Anesthesiology Digest – March 25, 2022

March 25, 2022

Anesthesiology Digest: News from March 2022.

HHS Distributes $413M More in Provider Relief Funds
By Kara Hartnett | March 22, 2022

The Health Resources and Services Administration is distributing another $413 million from the Provider Relief Fund to more than 3,600 providers, the Health and Human Services Department announced Tuesday.

These Phase 4 allotments target smaller providers and include bonuses to those that treat Medicare, Medicaid and Children’s Health Insurance Program enrollees, HHS said in a news release.

Including this round, $12 billion of the $17 billion available under Phase 4 has been allocated, according to HHS. HRSA has processed 89% of Phase 4 applications it’s received since September. Recipients have until June 20, 2023 to spend the monies.

Healthcare providers have clamored for more assistance as the COVID-19 pandemic continues. The American Hospital Association asked Congress to set aside another $25 billion but lawmakers have not done so. The AHA also has complained that HRSA is not moving swiftly enough to deliver the funds Congress previously approved.

To read more, go to Modern Healthcare.

President Biden Signs into Law the ASA-Endorsed Dr. Lorna Breen Health Care Provider Protection Act
March 22, 2022

On March 18, President Biden signed the ASA-endorsed Dr. Lorna Breen Health Care Provider Protection Act into law, an important measure to help prevent suicide, and address burnout, and other mental and behavioral health conditions impacting our nation’s health care professionals. The comprehensive, bipartisan legislation was co-led in the House by Rep. Raja Krishnamoorthi (IL-08), Rep. Susan Wild (PA-07), Rep. Judy Chu (CA-27), and Rep. David McKinley, P.E. (WV-01) and in the Senate by Senators Tim Kaine (D-VA), Todd Young (R-IN), Jack Reed (D-RI), and Bill Cassidy, M.D. (R-LA).

ASA believes this legislation is a vital step forward in reducing and preventing suicide and in addressing other mental health challenges among health care professionals. These challenges have been exacerbated by the COVID-19 crisis, especially among front line health care professionals, such as anesthesiologists who, in many cases, have been deployed to provide high stress, high risk critical care services.

ASA applauds Congress and the President for addressing the mental health and well-being of health care professionals nationwide.

Read ASA’s posting from Congressional passage of this legislation.

Biden Aides to Congress: Fund COVID Aid, Don’t Cut Budget
By March 22, 2022

Congress should provide the $22.5 billion President Joe Biden wants for continuing the battle against COVID-19 without cutting other programs to pay for it, senior administration officials said Monday.

And if Republicans continue to insist that additional federal efforts to combat the pandemic must be paid for by culling spending elsewhere, the GOP should specify what it wants to cut, the officials said.

The remarks came nearly two weeks after a new round of COVID-19 funding was pulled out of a $1.5 trillion government-wide measure after rank-and-file Democrats rejected cuts that party leaders had negotiated with Republicans to pay for it. Though Biden signed the overall bill into law, the deletion of the COVID-19 funds was a major setback for Biden and Democrats.

“Our concern right now is that we are going to run out of money to provide the types of vaccines, boosters, treatments to the immunocompromised, and others free of charge that will help to continue to battle” the pandemic, White House press secretary Jen Psaki said Monday.

Top House Democrats have said they believe they will have to find savings to pay for the additional spending to move legislation through Congress. The biggest hurdle would be in the Senate, where Democrats will need at least 10 GOP votes to reach the 60 votes needed to move most significant bills to passage.

The White House has said the government is running out of funds for vaccines, testing and treatments, even as Omicron variant BA.2, which is fueling a virus resurgence in Europe and Asia, is appearing increasingly in the U.S.

To read more, Modern Healthcare.

Becerra Eyes Work on Physician Pay, Medicare Advantage Reform
By Maya Goldman | March 17, 2022

Health and Human Services Secretary Xavier Becerra said Thursday that the department may readjust Medicare Part B premiums next month while it looks to work with Congress on other healthcare reforms in his second year on the job.

