Posted by Deb Dietsch on Wed, Oct 05, 2011 @ 01:59 PM
ACO stands for Accountable Care Organization, but what does it really mean? According to a recent article in The Wall Street Journal (WSJ), The Model of the Future, “these entities propose to unite doctors and clinics or hospitals in groups that pool their resources with the goal of trimming spending while boosting the quality of care.”
On one hand the ACO seems like a friend
While in theory, the ACO seems like a helpful solution to healthcare reform. Many physicians remain skeptical--especially specialists. Many specialists including anesthesiology have concerns that the ACO model and its web of new regulations pose financial risks for providers. Although the intent of the formation of ACOs may be the unification of multiple healthcare providers around quality patient care delivery, the question of how the ACOs will truly function in the market remains unanswered. Pilot ACOs are up and running around the country to prove the concept.
In May 2011, the Center for Medicare and Medicaid Services (CMS) released a long-awaited rule that outlines the creation and operation of ACOs that will be eligible for potentially significant Medicare incentive payments in coming years. The Medicare ACO program, as defined by the Affordable Care Act (ACA), is slated to begin on January 1, 2012. For details, see our blog Medicare Proposes Accountable Care Organization ACO Guidelines.
But, on the other hand it could be a foe
What this new model means for anesthesia practices and the independent anesthesiologist remains to be seen. There were significant legal, financial, and risk concerns voiced during the comment period after the March 2011 issuance of the proposed rules. Many providers and medical groups saw significant financial risk in just starting up an ACO ($1.8MM estimate by CMS), in addition to the concerns over how they would capture the incentives for hitting the quality of care targets and measurements. What about the retrospective assignment of beneficiaries? Can hospitals clear the legal hurdles allowing them participation in the Shared Savings? Time is running out, and CMS has given no indication of the definitive answers to these questions.
What is the future for anesthesiologists?
It is now early 4th quarter, and we are still waiting on the final ACO rules. Anesthesiologists have always been leaders (not late adopters) in process improvements and care coordination. Must they take a back seat or will they prevail as leaders once again? So, questions remain about the role of anesthesiologists with the pioneer model of ACOs suiting primary care-only. A multitude of events must take place NOW leading up to January 1, 2012.
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Posted by Steve Wirtz on Tue, Oct 04, 2011 @ 11:52 AM
In about two months the federal government's healthcare reform bill will celebrate its first birthday. The Patient Protection and Affordability Care Act has created a ripple effect of healthcare reform provisions that are dramatically affecting both the patients and healthcare provider. Anesthesiology practices are trying to figure out how they will have to change the way they deliver care, and how they will get paid. Both issues are still not settled.
Bundled Payments
Many reformers have believed that the solution to "fee for service" model that rewarded physicians for performing activities or services, would be to "bundle" payments around a particular health problem. This isn't new. Medicare proposed bundled payments for heart bypass surgery back in 1990. That demonstration project proved that bundled payments can work well. They were able to reduce costs, patients had better survival rates, and shorter hospital stays were part of the results. So, why hasn't there been a wider acceptance of these ideas, and adoption of the concept across a number of other specialties? There are a number of reasons, but the biggest one is---no one knows how to divide up the money in a fair and equitable manor. A second big issue is that there is no "standardized" patient, and hospitals are going to have those that blow their budgets with a peculiar health issue.
Enter the ACO
The Accountable Care Organization (ACO) is the latest rendition of the healthcare delivery team that will work cohesively to deliver great results at a lower cost. The rules around an ACO were announced in March 2011, and the final rule after a significant volume of questions were asked of CMS is due soon. The "Pioneer Model" of an ACO seems to have gained some traction for primary care providers, but many specialties and their associations (including anesthesiology) have voiced their concerns about the model.
From a story featured in Health Business Daily recently, a CMS official responded to feedback by health plans saying, "the Medicare Shared Savings Program (MSSP) needed some upgrades." He went on to state that the final rule would include the input and ideas from private health insurers. CMS administrator Dr. Donald Berwick has not given a specific date for release, but mentioned that release of a final rule to establish the ACO program for fee for service Medicare is "imminent." We will be covering this and other reimbursement issues in our upcoming issue of Vital Signs.
