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:
- Review contracts for safe harbor provisions
- Inform groups, providers of potential risks
- Check contracts for fair market value
- Request your own advisory opinion
- Insure that personal services & management contracts safe harbor requirements
Official resources
- HHS Office of Inspector General
- Advisory Opinion 13-15
- Advisory Opinion 12-06
- The American Society of Anesthesiology
CMS Proposes Onerous Changes to PQRS Reporting Requirements
Medicare is proposing sweeping changes to its Physician Quality Report System (PQRS) as part of its annual rulemaking process. Included in the FY 2014 Medicare Fee Schedule proposed rule are changes to the PQRS criteria that will adversely impact physician anesthesiologists. ASA is urging all members to submit comments to CMS regarding these changes.
ISSUE –Many ASA members use the “claims-based” method of reporting PQRS measures since it permits successful reporting when there are fewer than three measures applicable to an eligible professional (EP). At present, the Centers for Medicare & Medicaid Services (CMS) has criteria in place for physician anesthesiologists to successfully report quality measures; however, the proposed rule for the 2014 Medicare Physician Fee Schedule seeks to alter the criteria in a way that will place physician anesthesiologists at a great disadvantage. CMS is moving toward elimination of the claims-based reporting mechanism and is seeking comment as to whether that mechanism should be eliminated in 2017. Some of the actions described in the proposed rule would sharply curtail claims-based reporting even sooner. Specifically, of the more than 40 proposed new measures CMS intends to add to the 2014 PQRS, none allow reporting via claims.
Additionally, CMS proposes to increase the required number of measures that must be reported from the current three (3) measures to nine (9). These nine measures must cover at least three of the National Quality Strategy (NQS) domains: Patient and Family Engagement; Patient Safety; Care Coordination; Population and Public Health; Efficient Use of Health Care Resources; and Clinical Processes/Effectiveness.
Currently, there are a maximum of three measures applicable to most physician anesthesiologists. They all are within a single domain. Accordingly, if Medicare’s proposed rule is finalized, anesthesiologists will be unable to satisfactorily meet reporting requirements. This change would have a significant impact on anesthesiologist’s practice because 2014 is the performance period for your 2014 PQRS incentive and for the 2016 PQRS penalty adjustment.
WHAT CAN YOU DO? ASA has put together a grassroots effort to communicate how disadvantaged these new rules would make it for the Anesthesiology subspecialty. If you wish to join the grassroots effort use the link below and follow the ASA’s recommended steps. http://www.asahq.org/For-Members/Advocacy/Washington-Alerts/ASA-members-urged-to-contact-CMS-2.aspx