As Becerra approaches his one year anniversary in the position, he’s also fighting an uphill battle for more funding from Congress to keep COVID-19 relief and health coverage initiatives alive. HHS is interested in talking to Congress about Medicare Advantage overpayment issues and physician payment reform, Becerra told reporters Thursday.

“We can’t let this go over the cliff. Not when we’re on the verge of turning the page,” he said.

Part B Premiums
The Centers for Medicare and Medicaid Services’ plans for reassessing Medicare Part B premiums for 2022 will come soon, and Becerra said HHS will ensure seniors don’t pay more than necessary.

Becerra directed CMS to reassess Medicare Part B premiums in January after drugmaker Biogen slashed the price of its controversial Alzheimer’s drug, Aduhelm. CMS announced in November that covering Aduhelm would increase premiums by 15%. CMS has since proposed only covering the drug in clinical trials. A final coverage decision will come in April.

“Once we have that determination, we’ll be able to fully assess what impact Aduhelm may have had on premiums for seniors in Medicare,” he said.

Medicare Advantage
Becerra also indicated the department could look to Congress for help reforming the Medicare Advantage program in the future. However, he didn’t commit to how HHS would address some experts’ concerns that Medicare Advantage plans are overpaid relative to traditional Medicare. Insurers dispute claims of overpayment.

“We’re taking a close look at Medicare Advantage and working with our partners at [the Office of Management and Budget] and will try to make sure that we’re putting before Congress any reforms that will give Americans a better value for their Medicare buck,” he said.

The Medicare Payment Advisory Commission and other health policy experts have advised that HHS can take steps itself to level plan payment, like increasing the coding intensity adjustment, but the agency has not done so.

Physician Payment
HHS is interested in discussing physician payment reform with lawmakers, Becerra said. Congress last year partially offset cuts CMS made to provider Medicare reimbursement that mainly impacted specialists. Physicians want a more permanent fix to their payment system that keeps up with inflation and practice costs.

The agency will examine provider payment where it can, but would support physician fee schedule reforms.

“I remember those cliffs when I was in Congress, we always have to deal with those, and you’d never want professionals… thinking that there may be a different profession for them down the line because they’re just not making ends meet where they are,” he said. HHS is working to increase the pipeline of providers as well, particularly in underserved areas, Becerra said.

To read more, go to Modern Healthcare.

The Future of Education in Anesthesiology Is Here: e-Learning
March 10, 2022

In the fast-paced world of medical education, new challenges are always popping up for everyone involved, whether a teacher or student. The global COVID-19 pandemic has nudged these educational challenges straight into crisis territory as we watch classrooms staying closed for what is now nearly two full years.

Regular changes in healthcare provision and constant advances in medical science, information and technology drive the need for e- and micro-learning platforms.

The development of these platforms was around before the epidemic, but because of the pandemic it became practically the sole alternative to provide up-to-date medical education.

This article will begin by defining what e-learning and micro-learning really are, and how they differ from each other. The second part of the article will delineate the advantages and features of an effective e-learning platform by using a real-life example: describing the learning journey on, a platform that currently focuses on anesthesiology, pain, and perioperative medicine.

What Comprises e-Learning And Micro-Learning?
E-learning consists of using internet- and software-based platforms that, by using specially made tools, make studying more convenient and customizable. Through the use of various cognitive aids, e-learning can also enhance knowledge retention.

These platforms are becoming ever more popular as a teaching device in medicine in general, and anesthesiology is no exception. In fact, e-learning has existed in its earliest forms since the 1960s, although this might sound unbelievable.

Micro-learning has been defined as the new “holistic” learning approach by educating in bitesized pieces—learning in small units and through short time spans.

What Are the Main Benefits?
The main purpose of e-learning platforms lies in improving the efficiency and effectiveness of learning and by administering and reviewing education, while keeping up with social, informational and pedagogical advances.