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Posted by Steve Wirtz on Wed, Sep 28, 2011 @ 05:27 PM
We are closing in quickly on the first anniversary of the passing of the Patient Protection & Affordability Care Act. Its effects on anesthesia practices are still unknown. Responding to tough economic times, new regulations, and an uncertain reimbursement future has left many practice managers and administrators wondering where they can legitimately cut more costs.
The fat is long gone, and their are no easy pickings left to cut-with more reimbursement cuts projected for 2012. If Medicare follows through with another 30 percent cut in physician payments, the ability to run a successful, innovative practice could become an elusive dream for many in practice today. Doing more with less is common, but how do practice managers continue to cut in light of increasing operating costs?
Juggling all of these high priority items every week does not add up to a restful night's sleep. In reality it may cause insomnia and a nightmare or two.
These are some of the sleep-disturbing issues that are top of mind:
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Selecting a vendor and installing an EMR.
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Determining eligibility for EMR meaningful use incentives.
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Handling rising operating costs.
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Finding and participating in an ACO (Accountable Care Organization).
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Adapting to shared financial risk for the practice.
With the final rules on ACOs and the models for shared risk still unclear, there needs to be greater clarity to "produce better quality at a lower cost" mantra. The rules and guidelines are not clear. CMS is still saying that ACOs will be operational on January 1, 2012. Does that still hold?
And the previously listed concerns do not even include the compliance deadlines of ANSI 5010 and installation of new ICD-10 codes. IT infrastructures will need to accommodate and test for these vital issues to maintain the cash flow of the practice.
PPMIS is offering a compliance checklist and FAQ sheet to help you meet these goals. Download the ANSI 5010 fact sheet today!
Stay tuned in to our blog and our e-newsletter called Vital Signs.
Posted by Deb Dietsch on Tue, Sep 27, 2011 @ 02:53 PM
With the threat of cost reductions and pay-for-performance initiatives looming, surveys indicate that many physicians are avoiding various tests and procedures. Is this wise? Aren’t physicians still liable for their patients care despite these financial incentives?
As the pressures mount, will physicians begin to undertreat patients by avoiding costly tests and procedures? Will the cost of malpractice insurance increase with more and more patients being undertreated and the threat of healthcare providers being sued?
Some medical professionals question whether patients should be more involved with the decision-making of their treatment. Would patients forego costly tests if they were well informed? Could physicians implement informed refusal? These are many of the questions behind controlling healthcare costs while maintaining quality patient care.
Like other disciplines, the anesthesia community is adopting quality of care standards to ensure patient safety. Putting patients to sleep ought to result in waking them up. Standards and checklists make this vital mission possible.
The Anesthesia Quality Institute provides anesthesiology with an unbiased, national and internal source of quality indicators and standards. The AQI was formed to lead the quality assurance initiative rather than having mandates for performance forces on its specialty by federal agencies, regulators, private payers, and surgical societies. Learn more by reading Why Is Quality of Care Vital in an Anesthesia Practice and 6 Key Measurements for AQI Reporting?
Will specialists be forced to join an Accountable Care Organization just to stay in practice? Physicians and hospitals are facing these challenges with impending payment threats and new payment models. Will healthcare providers sustain financial security in the days, weeks, and months ahead?
Medicare has already threatened to reduce payments in 2012 by 29.5%. While Center for Medicare and Medicaid Services (CMS) has proposed similar but smaller reductions in payment every year for the last nine years (as required by Medicare law), Congress has taken action each time to override the rate decrease. Fortunately, Medicare reimbursement rates for physicians have remained relatively static or actually increased in small increments from year to year.
Anesthesia practices beginning the 2012 budgeting process should not assume that "zero percent update" means that Medicare payment in 2012 will be equal to 2011 levels. Read more…Déjà vu: Medicare Payment Reductions Threaten Again.
