Zotec Partners Anesthesiology Digest | September 2020

September 28, 2020

Anesthesiology Digest: News from September 2020.

HHS Changes Revenue Calculation for Keeping COVID-19 Relief Funds
By Rachel Cohrs | September 23, 2020
HHS again has changed the rules regarding how to document Provider Relief Fund grants and it could cause headaches for healthcare stakeholders.

HHS recently released reporting guidelines that changed how healthcare providers are supposed to calculate lost revenue from the COVID-19 pandemic, complicating accounting for more than$100 billion in grant funds.

Prior guidance from HHS had indicated that healthcare providers could calculate lost revenue by comparing 2020 revenue with budgeted revenue or with revenue from 2019, but the new notice says providers have to use net operating income instead. The document also puts a cap on how much lost revenue providers can claim.

Both of these changes are sending providers back to the drawing board as they figure out how to account for Provider Relief Fund grants and insulate themselves from False Claims Act liability and other potential consequences.

Revenue figures would have been simple to report, consultants and accountants who work with providers said, but net operating income is a more complex calculation that takes expenses into account.

“When you start adding in all of these expenses over course of the year, you are diluting what would have been a single metric. Will it always work out the same way? No,” said Polsinelli healthcare operations chair Colleen Faddick.

The guidance would also cap lost revenue providers can claim to their net 2019 gain, or net zero if the provider had a negative net operating income last year.

The formula limits providers to their 2019 financial performance if they want to qualify for the grant funds to help with lost revenue, Faddick noted.
To read more, go to Modern Healthcare.

House Passes Government Funding Bill, Including Plan to Extend Medicare Loan Repayments
By Rachel Cohrs |September 22, 2020
The House Tuesday night passed a bipartisan bill that will fund the federal government through Dec. 11 and relax Medicare loan terms for healthcare providers.

Lawmakers passed the deal—359 to 57—after negotiating through the day to reach a consensus. The package is designed to avoid a shutdown on Oct. 1. While House Democrats
and the White House decided to separate the funding bill from COVID-19 relief legislation, some policies that healthcare providers asked for were included.

Hospitals have implored Congress to forgive or relax repayment terms for $100 billion in COVID-19 relief loans that Medicare gave out in the spring. CMS was supposed to start recouping the funds by cutting providers’ Medicare fee-for-service reimbursement starting in August, but that hasn’t happened.

The bill would give providers one year after the Medicare Accelerated and Advance Payment Program loan was issued before recoupment would begin, an extension from 120 days under current law. The recoupment rate would also be lowered from its current 100% level to 25% for the first 11 months of repayment, and 50% for the six months afterward. Hospitals would have 29 months after payments to begin to pay back the funds in full before interest would begin to accrue. The interest rate would be lowered from the current rate of 9.6% to 4%.

House Energy & Commerce Chair Frank Pallone (D-N.J.) and Ways & Means Chair Richard Neal (D-Mass.) on Tuesday wrote to HHS and CMS accusing the administration of expanding the Medicare Accelerated and Advance Payment Program beyond its congressionally authorized scope and failing to provide requested information to lawmakers. Pallone and Neal also asked CMS to provide clarity as to when the Medicare loans would begin to be recouped.

The legislation also creates a new deadline for funding for several healthcare policies, including delaying cuts to Medicaid disproportionate-share hospital payments and extending funds for programs such as the Money Follows the Person demonstration, diabetes programs and community behavioral health clinics. The policies are set to expire on Nov. 30.
To read more, go to Modern Healthcare.

How Physician Shortages Could Change The Future of Anesthesiology
September 19, 2020
Every year since 2015, the Association of American Medical Colleges (AAMC) releases an updated report on a prospective shortage of U.S. physicians expected in the coming years. The estimates have varied through the years, most recently predicting a shortfall of up to 139,000 physicians by 2033, but the core message is always the same: The health care industry won’t be able to keep up with the growing demand.

“The gap between the country’s increasing health care demands and the supply of doctors to adequately respond has become more evident as we continue to combat the COVID-19 pandemic,” said David J. Skorton, MD, the president and CEO of the AAMC. “The challenge of having enough doctors to serve our communities will get even worse as the nation’s population continues to grow and age.”

While the AAMC report predicts a potential shortage of up to 139,000 physicians across all of health care, the projection for anesthesiology, among several other specialties, is between 17,000 and 42,000 physicians. The analysis does not provide details on how much of a shortage could be anticipated in anesthesiology specifically, leaving doubt among some experts about whether anesthesiology will experience a shortage at all.

