The change is a necessary step in improving access to care in rural and underserved areas of the state, Mr. Beshear said in a statement. “In cases like this, where the federal requirement is an obstacle to some of the best options for delivery of high-quality health care, we’re pleased to take this step to opt out,” he said.
The Kentucky Society of Anesthesiologists is opposing the opt-out. “An opt-out would have dangerous ramifications to the patients of Kentucky and jeopardize Kentucky’s ability to deliver quality medical care,” a KSA press release said.

The survey was sent to 307,000 physicians in the United States and gathered 10,214 respondents.
Here are the top two “best” payors indicated by physicians in different specialties. Overall, 29 percent of physicians reported Blues Plans as their best payor with Aetna a distant second, at 10 percent. 

Anesthesiology voted for :

1. Blues Plans: 21 percent  and
2. United Healthcare: 12 percent

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.

ACO formation is both capital and time intensive. By way of limited example only, there’s the legal and financial work in planning the structure, creation of the necessary entities, building the management and compensation structures, and developing relationships with physicians and convincing them, cajoling them, or even outright pressuring them to join.

 Given these high transaction costs – and once again, setting aside (at least for a few nanoseconds) the thoughts of shifting power and control — hospitals that create ACO structures will be predisposed to use them other than simply for purposes of chasing Medicare dollars: They will pursue private payer dollars as well.

 Physicians who become providers in an ACO believing that what is intended is simply another way of collecting and allocating Medicare dollars will soon find that a huge proportion of their entire book of business is now ACO business. If that is indeed the case, then it will functionally be as if you have one very large, or perhaps one sole, payor: the hospital. When that happens, will you still be running an independent practice?

Of course, this has significant economic implications for your financial future. It also has significant political implications vis-à-vis the medical staff: If all physicians are dependent upon the hospital for their livelihood, how independent can the medical staff ever be?

And, remember, that the reason – or excuse – that the model’s proponents use for the creation of an ACO is a drive to quality care. But if physician practice becomes more and more subject to the economic control of the hospital, what will happen to physicians’ satisfaction with medical practice and, therefore, with the quality of care that they give, even assuming every physician has patient care at the forefront of his or her thoughts?

The rule also includes a proposal to implement a national health plan identifier, required under the Patient Protection and Affordable Care Act of 2010 (ACA). This is a great step to help standize the health plans so that they can be uniquily identified, just like providers have been for years now.

In November, the court agreed to hear the lawsuit brought forth by 26 states, the National Federation of Independent Business (NFIB) and two individuals. The main issue at hand and the subject of the lawsuit is the claim that Congress exceeded its constitutional power by instituting the “individual mandate,” sometimes called the “minimum coverage provision,” which requires that most Americans buy health insurance starting in 2014 or face a fiscal penalty.

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.

The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule.  HHS will announce a new compliance date moving forward.

 ”ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius.  “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead.  We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”