Anesthesia Billing and Practice Management | Anesthesia Resources » Legislation

HIPAA Mega-rule Due June 2012

Robert Cox — Mon, 07 May 2012 17:01:29 +0000

The HIPAA mega-rule has reached its final hurdle and is expected to be released in June 2012.

The mega-rule will include:

Changes to privacy and security rules the HITECH Act mandates
Requirements for new enforcement and higher penalties
Final regulations of HITECH Act’s breach notification rule
Changes to HIPAA to incorporate Genetic Information Nondiscrimination Act

Just as you will have to adjust to the new provisions in the final rule, you will be under increased scrutiny to comply with them. The government is intensifying its enforcement to protect patients’ confidential health information due in large part to the increased number of security breaches that have resulted from the lack of staff training. Practices will have an arduous task incorporating all of the changes to avoid those HIPAA headaches and potential fines. The most proactive practices have begun to update privacy & security policies as well as re-train employees.

EHR Incentives Still Out of Reach of Anesthesia & Pain Providers

Robert Cox — Tue, 06 Mar 2012 14:29:10 +0000

The EHR incentive program is targeted at office-based practices. Indeed, the original version of the program would have excluded anesthesiologists explicitly. The July 28, 2010 final rule however, restricted the definition of “hospital-based” so that it only covered physicians who provide 90 percent or more of their services on an inpatient basis or in the emergency department. Most anesthesiologists do more than 10 percent of their cases on an outpatient basis, so they are not disqualified on the grounds that they are hospital-based. Nevertheless, they will be ineligible for the bonus because fewer than 50 percent of their Medicare allowables will be generated in facilities with certified EHR systems and/or because fewer than 80 percent of their patients will have records in a certified EHR system.

Then there are the meaningful use standards. Stage 1 requires the eligible professional to meet or qualify for an exclusion from each of 15 core objective functionalities (e.g., drug interaction checks) plus five out of a possible ten “menu set” measures. The EHR must allow the eligible professional to report at least six clinical quality measures, three of which are mandatory and three of which must be selected from a group of 38 measures. The majority of these objectives and clinical quality measures do not apply to anesthesiology or pain medicine practice. So the chances of quailifying for the EHR incentives are slim for anesthesia and pain professional, as the law is currently written.

Congress passes fee fix, avoids 27% physician pay cut

Robert Cox — Mon, 20 Feb 2012 14:55:40 +0000

Physicians are safe from the impending 27.4% cut to their Medicare payments set to hit March 1 thanks to Congress passing a temporary ‘doc fix’ Friday through the end of 2012.

The vote to extend the payroll tax holiday bill and keep the current $34.0376 conversion rate through Dec. 31 comes on the heels of intense debate among Congress members as to whether preventing the pay cut was fiscally sound. The $150 billion bill failed to include deeper cuts requested by GOP Congress members but remained largely budget neutral.

Congress originally approved a two-month fix that was set to expire Feb. 29. Once signed into law, the new fee fix will be good through Dec. 31.

ACO Resources now available from CMS

Robert Cox — Fri, 11 Nov 2011 16:09:23 +0000

The Centers for Medicare & Medicaid Services’ Medicare Learning Network
is offering several resources for providers looking for information on accountable care organizations and the Medicare Shared Savings Program.

Several electronic fact sheets that address topics are now available, including how to participate in an ACO and improve quality of care and information on the advanced payment model for ACOs. New fact sheets are also available detailing final rule provisions for ACOs under the shared savings program and fact sheets provide information on the methodology for determining shared savings and losses under the program.

Anesthesiologists as ACO Leaders

Robert Cox — Wed, 07 Sep 2011 16:44:15 +0000

As hospitals, Ambulatory Surgery Centers (ASCs), and physician providers formulate the transparent partnerships the new rules require to participate in an ACO, it is important to be reminded that anesthesiologists are integral providers to achieve the goals of this new ACO concept. Anesthesiologists have been critical players in the initial assessment and on-going management of patient’s care throughout the perioperative and obstetrical arenas. In addition, Anesthesiology has been a champion for patient safety and has contributed data to the Anesthesia Quality Institute (AQI), for years.

Recent professional editorials have talked about creating a “surgical home” or an Accountable Anesthesia Organization as concepts where anesthesiologists would lead a team dedicated to the goals of an ACO. A recent article published in the Journal of the American Medical Association addressed the potential mistakes in implementing ACOs, particularly in failing to recognize interdependencies (http://jama.ama-assn.org/content/306/7/758.full).

It will be interesting to see the CMS response to the final rules for ACOs when they are made available.

Physician Alignment Presents Challenge in Forming ACOs, Survey

Robert Cox — Fri, 24 Jun 2011 14:36:19 +0000

Healthcare administrators and physicians report one of the biggest obstacles they face in forming accountable care organizations (ACOs) is physician alignment, according to a survey conducted by AMN Healthcare, a healthcare staffing organization.

The survey of more than 800 administrators and physicians found that 58 percent said they were in the process of forming ACOs or are considering doing so, while 42 percent said their facilities would not be forming ACOs in the foreseeable future.

Of the administrators and physicians moving toward ACOs, 42 percent said physician alignment is the most serious obstacle to their efforts. Forty percent of the physicians and administrators who are not forming ACOs said physician alignment was the reason.

Other obstacles to forming ACOs included lack of capital, the absence of integrated IT systems, and no evidence-based treatment protocol data, according to the survey.