Practice managers are also faced with meeting the federally mandated deadlines ANSI 5010, ICD-10 diagnostic codes, and EMR implementation. It seems the challenges just get bigger with each passing day. Bottom line healthcare providers are in business to make money. Can they maintain their practice while meeting the growing demands and obstacles?
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Posted by Steve Wirtz on Tue, Sep 27, 2011 @ 10:09 AM
Many anesthesia practices are juggling resources and time lines getting ready for the HIPAA 5010 transaction set due to be implemented January 1, 2012. The Centers for Medicare and Medicaid Services (CMS), recently declared a 5010 Testing Week, and is also providing a series of "widgets" to help the industry prepare for the transition.
Almost right on the heels of this change, all medical practices will have to get ready for the changeover to the new ICD-10 diagnostic code set as well (2013). That change will move from the 13,000 codes being used today to a new set that will be over 140,000 separate codes for medical billing.
These are pretty compressed time frames, given the amount of work and testing needed to truly be ready. The federal government might be signaling that they won't be postponing their deadlines (which they did for ANSI 4010), and are lighting a fire under those entities that are behind in their testing. For a handy checklist for your practice, download our latest fact sheet. Failure to make the changes before the deadline exposes payers and providers to penalties.
What's a Practice Manager to do?
Is CMS also signaling that too many practices and the industry as a whole is not ready?
Will another delay be inevitable?
Are you willing to gamble?
That is a big gamble if your cash flow is interrupted, and your claim processing grinds to a halt. It would be a better move to keep on preparing, and keep a watchful eye on the CMS Web site (https://questions.cms.hhs.gov/app/answers/list/kw/5010).
Will your software vendor be ready?
For most providers who do not maintain their own IT systems, the work of writing the software code to support these changes is the responsibility of the software vendor.
PPMIS has been gearing up for ANSI 5010 since June 2010. We have included a list of questions to ask your software vendor in a previous blog post (http://info.ppmconnect.com).
Recent queries by MGMA and other organizations have found that as many as 50% of payers are not testing yet, and most of 2011 was to be spent testing their systems, with the software upgrades having been complete. The days of a system being partially driven by paper and software are drawing quickly to a close. Both electronic billing and electronic funds transfer mean that providers will have to have reliable software, and will be seeing fewer and fewer paper checks in the days ahead.
For more on this issue and others that affect your practice and revenue cycle management, subscribe to our new Vital Signs e-newsletter below.
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Posted by Deb Dietsch on Tue, Sep 20, 2011 @ 10:55 AM
In 1999, the Institute of Medicine declared medical errors were among the leading causes of death in the United States. In contrast, anesthesiology was cited as an area in which there have been impressive gains in safety and quality (as in the aviation industry). Our recently posted blog, 9 Ways the Anesthesia Practice Is Like Aviation, provides a great comparison.
The Anesthesia Quality Institute (AQI) was created to provide the specialty with an unbiased, national and internal source of quality indicators and standards. The AQI was formed to lead the quality assurance initiative rather than having mandates for performance forced on its specialty by federal agencies, regulators, private payers, and surgical societies. PQRI and P4P are two of these incentives.
The primary responsibility of the AQI is developing the National Anesthesia Clinical Outcomes Registry (NACOR). As defined by the AQI, “NACOR is a data warehouse that will eventually capture the 40 million anesthetics (a very rough estimate) and millions of pain clinic procedures performed each year by anesthesiologists in the United States. The growth of NACOR requires close collaboration between the AQI, individual providers, and healthcare information technology vendors. The focus of participation in the AQI is the ongoing contribution of case-specific data to the NACOR. AQI’s program recognizes the anesthesia practices, hospitals, and information technology vendors that have succeeded in this effort.”
Measurements
The main goal of AQI reporting is to aggregate the data from contributing anesthesia practices so that the practices can benchmark their care relative to peer groups. This data will be used for research into anesthesia risk factors, comparative effectiveness, and identification of best practices, which can then be used by ASA to develop quality measures, practice standards, and guidelines.
Quality management is vital in AQI reporting and ultimately provides the indicators for improving patient outcomes and business efficiency, and meeting regulatory requirements.
