Anesthesiology Digest: News from May 2021.
CMS To Reweight MIPS Cost Component for 2020
May 26, 2021
Last week, the Centers for Medicare & Medicaid Services (CMS) announced that it will not be calculating or applying the Merit-based Incentive Payment System (MIPS) Cost Performance Category score to 2020 MIPS participants or their groups. The decision comes after several months of CMS expressing caution on whether the cost performance category scores could be accurately calculated during the COVID-19 Public Health Emergency.
Ultimately, CMS indicated that the “volume of data available to calculate the scores for the cost measures [had] significantly decreased overall” resulting in a decision that CMS could not “reliably calculate scores that would adequately capture and reflect the performance of MIPS eligible clinicians.”
MIPS Eligible Clinicians and their groups do NOT need to take any action on this announcement.
Anesthesiologists may see little change in how their scores will be calculated since most anesthesiologists and their groups are not scored in the Cost performance category. For those anesthesiologists and groups who were likely to be scored in the cost category for 2020, the CMS decision will result in the MIPS Cost performance category (comprising just 15% of the total MIPS score) being reweighted, in most cases, to the MIPS Quality Performance Category.
To read more, go to ASA’s website.
Senate Approves CMS Administrator Nominee
By Jessie Hellmann | May 25, 2021
The U.S. Senate confirmed President Joe Biden’s nominee to lead CMS Tuesday, giving the agency a permanent leader at a key moment for the administration.
Chiquita Brooks-LaSure, who worked for the Obama administration and helped implement the Affordable Care Act, will oversee the agency’s efforts to expand the healthcare law, set the overall policy agenda for Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).
The nomination was approved 55-44 with four Republicans voting yes: Sen. Roy Blunt (R-Mo.), Susan Collins of Maine, Richard Burr (R-N.C.), Jerry Moran (R-Kan.) and Lisa Murkowski (R-Alaska).
Before being nominated to lead CMS, she was a consultant for Manatt Health and previously worked for the House Ways & Means Committee, where she helped draft the ACA.
“This is clearly one of the most important healthcare jobs in America,” Senate Finance Committee Chairman Ron Wyden (D-Ore.) said Monday.
“Ms. Brooks-LaSure brings decades of health policy experience to CMS and I think it would be fair to say she has worked on healthcare from just about every angle short of scrubbing into the operating room itself.”
Brooks LaSure’s nomination became controversial among Senate Republicans after CMS reversed the Trump administration’s decision to approve a Medicaid wavier for an unprecedented 10-year period, arguing it did not give enough time for public comment.
The waiver pays Texas hospitals for uncompensated care and will remain in place until September 2022 and state officials will likely renegotiate the terms of the waiver with CMS.
But Senate Republicans used the debacle as a reason not to support her nomination.
In her new role at CMS, one of her first duties will be implementing the ban on surprise billing passed by Congress last year. The law prohibits providers from sending large bills to patients who were treated by out-of-network providers despite seeking care at in-network facilities.
The first regulations are due July 1, with providers and insurers pushing for favorable treatment.
To read more, got to Modern Healthcare.
Laws to Curb Surprise Medical Bills Might be Inflating Healthcare Costs
By Michael Ollove | May 24, 2021
New state laws designed to protect patients from being hit with steep out-of-network medical bills may contribute to higher healthcare costs and premiums, some researchers warn.
Lawmakers and advocates who pushed for surprise billing laws say the measures have protected consumers from some of the most egregious bills, which can climb into the hundreds of thousands of dollars. But some researchers recently have raised alarms that doctors and other medical providers are leveraging state laws that rely on arbitration to increase in-network fees, thereby raising healthcare costs for everyone.
Stacey Pogue, a senior policy analyst at Every Texan, a social justice organization that pushed for a surprise billing law in Texas, said such measures “did the most necessary thing of protecting consumers.” But Pogue also acknowledged there may be unintended consequences. “We were also concerned about inflationary costs, and the jury is out on that,” she said.
