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The Anesthesia Insider

Inside information for anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) on the most current best practices during changing times.

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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Preparing for the Financial After-Life

Depending on how much fun you're having in the OR each day, at some point, you may decide to "discontinue full time professional engagement." Please note that I did not use the "R" word or the "W" word. With so many negative connotations, including declining physical and mental abilities and boredom, retirement, in the traditional sense of the word...
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A Refresher for Anesthesia Practices on Business Associate Agreements: Are Your Contracts in Order?

SUMMARY Covered entities, including anesthesia practices, are required under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to execute a contract with business associates to safeguard the privacy and security of protected health information (PHI). As the holder of the PHI, anesthesia groups should make sure they understand ...
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ASA, Anesthesia QCDRs Join Forces on MIPS Quality Measures

SUMMARY The American Society of Anesthesiologists and the anesthesia Qualified Clinical Data Registries, including ABC's QCDR, have formed a QCDR Roundtable to discuss and work on common interests related to measure development and implementation for the Merit-Based Incentive Payment System (MIPS). ABC encourages anesthesia groups participating in ...
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The National Practitioner Data Bank: What You Need to Know...

Neda M. Ryan, Esq. Corporate Compliance Attorney, ABCThe 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 requir...
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What Anesthesia Providers Should Know About Emergency Preparedness, Mass Casualty and Trauma

SUMMARY The mass shooting in Las Vegas reminds us of the vital role of anesthesiologists and nurse anesthetists in large-scale emergency preparedness and disaster response. We present a selection of items on this topic, including an OR Mass Casualty Checklist developed by the American Society of Anesthesiologists, a comprehensive must-read cha...
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Phoenix Project: Reconstructing a Local Group from the Ashes of Its Predecessor

Dateline PhoenixPhoenix. No, not the city in Arizona, but the mythical bird. The one that springs to life from the ashes of its predecessor.Anesthesia groups, like birds, have a life cycle. Birth to death. Formation to failure.The group's founders hatch the concept and bring it into existence. The group obtains business traction in its infancy and ...
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