- Administrative data
- AIMS data
- Hospital EHR data
- Quality and outcome data – your group and other specialties
- Patient satisfaction information
- Anecdotes
Where can you pull the data you need? Your data is available from various sources:
- The federal government (CMS – Medicare data and AHRQ – CAHPS data)
- Private insurance companies
- The Joint Commission
- The ABA
- Your IT vendors
Your IT vendor will play a major role is collecting your data. To participate as an AQI Preferred Vendor, the healthcare information technology company must have a product that actively meets AQI requirements for data transfer. The requirements in meeting the criteria include breadth and depth of data submitted, data formatted in accordance with the AQI-defined schema, data transfer to AQI in a safe and secure fashion, timeliness of data submission, and staying up to date with AQI changes.
AQI Preferred Vendor Status
PPMIS has met criteria deeming it a preferred vendor with the Anesthesia Quality Institute (AQI). This status is vital to PPMIS’ commitment to providing its clients with the tools for ensuring the best possible service to their patients. PPMIS clients can use the AQI reporting feature in our PPM: Connect and PPM Plus billing software for benchmarking the quality of care they provide.
With the Preferred Vendor status, PPMIS is posted on the AQI Preferred Vendor page at www.aqihq.org/AQIVendors.aspx.
PPMIS is a medical billing software and services company, specializing in anesthesia. Founded by anesthesiologist for the anesthesia community, PPMIS delivers a streamlined claim processing system.
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Posted by Steve Wirtz on Thu, Sep 15, 2011 @ 10:11 AM
Being a practicing anesthesiologist has a long list of hazards these days, and the list is growing. Just going to work every morning has some risks, but think briefly on the environmental risks alone for professionals in the anesthesia field today.
Walking into your OR can get you some nice exposure to:
- Radiation to your thyroid,eyes, and other vital organs
- Trace anesthetic gases
- Pharmaceuticals used in IV pumps
The pressure and professional demands can also lead to substance abuse, and even suicide. Are we having fun yet? And, we haven't even started to list all of the business "threats" (healthcare reform, ACOs, ICD-10 codes, EMRs, and others) that did not exist even three to five years ago. You can be easily left scratching your head from time to time asking, "why did I get into this?"
Taking a Whiff of the Nitrous?
So, a cannibal comes to see an anesthesiologist, and complains that he is bored and depressed. After a few minutes, the anesthesiologist says "the problem with you is that you are fed up with people."
Sound familiar?
That list might include on a given day for you:
- A surgeon?
- Your wife??
- A colleague?
- A patient?
- A practice manager?
Some days if you did not laugh, you would cry--or maybe a little of both on a long day. A group of Minnesota-based CRNAs put some new words to an old song (http://www.youtube.com/watch?v=WOrjcLJ2IE0).
Yes, waking up is hard to do, and the Laryngospasms have their own Web site where they convert some other tunes, too.
Have you heard the one about two anesthesiologists talking at a bar?
To learn more about updating news about healthcare reform and issues affecting anesthesiology, subscribe to Vital Signs, our quarterly e-newsletter.
Posted by Steve Wirtz on Tue, Sep 13, 2011 @ 12:19 PM
Medical advances and improved anesthesia practice techniques are moving some surgeries outside of the traditional hospital setting-and fast. Almost one-half of all surgeries are now being done in an outpatient facility or medical office. Patients are voting with their feet, and they like the flexibilty, comfort, and convenience of having a procedure done in an office setting, often with a return home later that same day. Some of the same techniques used in a hospital OR or ambulatory care centers are now being used in a medical office.
They can include:
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General anesthesia, which involves the total loss of consciousness
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Monitored anesthesia, during which a patient receives medications that alleviate pain and make the patient drowsy
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Regional anesthesia, which can include spinal blocks, epidural blocks, and extremity blocks
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Local anesthesia, which involves pain management or numbness to a small area of the body
In addition to the patient convenience, flexibility, and comfort, some experts say you can add additional safety to the list of reasons why venues outside of a hospital are increasingly preferred. Healthcare is already a high-risk business, but hospitals are becoming known as places where infections can be acquired, and complications due to medical errors can occur. The Institute of Medicine Report in 1999 (" To Err is Human") tabulated those human costs (see previous post - 9 Ways the Anesthesia Practice Is Like Aviation).
