Anesthesiology Digest – May 2023

April 28, 2023

Anesthesiology Digest: News from May 2023.
American Hospital Association Wants Congress to Intervene in Medicare and Medicaid Payments

By Susan Morse | April 25, 2023

Following the release earlier this month of acute care hospital inpatient payment rates the American Hospital Association called “woefully inadequate,” the AHA has released a report that it said shows a continuation of financial pressures that began at the start of the COVID-19 pandemic.

Expenses across the board saw double-digit increases in 2022 compared to pre-pandemic levels, including for workforce, drugs, medical supplies and equipment, as well as other operational services such as IT, sanitation, facilities management, and food and nutrition services, the report said. 

There has been a 17.5% increase in overall hospital expenses between 2019 and 2022, according to the AHA, citing data from Syntellis Performance Solutions, a healthcare data and consulting firm.

“Specifically, hospital expense increases between 2019 and 2022 are more than double the increases in Medicare reimbursement for inpatient care during that same time,” the AHA said.

These factors led to the most financially challenging year for hospitals and health systems since the beginning of the COVID-19 pandemic, leaving over half of hospitals operating at a financial loss at the end of 2022, the AHA said. Negative operating margins continued in January and February 2023, putting access to services at risk.

The first quarter of 2023 saw the highest number of bond defaults among hospitals in over a decade, according to the AHA.

“This also is one of the primary reasons that some hospitals, especially rural hospitals, have been forced to close their doors. Between 2010 and 2022, 143 rural hospitals closed – 19 of which occurred in 2020 alone,” the AHA said. “Finally, despite these cost increases, hospital prices have grown modestly. In fact, in 2022, growth in general inflation (8%) was more than double the growth in hospital prices (2.9%).”

To read more, go to Healthcare Finance

ASA Endorses Adding Inflation Adjustment to Medicare Physician Payments

By April 20, 2023

ASA has joined with other state and specialty medical organizations to endorse H.R. 2474, the Strengthening Medicare for Patients and Providers Act. This bipartisan legislation seeks to add a mandatory annual inflation update to Medicare physician payments.  While other sectors of Medicare, including hospitals and ambulatory surgical centers, have long enjoyed annual inflation adjustments, Medicare payments for physicians have lacked any type of similar mandatory update. 

As a result, Medicare physician payments have continued to fall behind, especially in periods of high inflation. ASA applaud Representatives Raul Ruiz, MD (D-CA), Larry Bucshon, MD (R-IN), Ami Bera, MD (D-CA) and Mariannette Miller-Meeks, MD (R-IA) for their leadership on this important proposal. 

To read more, go to ASA’s website.


5 Numbers Anesthesiologists Should Know
By Riz Hatton | April 17, 2023

Here are five numbers that provide insight into anesthesiologist compensation, burnout and more: 

$448,000: The average salary for anesthesiologists, according to Medscape’s “Physician Compensation Report” for 2023.

42,264: The total number of active anesthesiologists in the U.S., according to the Association of American Medical College’s “2022 Physician Specialty Data Report.”

$68,000: The average incentive bonus for anesthesiologists, according to Medscape’s “Physician Compensation Report” for 2023.

35 percent: The percentage of anesthesiologists that reported being burned out, according to Medscape’s “Anesthesiologist Lifestyle, Happiness & Burnout Report 2023.”

10 percent: The percent that anesthesiologists’ compensation grew from 2022 to 2023, according to Medscape’s “Physician Compensation Report” for 2023.

To read more, go to Becker’s ASC.


End of COVID-19 National Emergency: Status of Medicare Supervision Rule Not Yet Finalized

April 12, 2023

On April 10, 2023, President Biden signed into law H.J.Res.7 which terminates the COVID-19 National Emergency declared in March 2020. This legislation passed the House in February and the Senate in March, leading to an earlier than intended end of the National Emergency, as the White House had previously announced plans to end both the National Emergency and the Public Health Emergency (PHE) on May 11, 2023.  