“I think a lot of that press is conflating anesthesiologists and nurse anesthetist. There may be more need for people to give anesthesia, but that doesn’t necessarily translate into a
shortage of anesthesiologists,” said Karen Sibert, MD, FASA, an associate professor and the director of communications for the Department of Anesthesiology and Perioperative Medicine at UCLA Medical Center, in Los Angeles.

As Dr. Sibert highlighted, a specialty like anesthesiology could adapt to address any pending physician shortage in the coming years. So, although a shortage may affect the specialty, it won’t necessarily be through the inability to meet overwhelming demand.

The report from AAMC shows that major change is likely to occur across all health care industries, but it doesn’t get to the heart of that change for anesthesiology, according to Dr. Sibert, who was interviewed as part of the new season of The Etherist podcast.

Dr. Sibert, along with other experts in the specialty, sees a range of issues looming on the horizon for the anesthesiology field. The overall message is that physician anesthesiologists will be faced with major changes in the coming decade as issues ranging from changing practice and compensation models, to evolving business trends, to the fallout from the COVID-19 pandemic affect the industry.
To read more, go to Anesthesiology News.

ASA Comments on CMS’s Proposed Rule for the CY2021 Outpatient Prospective Payment System
September 15, 2020
In comments to the Centers for Medicare & Medicaid Services (CMS), ASA provided feedback to CMS on two issues included in CMS’s Proposed Rule for the CY2021 Outpatient Prospective Payment System (OPPS). In our letter, ASA cautions CMS against moving too expeditiously on expanding its prior authorization program to include implanted spinal neurostimulators. ASA urges the agency to carefully consider any action that could hinder access to non-opioid alternatives to pain medicine. This CMS Prior Authorization program was first implemented in July 2020 so meaningful and actionable data on its impact on patient care and it effect on utilization are not yet available.
To read more, go to ASA’s website.

ASA Urges CMS to Coordinate with Congress to Prevent Dramatic Payment Cuts
September 15, 2020
In formal comments responding to the Centers for Medicare & Medicaid Services (CMS) proposed rule for the CY2021 Medicare Physician Fee, ASA is urging CMS to work with Congressional leaders to pass legislation to prevent the implementation of scheduled Medicare payment cuts on January 1, 2021. ASA’s comments describe grave concerns about the proposed cuts to payments to anesthesiologists and other health care professionals. Acknowledging that CMS has limited authority to fully override the statutorily mandated budget neutrality requirement that is the cause for these cuts, ASA describes for CMS its alarm at the impact the cuts could have on patient care and physician practices. ASA urges CMS to stand up for anesthesiologists and others who are on the front lines of our nation’s battle against the COVID-19 pandemic.

Additionally, ASA commented on several CMS proposals for the Quality Payment Program (QPP), updates to the Merit based Incentive Payment System (MIPS) program and the development of the MIPS Value Pathways (MVP) program. We expect that CMS will not make any changes to the Anesthesiology Measure Set and we supported the performance threshold to avoid a MIPS negative adjustment being revised down to 50 total points.
To read more, go to ASA’s website.

Google Donates $8.5M to Fund Coronavirus AI, Analytics Projects
By Jessica Kim Cohen | September 10, 2020
Google.org, Google’s philanthropy arm, has donated a collective $8.5 million in grants to support 31 organizations’ COVID-19 response efforts, the tech giant said Thursday.
It’s part of a $100 million commitment to COVID-19 relief that Google.org announced in May.

The latest $8.5 million in funding goes to projects at academic institutions and not-for-profits that apply artificial intelligence and data analytics to better understand four areas related to COVID-19: monitoring the spread of the disease, addressing health equity and secondary effects of the disease, slowing transmission, and supporting healthcare workers.
That includes projects like Beth Israel Deaconess Medical Center’s research into COVID-19’s effect on patients seeking routine and preventive care; Florida A&M University and Shaw University’s research on how COVID-19 has affected racial minorities; and University College London’s work to model COVID-19’s spread using aggregated search trends data.
Google.org did not share the funding amount each of the 31 organizations received.

“COVID-19 has had a disproportionate effect on vulnerable populations,” wrote Mollie Javerbaum, program manager at Google.org, and Meghan Houghton, university relations program manager at Google Research, in a blog post Thursday. “We’re supporting efforts to map the social and environmental drivers of COVID-19 impact.”

