Anesthesia Industry eAlerts
Sent to subscribers every Monday morning, our eAlerts deliver timely updates on regulatory, legislative and practice management developments of interest to anesthesia professionals.
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eAlerts
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2024 Physician Fee Schedule: Impact on Chronic Pain
December 11, 2023
Last month, the Centers for Medicare and Medicaid Services (CMS) released its Medicare Physician Fee Schedule (PFS) final rule related to services beginning January 1, 2024. In a previous alert, we presented those portions of the rule that related to anesthesia. In addition, we detailed the conversion factors (both anesthesia and non-anesthesia) that will be utilized beginning next year and that will determine, in large measure, Medicare reimbursement for provider services. Reminder: it’s a disappointing downgrade.
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Anesthesia for Chronic Pain
December 4, 2023
In addition to the anesthesia services many of our clients provide to surgeons and obstetricians, some of our clients are being asked to provide anesthesia for chronic pain providers performing a variety of nerve blocks such as ESI, transforaminal, facet, RFA, spinal cord stims, etc. This particular subset of services poses a number of payment problems and may prove to be considerably less profitable on a per-hour basis than other anesthesia services. Although there are often good and compelling reasons for a practice to provide these services, it is important that providers understand the potential challenges they will inevitably encounter.
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Defining General Anesthesia: A Moving Target?
November 27, 2023
It’s something that philologists and etymologists would readily affirm: words and their meaning tend to be a moving target. That is, language and individual words within that language evolve over time so that the original meaning may no longer be reflected in later usage. “Cool” no longer refers only to relative temperature; it has also come to mean “neat.” And “neat” no longer just means “tidy”; it can also mean “awesome.” Interestingly, “awful” used to mean full of awe and wonder; now it has a completely negative connotation. So, yes, definitions are constantly changing, and medical terms are no exception to this dynamic.
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What Makes for an Ideal Relationship Between an Anesthesia Practice and the Hospital Administration?
November 20, 2023
Too many anesthesia practices are experiencing a less than collaborative relationship with the administration of the facility where they provide services. Given what an important role anesthesia plays in the management of the operating rooms, this can be a particularly troubling state of affairs. Anesthesia services bring such value to the facility. The anesthesia provider does more to enhance the patient’s overall surgical experience than the surgeon, leading many to wonder why the relationship is not more compatible. Obviously, part of the explanation is historical. In many facilities the anesthesia providers were the masked men about whom little was known. More recently, many in the administration see them as the annoying providers who are always asking for a bigger subsidy or other forms of financial support.
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2024 Medicare Physician Fee Schedule: Impact on Anesthesia
November 13, 2023
The Centers for Medicare and Medicaid Services (CMS) has released its 2024 Medicare Physician Fee Schedule (PFS) final rule. While there are minimal provisions that apply directly to the anesthesia specialty, anesthesiologists and CRNAs will find a few noteworthy changes for next year—not the least of which involves the rate of reimbursement for Medicare services. In addition to the 2,709-page rule, CMS also published a fact sheet that attempts to summarize the major changes for next year. The following will act to provide a couple of those highlights that will be of interest to the anesthesia community.
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Why Anesthesia Practices Should Have an Appropriate Collection Agency
November 6, 2023
Many anesthesia providers often ask this question: if we have contracted with a full-service billing company, why do we need a collection agency? The answer is not always obvious but can be significant. -
IDR Fees for Anesthesia Providers: The Latest and Greatest
October 30, 2023
The rollercoaster ride continues. Many of us actually enjoy the ride. The ups and downs and the change in direction and acceleration can be quite thrilling. That’s true for a carnival ride, but it’s not that exhilarating when it involves keeping up with the ever-changing rules proposed and implemented by federal authorities.
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Succession Planning for Anesthesia Practices
October 23, 2023
Effective management of any medical practice must include three distinct roles, which are often identified in classic business terms: the CEO, the CFO and the COO. Traditionally, the CEO is the one with the big vision, who sees the practice as a whole, who negotiates contracts with clients and payers. This is the person who should have the strongest relationship with administration. He or she should have a clear sense of what distinguishes the practice and what the practice’s value proposition is. In the current environment, CFOs play a critical role as they must have a sound understanding of their practices’ finances. It is their role to ensure that collections are being optimized and that expenses are being minimized. Ideally this person has a strong working relationship with the billing company or staff. Provider compensation can be a particularly challenging aspect of this role, especially given the national anesthesia manpower shortage. The term “chief operating officer” may not be the best description of this third role, as it is as much about customer service as manpower and staffing. Essentially, this is the person who deals with clinical issues, surgeon complaints and collaboration with the other members of the O.R. team.
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Under the Microscope: Anesthesia Giant Sued by Feds
October 16, 2023
It’s not a pleasant prospect. Being the focus of special scrutiny can be unnerving and even alarming. We’ve all endured the occasional background or credit check when seeking a job or a loan. And we all find ourselves increasingly subject to camera and software surveillance. These intrusions into our privacy have become fairly routine. But it’s another thing altogether to know that someone is looking into your business practices—especially when that someone is connected to a federal enforcement agency. That’s the position that one of the nation’s largest anesthesia groups now finds itself.
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Why Anesthesia Practices Fail
October 9, 2023
It has been the plan and aspiration of every founder of an anesthesia practice that there would be a strong and productive relationship between its providers and the facility administrations it serves. The expectation has always been that the practice would be a source of income and job security for its members. It used to be that when a physician or CRNA joined a practice they could put down roots and become a part of the community. There would always be a need for anesthesia, and so there would always be plenty of work. There was a time when most providers stayed with the same practice until they retired, but this is no longer the case. In the turbulent world of American medicine, anesthesia is no exception: the only constant is change. Like so many other businesses, very few anesthesia groups remain the same, and many simply cease to exist.