The National Emergency is a declaration by the president that permits use of federal emergency response funds and grants additional powers to the Administration to address the emergency.  The PHE is a declaration by the Secretary of the Department of Health and Human Services (HHS) that allows the Secretary to make grants, enter contracts, and make temporary personnel available, among other authorizations.

The end of the COVID-19 National Emergency will not affect the separate COVID-19 PHE declared by the Secretary of HHS beginning in January 2020. The PHE has been renewed every 90 days and is scheduled to expire May 11, 2023. The President has indicated he will not renew the PHE in May.

The PHE includes emergency waivers by the Centers for Medicare and Medicaid Services (CMS) of a full range of existing Medicare and Medicaid regulations, including the CMS Medicare anesthesia supervision requirement. To date, CMS has publicly indicated it intends for waiver of the supervision requirement to expire with the end of the PHE, a move strongly supported by ASA and its patient safety allies.   

Over the recent months, ASA has meet with senior officials throughout the Biden Administration to highlight the patient safety implications of removing the supervision requirement.  

To read more, go to ASA’s website.


Major Credit Bureaus Remove Medical Debt Collections Under $500

By Jacqueline LaPointe | April 12, 2023

Three major credit bureaus are giving consumers a break when it comes to medical debt. Equifax, Experian, and TransUnion jointly announced yesterday that any medical debt collection with an initial reported balance of under $500 has been removed from US consumer credit reports.

The credit bureaus wiped nearly 70 percent of the total medical debt collection tradelines reported to the Nationwide Credit Reporting Agencies (NCRAs) in light of the change, according to the joint announcement.

“Our industry plays an important role in the financial lives of consumers. We understand that medical debt is generally not taken on voluntarily and we are committed to continuously evolving credit reporting to support greater and responsible access to credit and mainstream financial services,” said Mark W. Begor, CEO Equifax; Brian Cassin, CEO Experian; and Chris Cartwright, CEO TransUnion.

“We believe that the removal of medical collection debt with an initial reported balance of under $500 from [US] consumer credit reports will have a positive impact on people’s personal and financial well-being,” the CEOs said.

Past-due medical debt impacts over one in seven adults, according to an Urban Institute report released last month. Additionally, nearly two-thirds of adults affected by past-due medical debt have incomes below 250 percent of the federal poverty line.

Regardless of insurance coverage, most adults under the age of 65 have experienced medical debt, reports Kaiser Family Foundation. This debt can lead to serious health consequences, including denied services and forgone care, as well as financial challenges, such as depletion of savings, going without household essentials, and damage to credit scores.

study published in the American Journal of Public Health in 2019 found the majority of bankruptcy filers said medical expenses contributed to their seeking relief. Since then, consumers have had to manage the health and financial repercussions of the COVID-19 pandemic, as well as recent inflation and economic uncertainty.

Last year, the NCRAs committed to supporting consumers with medical debt collection reporting changes. The group said the changes would “help people to focus on their personal wellbeing and recovery.”

Equifax, Experian, and TransUnion have already eliminated all medical debt collection that had been paid by the consumer from US consumer credit reports. The time period before unpaid medical debt collection appears on a consumer’s credit report also increased from six months to one year in an effort to give consumers more time to address the debt before it was reported on their credit file. These changes went into effect in July 2022.

To read more, go to Revcycle Intelligence.


Biden Ends COVID National Emergency After Congress Acts

By Associated Press | April 11, 2023

The U.S. national emergency to respond to the COVID-19 pandemic ended Monday as President Joe Biden signed a bipartisan congressional resolution to bring it to a close after three years — weeks before it was set to expire alongside a separate public health emergency.

The national emergency allowed the government to take sweeping steps to respond to the virus and support the country’s economic, health and welfare systems. Some of the emergency measures have already been successfully wound down, while others are still being phased out. The public health emergency — it underpins tough immigration restrictions at the U.S.-Mexico border — is set to expire on May 11.