Eighteen states have passed surprise billing laws since 2014, most of them in the past three years. Last year, former President Donald Trump signed a federal version that covers self-funded health plans, including those offered by many employers, as opposed to the individual and commercial health plans regulated by states.
The concerns stem from guidelines states have established to help impartial arbitrators resolve disputes between providers and insurance carriers over how much should be paid for surprise, out-of-network bills.
“An upward trend in payments for out-of-network care could push rates higher in in-network contracts,” health policy researchers at Georgetown University wrote in a blog post last month. “These costs, in turn, could push premium costs higher for employers and consumers.”
To read more, go to Modern Healthcare.
ASA Supports Legislation to Address Covid Liability Issues
May 19, 2021
The American Society of Anesthesiologists (ASA), along with other members of the Health Coalition on Liability and Access (HCLA), applaud the introduction of H.R. 3021, the Coronavirus Provider Protection Act, by Congressmen Michael Burgess, MD, (R-TX- 26) and Lou Correa (D-CA- 46). The bill, which was introduced earlier this month, will help ensure that health care professionals and facilities who have served on the front lines of the coronavirus pandemic are not drawn into unwarranted lawsuits for the care they have provided during the public health emergency. HCLA sent a formal communication (link to letter) to the bill’s co-sponsors thanking them for their leadership on this issue.
The patchwork nature of state protections reveals that federal action is still needed. H.R. 3021 will not only reduce lawsuits but will also maintain necessary mechanisms to protect patients harmed by substandard care. The narrow liability protections guaranteed in this bill will only apply if:
• The act or omission occurred during the declared COVID-19 public health emergency or within 60 days of termination of the emergency;
• The act or omission occurred while providing or arranging care;
• The services were within the provider’s scope of licensure/certification, without regard as to whether the service fell within the usual scope of practice;’
• The services were within the provider’s scope of licensure/certification, without regard as to whether the service fell within the usual scope of practice; and
• The services were provided in good faith.
Until the Coronavirus Provider Protection Act is passed, anesthesiologists who provided COVID care will remain vulnerable to the threat of unwarranted liability lawsuits. ASA joins a host of health care organizations in endorsing this bill and looks forward to working with Representatives Burgess and Correa to ensure this threat is avoided. Read the bill text
To read more, go to ASA’s website.
CMS and ONC Issue New FAQs on Information Blocking and Interoperability Regulations
May 14, 2021
On May 10, the Centers for Medicare and Medicaid Services (CMS) released several FAQs to assist anesthesiologists, hospitals, and others on several information blocking and interoperability regulations. Given the complexities involved with implementing these new regulations, anesthesiologists may have been left wondering about how their groups/practice can best comply with the new and emerging standards set forth by CMS and the Office of the National Coordinator for Health (ONC). Anesthesiologists and their groups are likely aware of patients having been granted expanded access to their health records under the new information blocking regulations found in the 21st Century Cures Act Final Rule. These FAQs are meant to help anesthesiologists and other stakeholders understand their responsibilities.
Likewise, ONC has posted a series of FAQs to assist in answering specific questions regarding the applicability of the information blocking regulations on health care providers. ONC has identified activities that are valid reasons to restrict information access and has set forth standards that qualify for an exemption. Anesthesiologists and their groups should engage their local counsel and/or hospital legal and compliance departments as well as any medical staff leadership and medical informatics officers on their responsibility to comply with the rule during the regulatory rollout.
Additionally, the CMS Interoperability and Patient Access Final Rule requires anesthesiologists to report their digital contact information through the National Plan and Provider Enumeration System (NEPPS). At this time, CMS is not establishing a penalty for providers who fail to report their digital contact information; however, CMS may report publicly the names and National Provider Identifier (NPIs) of providers who are noncompliant in the future. Anesthesiologists should check with their groups/hospital administration to ensure compliance with the NEPPS regulation.
To read more, go to ASA’s website.
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