CMS permits practice administrators to register and attest for EMR meaningful use

Robert Cox — Mon, 16 May 2011 13:00:03 +0000

The Centers for Medicare & Medicaid Services (CMS) published their new policy permitting third parties to register and attest for the Medicare and Medicaid EHR incentive program on behalf of eligible professionals (EPs). Under this program, EPs are eligible for up to $44,000 over five years under the Medicare program and up to $63,750 over six years under Medicaid. MGMA strongly advocated to persuade CMS to permit practice administrators to register with the agency on behalf of the practice’s EPs. CMS requires users registering or attesting on behalf of an EP to have an Identity and Access Management System (I&A) Web user account that must be associated with the EP’s National Provider Identifier. Practice administrators that do not have an I&A Web user account can create one on the CMS Website.

SGR One Month Fix Passed; A “Kick the Can” Approach

Robert Cox — Mon, 29 Nov 2010 21:17:27 +0000

This afternoon, the House of Representatives, by voice vote, passed the bill, (HR 5712) that provides for a one month delay in the 23 percent cut in payment rates that otherwise would have taken effect on December 1^st. Recall that the bill passed the Senate before the Thanksgiving recess.

While some Congressional leaders want to permanently fix the SGR, the costs to do so remain a big obstacle. As an example, the costs to fix this for one year are about $19 billion. The next deadline before the cuts take place is January 1^st. Whether the Congress deals with this issue before they adjourn, or the next new Congress deals with it (retroactively) remains to be seen.

Medicare Physician Reimbursement & SGR Explained

Robert Cox — Sun, 27 Jun 2010 13:05:34 +0000

Since Medicares beginning in 1965, the social insurance program has experimented with various formulas to determine the rate of physician reimbursement. Government officials have created complex formulas with funny names — the Medicare Economic Index in the 1970s, followed by the Volume Performance Standard in the 1990s. Each reimbursement formula losing favor and being replaced by the newest formula of the month.

The most recent incarnation of the Medicare reimbursement formula is called the Sustainable Growth Rate (SGR), put in place in 1998. The government uses the formula to set an overall target amount of spending for certain types of medical goods and services. Using Medicare spending in the late 1990s as a baseline, the SGR factored in overall economic growth to create a yearly budget. “It was enacted during a time period when physician payments were not growing rapidly,” said Paul Van de Water, an economist at the Center for Budget and Policy Priorities. “It was assumed that the relative slowdown was likely to continue.”

While the SGR formula seemed sound in 1997, it didn’t account for one huge detail. Overall medical spending grew much faster than inflation. The SGR turned out to be totally unsustainable, leaving physicians with a reimbursement rate that did not keep pace with increasing medical costs, thus requiring a fix — not of the formula but of the payment.

The problem first became apparent in 2002, when Medicare costs outpaced the SGR. A Republican-led Congress stepped in with extra funding the following year, preventing a reduction in physician payments. Congress has continued to do so for seven years now.

Under both Democratic and Republican leadership, Congress has consistently delivered the necessary funds to avoid cuts to physician payments. A CBO report this month estimated that $276 billion would be required to shore up Medicare for the next decade. Not surprisingly, no politician wants to get stuck with that check. So they’ve all politely deferred from the financial commitments in order to avoid the appearance of adding billions of dollars to the national deficit.

But the “doc fix” actually fixes nothing. Health policy experts agree that health spending is not slowing down, so the short-term patches only “kick the can down the road,” as Van de Water put it. “They want to have their cake and eat it, too.” In other words, it’s a face-saving gimmick that makes it look like Congress is sticking to Medicare cost controls when it isn’t, despite numerous red flags over the years. A CBO report in 2006 suggested that “the SGR mechanism … will substantially reduce payment rates for physicians’ services over the next several years. Payment rates could decline by a total of 25% and 35% during that period if physicians continue to provide services at the current rate.”

A 2007 report from MedPac, which advises Congress on Medicare, found that, in addition to failing to keep pace with spending, the SGR had not tamped down physician spending. “The SGR does not appear to have limited the growth in volume — that is, the number of services being furnished to each patient and the level of service intensity provided,” the report concluded.

One option would be to ditch SGR and find a new, better formula that would make the “doc fix” ritual obsolete. The American Medical Association, which has previously supported temporary “doc fix” legislation, has demanded this kind of permanent action, so the short-term fix that landed in the House proposal left them unsatisfied. “The pending Medicare proposal treats the symptoms,” AMA President J. James Rohack said in a statement late last week. “It’s not a cure for the disease. We urge Congress to take action well before the next deadline to cure this problem once and for all to preserve access to care for seniors and military families and enable the success of health system reform and delivery innovations.”

But Congress has declined to move in that direction, and, for now, the exercise carries on. In 2010 alone, Congress has already headed off three scheduled payment drops — in January, March and April. This week, if all goes as the Democrats planned, they will extend the “doc fix” for an additional three years. The problem will be settled in the short term — until the 112th Congress takes up the issue all over again.

Another Bandaid for the SGR issue

Robert Cox — Fri, 25 Jun 2010 12:34:00 +0000

The House of Representatives just passed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962) by a vote of 417 to 1. This legislation contains provisions that block the 21.3 percent cut to Medicare physician payments until Nov. 30. The Senate passed identical legislation late last week. The president is expected to sign the bill into law shortly. Practices will then see a 2.2 percent increase to Medicare physician payment for claims with dates of service from June 1 through Nov. 30.

Why can’t the Obama Administration get this right and fix the underlying reimbursement problems asociated with the SGR? With the large number of uninsured that will now be insured under the new Obamacare plan we will need all healthcare providers, MDs, RNs, PAs, etc. in the sytem and productive to meet the increased demand anticipated. Any reimbursement changes that have the impact that the SGR could, would drive providers out of the sytem in great numbers. Let’s fix the SGR problem once and for all.