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.

Anesthesia Service Contracting can Raise Compliance Issues; the OIG can Help

Anesthesia practices are more and more feeling that surgical groups or other providers are pushing them into unfavorable financial deals. If you find yourself in this predicament, you have a way to push back by using a recent advisory opinion from the HHS Office of Inspector General (OIG).

 In one OIG reviewed deal, the OIG found that an arrangement between an anesthesia group and a psychiatric group potentially violated the Anti-Kickback Statute and could trigger penalties if the deal went forward, according to Advisory Opinion 13-15. Under the deal, the anesthesia group would provide care for patients of a psychiatric group who were undergoing electroconvulsive therapy (ECT) at the hospital. The anesthesia group would reassign its billing rights for these services to the psychiatric group, which would pay the anesthesia group a fixed, per diem amount and keep the difference between what Medicare paid and the anesthesia group’s fee. The anesthesia group that requested the opinion stated the fixed, per diem amount was well below fair market value. 

The OIG could not give an opinion on whether the payments were fair market value. The OIG’s concern is that the providers will order more services simply because it has a financial incentive to do so. The Psychiatric group would likely dictate the charges to be submitted for reimbursement.

 Even though advisory opinions only apply to the requestor, you should start your deal negotiations by sharing this with the surgical group. Also use Advisory Opinion 12-06. That opinion focused on two fee arrangements with an anesthesia group, which the OIG also found could violate the statute. Tell the group that based on the advisory opinions, you don’t believe a proposed deal is legal.

 Other things to consider:

  1. Review contracts for safe harbor provisions
  2. Inform groups, providers of potential risks
  3. Check contracts for fair market value
  4. Request your own advisory opinion
  5. Insure that personal services & management contracts safe harbor requirements

 Official resources