Riskier than Flying?
A recent report from the newly appointed envoy for patient safety at the World Health Organization (WHO) stated that said,"millions of people die each year from medical errors and infections linked to health care and going into a hospital is far riskier than flying." (http://www.reuters.com/article/2011/07/21/us-safety-idUSTRE76K45R20110721
He went on to say,"Your chances of dying due to an error in health care would be 1 in 300. This compared with a risk of dying in an air crash of about 1 in 10 million passengers."
Some of the health care reform measures in the new Patient Protection and Affordability Care Act are designed to improve quality and patient care, but healthcare delivery has a long way to go. Anesthesiology as a specialty has set up the Anesthesia Quality Institute (AQI), to gather data that can improve the profession.
To learn more, stay in touch through our blog and RSS feed. Subscribe to our e-newsletter, Vital Signs.
Posted by Deb Dietsch on Thu, Sep 08, 2011 @ 11:52 AM
As the deadline for ICD-10 implementation nears, it’s amazing the number of providers who are both unaware of this transition and not preparing for it. Unfortunately, the transition from ICD-9 codes to ICD-10 codes is not optional. All healthcare providers, hospitals, and software vendors who use CPT codes must transition to the new version on October 1, 2013. Many providers believe this deadline may slide due to so many other changes with healthcare reform.
Is it too much at one time?
The deadlines include:
ANSI 5010 on January 1, 2012
ICD-10 on October 1, 2013
EMR implementation in 2014
While these deadlines are federally mandated, the most significant one is the EMR implementation. It is not only costly, but penalties are likely to be levied on entities dealing with patient healthcare data unable to upgrade themselves to electronic record technologies in 2015 and beyond.
The time to prepare is now!
It doesn’t look like healthcare changes will be slowing down anytime soon.
PPMIS has addressed many of these issues on its blog. The most recent one is The EMR and Anesthesiology. Learn more.
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Posted by Deb Dietsch on Wed, Sep 07, 2011 @ 10:50 AM
Labor Day is behind us, and after a long, hot summer of the federal government getting an earful about Accountable Care Organizations (ACOs), we can expect the final regulations pretty soon. The Secretary of Human Health Services has to get this concept up and running by January 1, 2012 according to the statute. So, the questions remain about the role of specialists in general, and anesthesiology in particular, with the pioneer model of ACOs suiting primary care-only. A lot has to happen between Labor Day and the new year.
So What Now?
What this new model means for anesthesia practices and the independent anesthesiologist remains to be seen. There were significant legal, financial, and risk concerns voiced during the comment period after the March 2011 issuance of the proposed rules. Many providers and medical groups saw significant financial risk in just starting up an ACO ($1.8MM estimate by Centers for Medicare & Medicaid Services [CMS]), in addition to the concerns over how they would capture the incentives for hitting the quality of care targets and measurements. What about the retrospective assignment of beneficiaries? Can hospitals clear the legal hurdles allowing them participation in the Shared Savings? Time is running out, and CMS has given no indication of the definitive answers to these questions.
Anesthesiologists as Leaders in ACOs
As hospitals, Ambulatory Surgery Centers (ASCs), and provider groups formulate the transparent partnerships the new rules demand to participate in an ACO, anesthesia is the integral linchpin to achieve the goals of this new concept. Anesthesiology is the central cog in the wheel in the initial assessment and further management of a patient's care through most procedural, surgical, and obstetrical areas of both acute and ambulatory settings.
In addition, the specialty is a champion of patient safety, and has been gathering great data through the AQI (Anesthesia Quality Institute) for years. Recent professional editorials have also talked about creating a "surgical home" or Accountable Anesthesia Organization as concepts where anesthesiologists can 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)
As we get further into September, we will cover the CMS response on the final rules for ACOs when they are made available. You can stay informed by subscribing to our e-newsletter called Vital Signs.