Zotec Partners Anesthesiology Digest | October 2020

October 23, 2020

Anesthesiology Digest: News from October 2020.

OxyContin Maker to Plead to 3 Criminal Charges
Associated Press | October 21, 2020
Purdue Pharma, the company that makes OxyContin, the powerful prescription painkiller that experts say helped touch off an opioid epidemic, will plead guilty to three federal criminal charges as part of a settlement of more than $8 billion, Justice Department officials told The Associated Press.

The company will plead guilty to a criminal information being filed Wednesday in federal court in New Jersey to three counts, including conspiracy to defraud the United States and violating federal anti-kickback laws, the officials said.

The deal does not release any of the company’s executives or owners — members of the wealthy Sackler family — from criminal liability. A criminal investigation is ongoing.
The officials were not authorized to discuss the investigation publicly and spoke on condition of anonymity.

The settlement is the highest-profile display yet of the federal government seeking to hold a major drugmaker responsible for an opioid addiction and overdose crisis linked to more than 470,000 deaths in the country since 2000.

The settlement comes less than two weeks before a presidential election where the opioid epidemic has taken a political back seat to the coronavirus pandemic and other issues. But the deal does give President Donald Trump’s administration an example of action on the addiction crisis, which he promised early in his term.
To read more, go to Modern Healthcare.

How Anesthesiologists Can Keep the Revenue Cycle from Going Under
October 19, 2020
Ensuring financial stability and maintaining a smooth revenue cycle has gotten harder and harder for independent anesthesia practices.

Many anesthesiologists are being forced out of networks as private insurers terminate their physician contracts with little to no notice, according to the American Society of Anesthesiologists (ASA). Furthermore, a new Medicare reimbursement rule is seeking to increase payment rates for certain services, which would mean cuts in other areas of the Physician Fee Schedule, including those most commonly used by anesthesiologists.

On top of all this, anesthesia practices are up against one of the greatest public health emergencies of the time – COVID-19.

A recent survey of anesthesia administrators and executive members of ASA found more than 90 percent of practice respondents reported case volume decreases by over 50 percent – most were at 70 to 80 percent – since the declaration of the national emergency and the cancelation of nearly all elective and non-emergent care.

Communities are resuming normal operations since the height of the pandemic earlier this year but coming back from drastic volume, and subsequently, revenue declines will be tough for independent practices. But it is not impossible – in fact, financial stability and profitability are still achievable goals for practices.

Strategies for overcoming COVID-19, other revenue challenges
Revenue cycle management optimization is crucial to overcoming the financial and operational challenges brought on by COVID-19 and other events in the healthcare industry, like unexpected payer contract terminations.

A critical first step in the optimization process is leveraging data analytics and automation to streamline revenue cycle processes and increase efficiency. Despite troves of technological advancements in healthcare, the revenue cycle is still a largely manual process. About 88 percent of providers, for example, rely on paper bills and statements to collect patient payments in this digital world. Consequently, most providers reported that collections usually takes over a month, making patient receivables a top primary revenue concern for respondents.

Seeking out improvements for employee utilization and operating room productivity is one way to leverage the data. A well-managed operating room not only results in high surgical turnover, but also reduced postoperative complications and improved patient-centric outcomes. Groups can achieve significant improvements in efficiency by analyzing operating room data and devising strategies for maximizing the most common delays, while subsequently measuring physician accountability, streamlining procedures, enhancing interdisciplinary teamwork, and collecting accurate data.
To read more, go to Revcycle Intelligence.

31 States with No CRNA Supervision Requirement in ASCs
By Angie Stewart | October 14, 2020
As of September, there was no physician supervision requirement for nurse anesthetists in ambulatory surgical facilities across 31 states and Washington, D.C., according to information provided to Becker’s ASC Review by the American Association of Nurse Anesthetists.