One of the projects Google.org highlighted in its latest announcement, an effort to develop a COVID-19 health equity map of the U.S., was initially awarded in May.

Google.org had awarded the Satcher Health Leadership Institute at Morehouse School of Medicine a $1 million grant to create a database with information about COVID-19 cases, hospitalizations and deaths as part of that project, with an option to drill down into those cases by race, ethnicity, gender, socioeconomic status and other demographic factors.

The project aims to understand why black and Latino populations have been disproportionately affected by COVID-19, so that policymakers can better target resources to those populations. A team of Google engineers has been working on the project as part of a fellowship program at Google that lets employees work on pro bono projects full-time for up to six months.

Google has made numerous moves into the healthcare market in recent years, many of which have entangled the company in controversies related to privacy and concerns over data access.
To read more, go to Modern Healthcare.

Proposed Medicare Cuts Threaten Anesthesiology Practices Already Struggling Amid Pandemic
September 8, 2020
Medicare has proposed drastic cuts to its payment rates for important health care services, threatening the practices of physician anesthesiologists who have been on the front lines of the battle against the COVID-19 pandemic. The American Society of Anesthesiologist (ASA) opposes these detrimental payment reductions and urges Congress to take action to override the budget neutrality requirements that are the cause for these cuts and thereby ensure physician anesthesiologists can continue to care for their patients while being more fairly compensated for their work.

During the pandemic, the important role of physicians – the foundation of our nation’s health care system – has never been more evident. More has been asked of them than ever before, and they should not be threatened by funding cuts that make the economic status of their practices less stable.

“Physician anesthesiologists are at the forefront of the pandemic. With their medical expertise in anesthesiology and critical care – specifically intubation and ventilation – they are taking care of critically ill patients and putting themselves at risk by working inches away from patients’ airways, where the virus is transmitted,” said ASA President Mary Dale Peterson, M.D., MSHCA, FACHE, FASA. “These proposed payment reductions will hurt practices already weakened by the economy. Now is not the time for payment cuts to frontline physicians.”

Each year, Medicare releases proposed payment rates for physicians. Federal law requires payment increases for services paid in the fee schedule must be offset by a reduction in others when the total spending surpasses the outdated threshold. If a specialty does not perform the services that are increasing, the impact can be severe and significant, directly effecting the ability to care for patients. In the recently released rates, the specialty of anesthesiology will have its Medicare rates reduced close to those set in 1991, 30 years ago.

ASA urges Congress to eliminate the requirement to offset payment increases with cuts and remove this threat to physician anesthesiologists’ practices at a time when their expertise and critical care skills have never been more important.
To read more, go to ASA’s website.

One of Hospitals’ Biggest Surprise Billing Allies Survives Primary Challenge
By Rachel Cohrs | September 2, 2020
One of hospitals’ staunchest congressional allies in the debate over surprise medical bills survived a primary challenge from a progressive mayor.

House Ways & Means Chair Richard Neal (D-Mass.) defeated Holyoke, Mass., Mayor Alex Morse in a race that put surprise billing issues center stage. Neal has refused to fall in line
with other House Democrats, who are working to build consensus on a ban on surprise billing that would use payment benchmarks that provider groups oppose.

Neal effectively torpedoed a bicameral, bipartisan compromise proposal in December by putting out a bare-bones outline of a bill developed in his own committee just days before an important appropriations deadline.

When Neal released the bill he wrote with House Ways & Means ranking member Kevin Brady (R-Texas) in February, hospital and provider groups lined up in support.

A progressive group called Fight Corporate Monopolies ran television advertisements accusing Neal of being cozy with corporate interests, including what the ad calls “hospital monopolies.”
The American Hospital Association spent nearly $500,000 to support Neal in his race, the group’s only independent expenditures so far this election cycle, according to campaign finance records. The expenditures were first reported by Politico.

Provider allies are trying to frame Neal’s win as a mandate to continue advocating his surprise billing proposal, which would ban balance billing and institute a 30-day negotiation period followed by a baseball-style arbitration period if providers and insurers can’t agree on payment.

“The fact that advocates of rate setting couldn’t gain traction in this race says a lot about the political saliency of their position,” a consultant to provider groups said.

Prospects for a surprise billing fix in Congress this year appear dim as talks on another COVID-19 relief package have stalled. Lawmakers created a deadline at the end of November for funding for community health centers and some other Medicare and Medicaid programs, but it’s unclear how much motivation lawmakers will have to move on a policy that has divided powerful healthcare industry players.
To read more, go to Modern Healthcare.

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