The White House issued a one-line statement Monday saying Biden had signed the measure behind closed doors, after having publicly opposed the resolution though not to the point of issuing a veto. More than 197 Democrats in the House voted against it when the GOP-controlled chamber passed it in February. Last month, as the measure passed the Senate by a 68-23 vote, Biden let lawmakers know he would sign it.

The administration said once it became clear that Congress was moving to speed up the end of the national emergency it worked to expedite agency preparations for a return to normal procedures. Among the changes: The Department of Housing and Urban Development’s COVID-19 mortgage forbearance program is set to end at the end of May, and the Department of Veterans Affairs is now returning to a requirement for in-home visits to determine eligibility for caregiver assistance.

Legislators last year did extend for another two years telehealth flexibilities that were introduced as COVID-19 hit, leading healthcare systems around the country to regularly deliver care by smartphone or computer.

To read more, go to Modern Healthcare.


CMS Opens MIPS Value Pathway Registration for 2023

April 7, 2023

This week, the Centers for Medicare and Medicaid Services (CMS) opened registration for Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs)  in performance year 2023. The registration window will be open for individuals, groups, subgroups, and Alternative Payment Model (APM) entities through November 30, 2023.

MVPs are available for voluntary reporting  beginning in the 2023 performance year. According to CMS, the MVP framework “aims to align and connect measures and activities across the quality, cost, and improvement activities performance categories of MIPS for different specialties or conditions.” ASA has published additional information and practice considerations for MVPs and the “Patient Safety and Support of Positive Experience with Anesthesia MVP.”

To access the MVP registration form and an MVP fact sheet, download CMS’ ZIP folder. The completed registration can be emailed to with the subject “MVP registration.” The full list of available MVPs is published on CMS’ “Explore MVPs” web page.

Ahead of registration, prospective MVP participants are required to determine whether they want to be evaluated on an outcomes-based administrative claims quality measure (if applicable); select a population health measure; and identify whether they will participate as a group, subgroup, individual, or APM entity. Those submitting registration must have a QPP Security Official designation – the QPP Access User Guide  provides instructions on obtaining this designation. Please check the ASA website  for how these selections may apply to anesthesiologists.

To read more, go to ASA’s website.


Lawmakers Want to Tie Physician Payment Updates to Inflation

By Jacqueline LaPointe | By April 6, 2023

Several lawmakers are seeking to tie physician payment updates in Medicare to inflation to prevent potential physician shortage issues.

Representatives Raul Ruiz, MD (D-CA-25), Larry Bucshon, MD (R-IN-08), Ami Bera, MD (D-CA-06), and Mariannette Miller-Meeks, MD (R-IA-01) introduced H.R. 2474, the Strengthening Medicare for Patients and Providers Act, today. The bill would link the Medicare Physician Fee Schedule to the Medicare Economic Index, a measure of the average annual price change for the market basket inputs, including physician compensation and practice expenses.

Just recently, the Medicare Payment Advisory Committee (MedPAC) recommended in its March report to Congress that lawmakers increase physician payments above current law next year by tying the payment update to the Medicare Economic Index.

The Medicare Economic Index has increased significantly over the past decade, exceeding the 6 percent cumulative boost in annual updates to the Medicare Physician Fee Schedule rates, MedPAC reported. Meanwhile, the American Medical Association (AMA) reports that physician payments have declined by 26 percent since 2001, even after adjusting for the inflation of practice costs.

“I am deeply concerned about the impact the outdated Medicare physician payment rate is having on [healthcare] access for my constituents,” said Representative Ruiz said in a statement. “That is why I am announcing legislation that will move us away from a system where every year seniors’ access to care is threatened due to uncertainty over potential cuts.”

The bipartisan bill aims to bring certainty to physicians and their Medicare beneficiaries by preventing a possible physician shortage in the federal healthcare program, the coalition of doctors in Congress added in the statement.

