA Business Associate Agreements: Why These Contracts Matter

Kathryn Hickner, Esq. Ulmer & Berne LLP, Cleveland, OH No one loves drafting, reading or negotiating HIPAA Business Associate Agreements (BAAs). Yet many of us need to do so, and some of us do so daily.They are often boring, dense and technical, but BAAs are important from both a legal and a business perspective, and they deserve our attention....
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Anesthesia Groups: Target Over-Utilized OR Time to Improve Efficiency

Summary To improve efficiency in the OR, reduce your hours of over-utilized OR time, increase first-case on-time starts, use an OR manager with a solid grounding in the scientific principles of OR efficiency to drive improvement with electronic notifications, and search the scientific literature to find examples of what works. We summarize these an...
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Anesthesiologists in the ICU: Economics and Other Considerations

Very few private anesthesia practices provide services in their hospitals' intensive care units (ICUs). The lack of enthusiasm for staffing the ICU relates directly to a perception that ICU coverage is not as profitable as operating room (OR) coverage. The entire Anesthesia Business Consultants client database only yields a few examples of private ...
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Informed Consent for Anesthesia: ‘It’s a Process, Not a Form.’

Summary A direct dialogue between the anesthesiologist and patient is best in obtaining informed consent for anesthesia, according to attorney Judith Jurin Semo, JD, who spoke at ANESTHESIOLOGY® 2017. We present a summary of selected takeaways from Ms. Semo's presentation. Faced with tight time constraints and pressure to maximize operating room ef...
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The Smart Anesthesia Group’s Guide to Defending a Payer Audit

Vicki Myckowiak, Esq. Principal, Myckowiak Associates, PC, Detroit, MIAnesthesia groups currently find themselves in the uncomfortable position of being a target of the Office of Inspector General (OIG) of the Department of Health and Human Services, the largest inspector general's office in the federal government, with approximately 1,600 people d...
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Anesthesia and Pain Group Compliance in 2018: A Year for Heightened Diligence?

Summary With civil monetary penalties, assessments and exclusions based on prohibited conduct and violations of healthcare laws on the rise, anesthesia and pain groups might consider enhancing efforts to improve practice compliance and documentation in 2018. We provide several examples of settlement agreements reported by the Health and Human Servi...
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2017: A Year of Uncertainty for Healthcare and Anesthesia

We close the year with a glance back at some of the most significant healthcare- and anesthesia-related developments of 2017. The word of the year in health law and bioethics was "uncertainty," Carmel Schacar and I. Glenn Cohen of Harvard Law School proclaimed on Health Affairs' blog. The same might well be said of the healthcare sector as a whole ...
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2018 CPT Coding and Key Reimbursement Changes Pain Management and Anesthesia

• The 2018 CPT edition includes 170 new CPT codes, 60 revised codes and 82 deleted codes along with two new modifiers. It is important to understand the changes and what should be documented to support the utilization of these codes.• The majority of the changes for 2018 were new CPT codes added to the Surgery section, Pathology/Laboratory section ...
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Is it Time to Add TAP Blocks to Your Anesthesia Practice?

First described in 2001, the transverse abdominis plane (TAP) block is a peripheral nerve block designed to anesthetize the nerves supplying the anterior abdominal wall (T6 to L1). In a 2011 meta-analysis, the TAP block was shown to reduce the need for postoperative opioid use, increase the time to first request for further analgesia and provide mo...
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2018: Anesthesiologists to See Cuts to Some Ancillary Procedure Payments

The 2018 Physician Fee Schedule (PFS) (published in the Federal Register on November 15, 2017) contains significant reductions in the work values for several flat-fee ancillary services. Flat-fee services are those for which payment is determined under the Resource Based Relative Value Scale (RBRVS) and for which time is not a factor in determining...
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What Does “Patient Satisfaction” Mean to and for Anesthesiologists?

"Patient satisfaction" and the patient experience are considered key measures of quality and performance in our increasingly value-based healthcare system. The American Society of Anesthesiologists' Committee on Performance and Outcomes Measurement (ASACPOM) has acknowledged that "monitoring of patient satisfaction has already been incorporated int...
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Pain Doctors, Anesthesia Providers: Team Up with Hospitals on Opioids—and Check Your Own Documentation

Citing eye-opening statistics from the American Society of Addiction Medicine indicating 52,404 fatal drug overdoses in 2015, healthcare leaders are calling for a multi-pronged effort in combatting the opioid epidemic in America. With their deep pharmacological expertise and clinical experience, anesthesia providers and pain specialists are eminent...
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Thinking About Medical Errors

Press releases following a recent publication in the British Medical Journal (BMJ) hysterically echoed the article's headline: "Medical error—the third leading cause of death in the U.S."1 The authors used a variety of published sources on the incidence, lethality and preventability of medical errors to produce an estimate of 251,000 deaths per yea...
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2018 Physician Fee Schedule Includes Modest Anesthesia Increase

The 2018 Physician Fee Schedule (PFS) published by the Centers for Medicare and Medicaid Services (CMS) in the Federal Register on November 15, 2017 has set a national conversion factor (CF) of $35.9996 for non-anesthesia services. This includes all evaluation and management codes as well as all surgical procedures. This represents a 0.5 percent po...
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Expanding Into Non-Hospital Venues: The True Measures of Success

The typical anesthesia practice now includes a combination of traditional hospital facilities and ambulatory surgery centers (ASCs), endoscopy centers and other outpatient venues such as doctors' offices. With the continued migration of surgical cases from inpatient to outpatient place of service, a variety of service locations is considered essent...
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2018 Physician Fee Schedule Slashes Reimbursements for Some GI Anesthesia Services

SummaryThe 2018 Medicare Physician Fee Schedule reduces the base unit value for screening colonoscopy from 5 to 3—a 40 percent reduction that translates into an estimated 28 percent reduction in reimbursement, based on an average of 7.2 units billed. CPT codes 00740 (anesthesia for upper GI procedures) and 00810 (anesthesia for lower GI procedures)...
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Leading Leaders: Building Influence in a High-Talent Group

Will Latham, MBA President, Latham Consulting Group, Inc., Chattanooga, TNIn despair at the way its programs were organized, the business school at one university recruited as the director of programs a successful businessman, who had made a modest fortune in his own business and wanted to move on to a new career. "I will soon put some order in thi...
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Opioids a National Public Health Emergency: What Does it Mean for Anesthesia Practitioners and Pain Specialists?

Following on the heels of President Trump's declaration of the opioid epidemic as a national public health emergency, the president's commission on the opioid crisis last week issued its final report containing more than 50 recommendations for addressing what has been called the most serious drug problem in U.S. history. The report, the heightened ...
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The Smart Anesthesia Group’s Guide to Defending a Payer Audit

Anesthesia groups currently find themselves in the uncomfortable position of being a target of the Office of Inspector General (OIG) of the Department of Health and Human Services, the largest inspector general's office in the federal government, with approximately 1,600 people dedicated to combating fraud, waste and abuse in government programs, i...
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