BMI, Calculating It will Provide Clinical Support to Anesthesia
Anesthesia groups should educate providers and focus on the pre-evaluation documentation to help support the specific risk factors or medical conditions that validate the need for an anesthesia provider. A perfect example is the documentation for morbid obesity. We see this written on the records but many of the policies we are seeing state that the BMI must be greater than 40. Rarely do we see documentation that gives the patient’s exact BMI so that the record would clearly support the policy if audited. Having a focused audit on the pre-evaluations for MAC services would be a very good step for anesthesia compliance programs.
This issue is not new and it is not going away. As we have predicted, more and more carriers are limiting payment for these services. Anesthesia billing professionals and managers should monitor the draft policies and immediately go into action by working with their state societies when the draft policies are issued.
In addition, anesthesia groups should develop financial policies that can be presented to the patient up front that explains medical necessity limitations from the carrier and gives the patient an option to pay for the services personally. While this does put anesthesia groups in unfamiliar territory of collecting payments at time of service, getting paid for the services will be necessary, if a group is to survive.
CMS approves NACOR as Registry for Anesthesiologists
The National Anesthesia Clinical Outcomes Registry (NACOR) has been designated by the Centers for Medicare and Medicaid Services (CMS) as a Qualified Clinical Data Registry (QCDR). A QCDR is a new mechanism to report physician performance. NACOR was among the first 40 registries to receive the QCDR designation. This designation will have significant implications for our specialty. In the next five years, CMS will phase out claims-based reporting in favor of registry-based reporting. With this change, responsibility for measure development, data collection and reporting will move from CMS to specialty society registries like AQI/NACOR. The most important aspect of the QCDR designation is that it allows ASA to select and develop its own measures. Previously, physician anesthesiologists were limited to reporting three measures to the Physician Quality Reporting System (PQRS). Now we can use more than a dozen additional anesthesia-related measures through the QCDR option to meet the evolving federal requirements. Further, we will have the ability to add additional measures in coming years, to cover subspecialty areas and related disciplines such as pain medicine and critical care. The goal is to enable every physician anesthesiologist to readily report on outcomes that matter to them and their patients.
New QCDR Registry Measures include:
- Post-anesthestic transfer of care: Use of checklist or protocol for direct transfer of care from procedure room to Intensive Care Unit (ICU)
- Post-anesthestic transfer of care measure – procedure room to post-anesthesia care unit
- Prevention of post-operative nausea and vomiting – combination therapy (adults)
- Prevention of post-operative vomiting – combination therapy (pediatrics)
- Composite anesthesia safety
- Immediate perioperative cardiac arrest rate
- Immediate perioperative mortality rate
- PACU reintubation rate
- Short-term pain management
- Composite procedural safety for central line placement
- Composite patient experience measure
The QCDR option has far-reaching implications regarding how physician anesthesiologists receive the 2014 payment bonus or incentive of 0.5 percent. It will also impact physician anesthesiologists who fail to successfully report after 2015 with payment penalties starting at 1.5 percent and increasing steadily afterwards. This new reporting vehicle will transform how physician anesthesiologists participate in PQRS. It will also significantly change how measures impacting patients, physician anesthesiologists and other providers are developed, tested and ultimately used to improve patient care and safety. More information about performance reporting and the QCDR mechanism is available at www.aqihq.org/PQRSReporting.aspx. Practices wishing to use NACOR and the QCDR mechanism to report performance in 2014 should notify Lance Mueller, director of the Anesthesia Quality Institute (AQI), at l.mueller@asahq.org or call (847) 825-5586, ext. 190.