“At a time when our [healthcare] system is already strained, instability in our Medicare payment system creates further access and workforce issues,” said Representative Bera, former Chief Medical Officer for Sacramento County.

AMA said it welcomes the bill that “could put Congress on the path to finally reforming the outdated Medicare payment system.” The Association has long backed tying physician payments to the Medicare Economic Index, it said in a statement today.

Medicare physician payments are currently subject to a six-year freeze expected to last until 2026. Additionally, Congress recently cut physician payment rates by 2 percent under the year-end omnibus bill.

As physicians deal with inflation, burnout, and the lingering effects of the COVID-19 pandemic, many healthcare stakeholders fear physician payments are not adequate to keep doctors practicing, especially those treating historically underserved and marginalized communities. Inadequate payments could also threaten the financial viability of small, independent, and rural practices.

To read more, go to Revcycle Intelligence.


Private-payer Billings Not Radiology’s Revenue Category to Lead

By Dave Pearson | April 3, 2023

Going by claims submitted to commercial insurers, radiology ranks 15th out of 18 physician specialties, according to a new report from the healthcare staffing company AMN Healthcare.
With average private-payer billings of approximately $2 million per year, radiology falls well below the all-specialty annual average, $3.8 million, the report shows.

Many practices generate revenues ‘considerably higher than the remuneration they receive’

AMN further found the push for quality-based payments is still mostly aspirational: The analyzed billings reflect widespread reliance on volume, whether measured by relative value units, number of patients seen or other productivity metrics.

The report, posted April 3, does not analyze real-world amounts physicians collect. AMN notes the commonness of commercial bills getting only partially paid as insurers apply discounts or deny claims outright. Further, collection rates can vary widely by individual practice as well as specialty, the firm points out.

However, given a hypothetical collection rate of 50%, the average collection amount for all providers in the report is $1.9 million, the company suggests.
Also unaccounted for in tallies of commercial claims are revenues produced by downstream services ordered after initial diagnostic testing.

The report shows that physicians practicing in procedure-oriented specialties “consistently generate higher billing amounts than those in consultative specialties,” AMN concludes.
The project also provides an interesting measure of productivity while demonstrating that physicians and advanced practitioners “generate revenues considerably higher than the remuneration they receive.”

AMN is offering the report free in exchange for name and email here.

To read more, got to Becker’s Payer Issues.


Biden Appeals Texas Ruling Tossing Range of Preventive Care Coverage Under ACA

By Andrew Cass | April 3, 2023

The Biden administration appealed a federal Texas judge’s ruling that struck down an ACA provision that requires insurance companies to provide coverage for preventive services such as certain cancer screenings and HIV prevention drugs, CNBC reported March 31.

U.S. District Judge Reed O’Connor said in his March 30 ruling that preventive care recommendations made by the U.S. Preventive Services Task Force do not need to be complied with and blocked the federal government from enforcing its recommendations. 

“Preventive care is an essential part of health care: it saves lives, saves families money, and improves our nation’s health,” an HHS spokesperson said, according to the report. “Actions that strip away this decade-old protection are backwards and wrong.” 
The case will go before the 5th Circuit Court of Appeals. 

The new ruling only applies to task force recommendations made by the panel on or after March 23, 2010 (when the ACA became law), such as statins, lung and skin cancer screenings, and preexposure prophylaxis, or PrEP, an HIV prevention drug. STI screenings and cancer screenings such as mammograms and cervical screenings would still be included for preventive coverage.

It’s likely that most insurers will still cover preventive services, but they may raise cost-sharing for members for certain services, according to the Kaiser Family Foundation. An increase in costs will not happen immediately because of current contracts, but that could change in the next calendar year. For PrEP specifically, there could be substantial cost-sharing. Generic PrEP costs around $360 a year, while branded prescriptions can reach upward of $20,000 annually.

To read more, go to Beckers Payer Issues.

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