The following have no supervision requirement “concerning nurse anesthetists in nurse practice acts, board of nursing rules/regulations, medical practice acts, board of medicine rules/regulations, ambulatory surgical facility licensing statutes, ambulatory surgical facility licensing rules/regulations, or their generic equivalents”:

Alaska, Arizona, California, Colorado, Delaware, Washington, D.C. , Georgia, Kentucky, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, Oklahoma, Oregon*, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, Idaho, Illinois, Iowa, Kansas, New Hampshire, New Mexico, North Carolina, North Dakota, Washington, Wisconsin, Wyoming
*Note: Oregon ambulatory surgical facility licensing statutes, rules or regulations don’t require supervision, direction or collaboration, but facilities themselves may establish such requirements for a certified registered nurse anesthetist.
To read more, go to Becker’s ASC Review.

CMS Announces New Repayment Terms for Medicare Loans Made to Providers During COVID-19
October 14, 2020
Last week, the Centers for Medicare and Medicaid Services (CMS) announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program. Under the recently passed government funding legislation, repayment for the Medicare loan program that allows CMS to make advance payments to providers will now begin one year from the issuance date of each provider’s payment. Previously, providers were required to make payments starting in August of this year, but with this action, repayment will be delayed until one year after payment was issued. After that first year, Medicare will automatically recoup 25% of Medicare payments otherwise owed to the provider or supplier for 11 months. At the end of the 11-month period, recoupment will increase to 50% for another 6 months. If the provider is unable to repay the total amount of the AAP during this time-period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of 4%.

Fact Sheet with new repayment terms

FAQs on the AAP Program

ASA COVID-19 Resources

HHS Secretary Alex Azar Reauthorizes COVID-19 Emergency; Flexibilities in Place Through End of the Year
October 7, 2020
HHS Secretary Alex Azar has reauthorized the declaration of a public health emergency (PHE), meaning the PHE and its special rules for providers remain in effect at least through the end of the year.

At the federal government’s PHE website, Azar declared on Oct. 2: “As a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Alex M. Azar II, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective October 23, 2020, my January 31, 2020, determination, that I previously renewed on April 21, 2020 and July 23, 2020, that a public health emergency exists and has existed since January 27, 2020, nationwide.”

As this is a 90-day authorization, physician practices can count on the flexibilities instituted by CMS under the authority of the PHE—such as the right to provide and bill Medicare for expanded telehealth and even telephone services regardless of site of service and expanded scope of practice for many non-physician practitioners—to continue through the end of the year.
The renewed 90-day period will cover Oct. 23 to Jan. 21, 2021. But this is no guarantee that Azar will reauthorize again in January.

It also remains to be seen whether CMS will retain the flexibilities in 2021—the recent proposed rule for the physician fee schedule suggests the agency is eager to drop at least some of them.
To read more, go to Health Leaders Media.

Practice Without Fear: Advice for Residents on the Future of Our Profession
By Karen Sibert MD, FASA | October 5, 2020
You may be weary of being told that our profession is facing a time of unprecedented threat—from third-party payors, the government, and advanced practice and nonphysician practitioners. You’ve heard it so often that your brain is tuning it out. Is the threat level exaggerated for dramatic effect? Is it better just to go on with your day and not think about it at all?

That would be a mistake. The real question is, how should we deal with the upcoming “market adjustment” that almost certainly will result in lower anesthesiologist compensation? In the face of gloomy reality checks, how can we promote pride in our profession and recruit the best medical students? How can we continue research that will reduce risk and improve outcomes? How do we avoid becoming irrelevant or extinct, like Kodak, Xerox, Sears and now Hertz? It’s time to face the future.

The Threats Are Real
Unfortunately, the “unprecedented threat” claim is all too real. Department chairs everywhere worry that they will not be able to maintain the compensation rates that anesthesiologists have enjoyed up to now. Why?