To read more, go to Anesthesiology News.

Congress’ $1.5 Trillion Spending Deal Includes 340B, Telehealth Coverage
By Jessie Hellmann | March 9, 2022

Congress reached a deal early Wednesday morning on a $1.5 trillion package to fund the government, but additional money to respond to the COVID-19 pandemic was stripped out at the last minute.

The long-awaited package comes after months of negotiation between Democrats and Republicans and disagreements over additional COVID-19 funding. The House plans to pass the package Wednesday with a vote in the Senate potentially by the end of the week.

About $15.6 billion in supplemental funding was removed from the bill Wednesday afternoon after some Democratic members objected to the offsets: cuts in planning relief funding to state and local governments.

The $15.6 billion was already $7 billion less than the Biden administration had asked for, and now it’s not clear when or if Congress will pass additional COVID-19 response funding.

“It is heartbreaking to remove the COVID funding, and we must continue to fight for urgently needed COVID assistance, but unfortunately that will not be included in this bill,” House Speaker Nancy Pelosi (D-Calif.) wrote in a letter Wednesday to Democratic members.

More than $10.5 billion of the funding would have gone to the Health and Human Services Department for research, manufacturing, production and distribution of vaccines, treatments, diagnostics and medical supplies.

The remainder of the funding would have gone toward the global COVID-19 response.

The supplemental funding doesn’t include money for an HHS program that reimburses providers for treating uninsured COVID-19 patients. The Biden administration had initially asked Congress for $3 billion to replenish this fund, which is expected to run out of money by spring or early summer.

Congressional Republicans had raised concerns about how the money has been spent so far.

The Biden administration says all of the funding that was appropriated by Congress in the past to respond to COVID-19 has been spent or obligated.

The overall package also does not include several other provider group requests, including another delay of Medicare payment cuts, which are set to partially resume in April.

The package also does not include more money for the Provider Relief Fund, which helps providers offset financial losses due to COVID-19, nor does it include a suspension of Medicare loan repayments.

To read more, go to Modern Healthcare.

Staff Shortages, Deferred Treatment Driving Changes in Care Models
By Kara Hartnett | March 8, 2022

Patients previously considered low-risk became sicker and health disparities likely widened because of clinical staff shortages and volume surges during the COVID-19 pandemic. As a result, care delivery models need to evolve to make up the backlog and meet the ongoing needs of those whose ailments manifested or became more severe because they couldn’t receive treatment.

The pandemic, along with the healthcare system’s response, have had a disproportionate effect on older and sicker patients as well as people from underserved communities that’s going to linger. The public health emergency also highlighted and exacerbated staffing shortages, leaving a smaller, exhausted workforce to deal with the clinical consequences of deferred care. The pandemic eventually will go away, but the patients who didn’t get the treatment they needed will not.

The impact of delayed care on patients is still being empirically explored, but a general consensus has emerged: Many became sicker and diseases progressed undetected as preventive care and screening went by the wayside. Wellness visits declined 69%, breast cancer screenings dropped 88% and childhood vaccinations for measles, mumps and rubella fell 60% as people stayed clear of the healthcare system in 2020, according to data from UnitedHealthcare.

Hospitals are grappling right now with how to optimize their workforces to face these challenges by reconsidering how care is delivered. Telehealth and value-based care will play critical roles.

To read more, go to Modern Healthcare.

ASA Urges CMS to Ensure Medicare Advantage Plans Include Sufficient Number of Anesthesiologists in Their Networks
March 4, 2022

ASA has submitted formal comments to the Centers for Medicare and Medicaid Services (CMS) in response to the agency’s proposed policy and technical changes to the Medicare Advantage and Medicare Part D Benefit Program for CY 2023. In the letter, ASA makes the following points:

• ASA supports CMS’s proposal to require these plans to demonstrate that they meet network adequacy standards as part of the plan’s application process
• ASA requests that CMS add anesthesiologists and pain medicine specialists to its list of specialties for which it specifically tracks network adequacy for these plans
• ASA recommends that the criteria used by these plans to evaluate the inclusion of a physician or practice group in its network be submitted to CMS and be made publicly available
• ASA emphasizes the need for ongoing monitoring of network adequacy and recommends that CMS require these plans to submit data on an annual basis to ensure appropriate adequacy standards are met and maintained.

