Anesthesia Billing and Practice Management | Anesthesia Resources » Healthcare Reform

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.

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.

Healthcare Reform’s 10 Year Timeline for Roll-out

Robert Cox — Wed, 24 Mar 2010 15:00:22 +0000

Many of the provisions included in the healthcare reform legislation passed recently will take place not immediately, but along a 10-year timeline through 2020. Here’s a glimpse of how that timeline rolls out:

2010

Adults with pre-existing conditions who have been uninsured for at least six months can enroll in a temporary high risk health insurance pool and receive subsidized premiums–beginning three months after the bill’s passage. (The pools expire when exchanges are implemented in 2014.)
All health insurance plans are to offer dependent coverage for children through age 26; insurers are prohibited from denying coverage to children because of pre existing health problems.
Insurance companies can no longer put lifetime dollar limits on coverage and cancel policies–except in cases of fraud.
Tax credits will be provided to help small businesses with 25 employees or fewer to get and keep coverage for these employees.
The Medicare “doughnut hole,” in which beneficiaries had to pay full cost of their prescription drugs, begins narrowing by providing a $250 rebate this year to those in the gap, which starts this year after they have spent $2,830. The doughnut hole fully closes by 2020.
Indoor tanning has a 10% sales tax.

2011

For Medicare beneficiaries reaching the Medicare doughnut hole, prescription coverage will be available with a 50% discount on brand name drugs.
A 10% Medicare bonus will be provided to primary care physicians and general surgeons practicing in underserved areas, such as inner cities and rural communities.
Medicare Advantage plans would begin to have their payments frozen—and then lowered in 2012. The plans would have to spend at least 85 cents out of every dollar on medical costs, while leaving 15 cents for plan operations, including overhead and salaries. Reductions would be phased in over the next three to seven years.
A voluntary long term care insurance program would be made available to provide a modest cash benefit for assisting disabled individuals to stay in their homes or cover nursing home costs. Benefits would start five years after people begin paying a fee for coverage.
Funding for community health centers would be increased to provide care for many low income and uninsured people.
Employers would be required to report the value of healthcare benefits on employees’ W 2 tax statements.
Pharmaceutical manufacturers will have a $2.3 billion annual fee that will increase over time.

2012

Nonprofit insurance co ops would be created to compete with commercial insurers. Hospitals, physicians, and payers would be encouraged to band together in “accountable care organizations.”
Hospitals with high rates of preventable readmissions would face reduced Medicare payments.

2013

Individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax of 2.35%—up from the current 1.45%. A new tax of 3.8% on unearned income, such as dividends and interest, is also added.
Medical expense contributions to tax sheltered flexible spending accounts (FSAs) are limited to $2,500 a year—indexed for inflation. In addition, the thresholds for claiming itemized tax deduction for medical expenses rise from 7.5% to 10% of income. People age 65 or older can still deduct medical expenses above 7.5% of income through 2016.
Medicare device makers would have a 2.3% sales tax on medical devices; devices such as eyeglasses, contact lenses, and hearing aids would be exempt.

2014

New state health insurance exchanges would be created. Income based tax credits will be available for many consumers in the exchanges. The sliding scale credits phase out for households that are four times above the federal poverty level (about $88,000 for a family of four).
Medicaid would be expanded to cover low income individuals up to 133% of the federal poverty level—about $28,300 for a family of four.
Insurers would be prohibited from denying coverage to people with pre existing conditions, or charge higher rates to those with poor or chronic health conditions. Premiums (with limitations) can only vary by age, place of residence, family size, and tobacco use.
Insurers will be required to cover maternity care as they do other medical procedures
All legal residents would be required to have health insurance—except in cases of financial hardship—or pay a fine to the IRS. The individual penalty starts at $95 each in 2014—rising to $695 in 2016. Family penalties are capped at $2,250; penalties will be indexed for inflation after 2016.
Employers with more than 50 workers would be penalized if any of their workers get coverage through the exchange and receive a tax credit. The penalty is $2,000 times the total number of workers employed at the company. However, employers get to deduct the first 30 workers.

2018

A tax would be imposed on employer sponsored health insurance worth more than $10,200 for individual coverage, and $27,500 for a family plan. The tax is 40% of the value of the plan above the thresholds, indexed for inflation.

2020

Doughnut hole coverage gap in Medicare prescription benefit is phased out. Seniors continue to pay the standard 25% of their drug costs until they reach the threshold for Medicare catastrophic coverage.

Courtsey of Janice Simmons, for HealthLeaders Media, March 23, 2010

Unintended Consequences Part 2: Healthcare Reform

Robert Cox — Fri, 09 Oct 2009 17:34:34 +0000

Carl McDonald of Oppenheimer has written a thoughtful editorial on the potential unintended consequences of healthcare reform under the Baucus bill. The current health reform legislation has a lot of objectives, but two key goals are to provide coverage to all Americans and to control the growth in health care cost trends. The legislation currently pending in Congress would achieve partial success in covering more people, but we think it will fail miserably in slowing health care costs. Because there’s so little in the bill that actually deals with cost, we wouldn’t be surprised if reform actually caused health care trends to accelerate more than if we’d done nothing. And so while health reform is laudable for its efforts to cover more people, it just isn’t a very good outcome for the country…. Among his other points:

Seniors in Medicare Advantage will face higher premiums and lose valued benefits, while younger people will have to pay significantly more for healthcare because they will be subsidizing older sicker people.
The legislation will leave 10-20 million uninsured because subsidies to help people buy insurance are modest and penalties for not having insurance are minor. Plus, the legislation doesn’t cover illegals.
Taxes levied on health insurers will ultimately be passed onto employers and consumers, raising premium rates by over 1% each year and hitting the middle class.
The middle class will also get hit with the brunt of the cost of Medicaid expansion through higher state income, sales and property taxes.

I’m sure McDonald has his own thoughts on what all this means. To me, it suggests once again that the current reform effort is at best an incremental step on the road to where we need to go: either a single-payer system or a highly regulated public-private insurance market.