  • The Medicare Trust Fund is expected to become insolvent as soon as 2024.1 The chair of the Medicare Payment Advisory Commission, Michael Chernew, PhD, recently commented, “We are very dedicated to finding payment models to promote efficient delivery of care.”2 No one could possibly think this will mean anything other than lower payments to physicians.
  • Scope-of-practice expansion is gaining ground. On March 30, the Centers for Medicare & Medicaid Services issued an array of “temporary” waivers and new rules, waiving the requirement that a nurse anesthetist must work under the supervision of a physician.3 How likely are these new rules to be reversed under a new administration, whether Republican or Democratic? Whether or not you live in an “opt-out” state may not matter in the near future.
  • Hospitals were in trouble even before the COVID-19 pandemic. Many have gone bankrupt4; others are merging with larger health systems. At present, around 80% of hospitals subsidize their anesthesiology departments to the tune of millions of dollars each year. Realistically, can these subsidies continue? Probably not. Will hospital administrators seriously consider cheaper staffing models for delivering anesthesia care?5 Probably.

To read more, go to Anesthesiology News.

Trump Signs Short-term Gov’t Funding Bill that Alters Medicare Loan Repayment
by Robert King | October 1, 2020
President Trump signed into law late Wednesday a short-term government funding bill that includes changes to repayment terms for certain providers for COVID-19 loans.

The continuing resolution, which funds the government through Dec. 11, includes new deadlines for participants to repay loans from the Medicare Advance and Accelerated Payments program. The program enabled hospitals and certain providers in Part A and suppliers in Part B to get advance loans to cover major financial hits caused by the pandemic.

“Medicare accelerated and advanced payments have been a lifeline to many hospitals and health systems in the fight against this historic pandemic, allowing them to continue to deliver the care that their patients and communities depend on,” said American Hospital Association President and CEO Rick Pollack in a statement after Congress passed the bill on Wednesday.

CMS had doled out more than $100 billion in advance loans to providers at the onset of the pandemic. The agency suspended the program in April.

But the loans started to become due starting on Aug. 1. CMS could garnish Medicare payments to such providers to repay the loans.

The pressing deadline alarmed provider groups who say their members are still suffering from the financial crisis caused by COVID-19.
To read more, go to Fierce Healthcare.

HHS Announces $20B in New Phase 3 Provider Relief Funding
October 1, 2020
The Department of Health and Human Services (HHS) announced $20 billion in new funding for providers on the frontlines of the coronavirus pandemic through Phase 3 General Distribution allocation. HHS stated that providers who received Provider Relief Fund payments can apply for additional funding, as well as previously ineligible providers, such as “those who began practicing in 2020 will also be invited to apply, and an expanded group of behavioral health providers confronting the emergence of increased mental health and substance use issues exacerbated by the pandemic will also be eligible for relief payments.”

HHS stated that the new Phase 3 General Distribution is “designed to balance an equitable payment of 2 percent of annual revenue from patient care for all applicants plus an add-on payment to account for revenue losses and expenses attributable to COVID-19.” HHS Secretary Alex Azar stated, “HHS has worked to ensure that all American healthcare providers receive support from the Provider Relief Fund in a fast and fair way, and this new round helps ensure that we are reaching America’s essential behavioral health providers and takes into account losses and expenses relating to coronavirus.”

Additional Details on Eligibility – HHS states that it is “making a large number of providers eligible for Phase 3 General Distribution funding, including:

  • Providers who previously received, rejected or accepted a General Distribution Provider Relief Fund payment. Providers that have already received payments of approximately 2% of annual revenue from patient care may submit more information to become eligible for an additional payment.
  • Behavioral Health providers, including those that previously received funding and new providers.
  • Healthcare providers that began practicing January 1, 2020 through March 31, 2020. This includes Medicare, Medicaid, CHIP, dentists, assisted living facilities and behavioral health providers.”

Providers may apply for funding from October 5, 2020 through November 6, 2020.
Additional information can be found in the HHS press release.

Learn more about what Zotec Partners can do for your anesthesiology practice here.