ASA specifically notes a disturbing trend of plans not contracting with anesthesiologists – possibly due to implementation of the No Surprises Act – and accentuates the need for robust requirements for ensuring that payer networks include an appropriate number of anesthesiologists.

To read more, go to ASA’s website.

No Surprises Act Regulators Withdraw Independent Dispute Resolution Guidance – To Rewrite IDR Regulations
March 4, 2022

On February 28, the Center for Consumer Information and Insurance Oversight (CCIIO) released a memorandum withdrawing portions of its formal No Surprises Act (NSA) implementation guidance. CCIIO’s action came in response to a Texas Medical Association (TMA) lawsuit ruling on February 23 invalidating the government’s NSA regulations directing arbiters to give primary consideration to an insurers median in-network rate when adjudicating payment disputes between physicians and insurers. The courts found that the regulations were in conflict with the actual text of the NSA law.

CCIIO, the federal government’s lead agency on the No Surprises Act (NSA) implementation, had issued guidance related to its Independent Dispute Resolution (IDR) regulations that created a “rebuttal presumption” that the insurer’s median in-network rate, also referred to as the Qualifying Payment Amount, was the appropriate payment rate. TMA argued that the regulation was inconsistent with the text of law which directs the arbiter to consider a broad range of factors, without preference to any one factor, in determining the appropriate payment rate.

At the direction of the Court, the federal agencies will need to rewrite the regulation related to the IDR process, and issue the revised regulations and related guidance.

The federal government may also choose to appeal the TMA ruling.

The arguments made by the TMA in their Texas-based litigation track closely with the lawsuit filed in Chicago, IL by ASA, the American College of Emergency Physicians and the American College of Radiology challenging the same NSA regulation.

To read more, go to ASA’s website.

CMS to Reweigh MIPS Data for Some Physicians Amid Pandemic
By Lisa Gillespie | March 1, 2022

The Centers for Medicare and Medicaid Services is giving physician groups participating in its Merit-based Incentive Payment System more time to apply for an extreme and uncontrollable circumstance waiver so that 2021 quality data has less of a chance of negatively impacting their payments.

Physician groups, virtual groups and alternative payment model entities can apply for a waiver until March 31, and if granted, will have their data re-weighted to account for COVID19 impacts. In addition, if physician groups didn’t submit data, they will not receive a penalty. The previous deadline was on Dec. 31, 2021, but the American Medical Association and others argued that physician groups needed an extension.

“The increase in COVID cases — and increased demands — coincided with the original E&C hardship application deadline at the end of 2021,” said Dr. Gerald E. Harmon, president of the American Medical Association. “As a result, physicians might have missed the opportunity to file for a hardship application and faced a payment adjustment, and the re-opening of the 2021 application period will give physicians, including APM participants, much-needed relief and better ensure they avoid a negative 2023 MIPS payment adjustment.”

The move comes after the agency provided individual physicians with an automatic exemption in November 2021.

Congress established MIPS in 2015 with the intention to improve outpatient outcomes and reduce spending. Providers can pick from a range of measures. Of the1 million clinicians who participated in MIPS’ first year in 2017, 93% received bonuses that were applied in 2019. About 5% of providers received penalties that capped at 4%.

CMS’ decision may signal how they will treat hospital quality and safety data from 2021. The agency waived requirements to submit for 2020, but has remained silent on 2021, when the pandemic hit health systems with additional COVID-19 waves.

To read more, go to Modern Healthcare.

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