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Anesthesia Time in Extended Situations
October 2, 2023
It happens occasionally. A teacher waits for a delayed parent to pick up the last remaining child at the end of a school day. The babysitter demands another ten because you arrived home an hour later than arranged. These temporal disruptions in our otherwise routine schedules are not supposed to occur, but they inevitably do. Now what? That’s what many anesthesiologists and anesthetists would like to know. After all, they, too, are not immune to the caprices of time.
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Is Big Better? The Age-Old Question for Anesthesia Providers
September 25, 2023
Is big better when it comes to anesthesia practices? The answer depends on who is asking the question and what the goals and objectives of the practice are. Merger mania has certainly dominated the marketplace for decades, leaving many providers with the impression that only the largest entities will survive the challenging currents of American healthcare. The prevailing perspective is that small group practices are dinosaurs en route to extinction. The reality is that there has never been such turmoil in the specialty. So many practices have either merged, been bought out or simply ceased to exist. Hospital employment seems to be claiming an ever-growing percentage of providers. Paradoxically, this may be an especially opportune time for small practices willing to partner with their hospital administrations. After all, the key to success in today’s market is customer service.
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Understanding the Importance of Medicare Provider Enrollment
September 18, 2023
Though often overlooked, provider enrollment can have a major impact on the overall success of a medical group practice. Navigating the enrollment process can be tricky, especially when one considers that each carrier has its own unique set of regulations concerning who can participate and how the enrollment process must be completed.
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The Significance of Customer Service in Anesthesia
September 11, 2023
As anesthesia practices evolve and diversify, it becomes increasingly difficult to maintain a consistent level of customer service. While the quality of the anesthesia care provided may be exceptional for most patients, there is much more to an optimum relationship with administration than just good clinical outcomes. In the current environment, quality of care is often taken for granted; and it used to be that what happened in the operating room was all that really mattered, but times have changed. The anesthesia department has become a critical business partner.
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Presurgical Clinics: A Growing Strategy for Anesthesia Practices
September 5, 2023
Last week, we brought you an alert on certain strategies being used by anesthesia groups across the country to enhance their revenue opportunities. We discussed acute pain, chronic pain, adding new places of service and experimenting with ketamine clinics. In keeping with this theme, there is another avenue of additional reimbursement potential that some practices are now pursuing: presurgical testing. What does this service entail, and what can anesthesia groups expect to reap by adding this component to their line of services?
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Anesthesia Revenue Opportunities
August 28, 2023
By far, the greatest challenge facing most anesthesia practices today is the ability to generate enough revenue to recruit and retain a sufficient staff of qualified providers to meet the clinical and coverage requirements of the facilities they serve. It is the economic reality of today’s market that has made it necessary for most practices to request significant financial support from hospital administrations; fee for service collections simply do not generate enough revenue to cover the growing cost of anesthesiologists and CRNAs.
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No Surprises Act Update: HHS on the Losing Side Again
August 21, 2023
You know you’re having a bad day when you’ve just lost your third lawsuit in a row to the same group of plaintiffs. That’s especially irksome when you represent the almighty federal government and you’ve just been beaten again by a group of Texas doctors. So much for not being able to successfully fight city hall.
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Understanding the Value of a Strong Collection Agency for Anesthesia Practices
August 14, 2023
Many anesthesia groups often wonder why it is difficult for billing companies to collect on patient balances. It is a reasonable query, the answer to which goes to the complexity of American healthcare economics and the distinction between the nature of a billing company and the fundamental role of a collection agency. Each type of organization is structured to provide a specific scope of services and although there might appear to be some overlap, there actually is not.
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2024 PFS Proposed Rule: Implications for Chronic Pain Providers
August 7, 2023
Like every year, the Centers for Medicare and Medicaid Services (CMS) generates new proposals that will affect the practices of medical professionals throughout the country. The Medicare Physician Fee Schedule (PFS) Proposed Rule for 2024 is no different. We’ve already shared in a previous alert what the rule proposes as it concerns the anesthesia specialty, generally, as well as the RBRVS conversion factor (hint: it’s lower next year). Today’s article will focus specifically on those issues most likely to have implications for chronic pain practices.
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Appreciating the Complexity of Anesthesia Billing
July 31, 2023
The percentage of anesthesia practices that have elected to outsource their billing has increased dramatically over the past decade or more. What is it about anesthesia billing that makes it so difficult to execute effectively? There was a time when many practices—even some very small ones—thought all they needed was a few good employees and an effective software package to optimize their cash flow. The fact is those days are long gone. Now, it takes a significant team of qualified accounts receivable specialists to effectively navigate the complicated and ever-changing waters of American medical payment. Why is this? It is time to do a quick review of the evolution of anesthesia billing challenges.
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2024 PFS Proposed Rule: Impact on the Anesthesia Specialty
July 24, 2023
This month’s release of the 2024 Medicare Physician Fee Schedule (PFS) Proposed Rule marks another milestone for a federal agency that remains dead set on reducing payments to hardworking medical professionals. Rather than a milestone, some would liken it to a millstone—burdensome and heavy, and hung around the necks of the nation’s anesthesia providers. There is no rest for the weary, and it appears there are no raises for the tireless practitioners of the pain-easing arts.
