The fiscal year 2013 U.S. Health and Human Services budget strives to make wise investments while being fiscally responsible, HHS officials said yesterday during a live web broadcast announcing its budget proposal.

“This budget also recognized our solemn responsibility to safeguard tax payer dollars and to make the most of every investment by spending wisely,” said Bill Corr, HHS’ deputy secretary during his opening remarks on Monday.

HHS’ proposed budget is composed of $941 billion in outlays; 56

Antifraud efforts net U.S. $4.1B in healthcare fraud recoveries

The efforts to curtail healthcare fraud have returned $4.1 billion to U.S. taxpayers in 2011, says a new report from the U.S. Department of Health and Human Services and the Department of Justice.

“Today’s report also shows that going after healthcare fraud continues to be one of the best investments we can make as a country. Over the last three years, for every dollar we’ve spent, we’ve put more than $7 back in the hands of American

ICD-10 Deadline Postponed, Sebelius Confirms

Health and Human Services Secretary Kathleen Sebelius said Thursday that the federal government will delay for an unspecified time the implementation date for the ICD-10 diagnostic and procedural coding system.

In a media release Thursday afternoon, Sebelius said federal officials were acting on providers' concerns "about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace

Congress OKs measure averting doc-pay cut

Details of SGR deal released The House and Senate approved a payroll tax package that includes a provision to stave off a 27.4% cut in Medicare physician payment rates scheduled for March 1 and freezes rates at their current level until Dec. 31, 2012.

House members voted 293 to 132 to approve the legislation, which received support from 146 Republicans and 147 Democrats. Meanwhile, 91 Republicans and 41 Democrats voted against it. Reps. Phil Gingrey (R-Ga.

CMS Issues Proposed Rule Clarifying Overpayment Provision  The Centers for Medicare and Medicaid Services (CMS) issued an advance copy of proposed regulations concerning provider's obligations to report and return identified Medicare and Medicaid overpayments, pursuant to section 6402 of the Patient Protection and Affordable Care Act (PPACA).

Some of the key provisions of the proposed rule include:

Definition of "Identified" — A provider will be deemed to have "identified" an overpayment when the

CMS Proposes 10 Year Look-Back Period in Medicare, Medicaid Overpayment Rule On February 14, CMS issued a proposed rule that addresses providers’ obligations to report and return Medicare and Medicaid overpayments.  Based on a provision in the Affordable Care Act, the proposed rule requires providers and suppliers to report and return self-identified overpayments either within 60 days of the incorrect payment being identified or on the date when a corresponding cost report is due – whichever is

Feds beef up screening for Medicare providers agency recovered $4.1 billion last year  Federal authorities say they recovered $4.1 billion in health care fraud judgments last year, a record high which officials on Monday credited to new tools for cracking down on deceitful Medicare claims.

The recovered funds are up roughly 50 percent from 2009. Attorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius were expected to make the announcement at a news con

Congressional Negotiators Reach Tentative Agreement On "Doc Fix," Payroll Tax Cut, Unemployment Insurance  House and Senate negotiators reportedly are nearing an agreement that would extend a payroll tax cut and delay the scheduled cut in Medicare physician reimbursements for 10 months.  If current law is not changed, Medicare payments to physicians will be reduced by 27 percent on March 1.  According to reports, the cost of extending the Medicare “doc fix” until the end of 2012 would be offset

Methods to fight denied claims

Use Employee Retirement Income Security Act of 1974 (ERISA) protections to your advantage, make insurers follow the law

ERISA requires health insurers to respond to claims in a timely manner. Failure to do so can mean the claim is eligible for immediate payment.

The following explanation of how the ERISA rules apply and how a provider can respond to an insurer's violation:

•The insurer must pay or deny a claim within 30 days, or ask for additional information. The paye

Short-term SGR fix could come today, lawmaker says

A GOP senator serving on the conference committee responsible for finding a solution to Medicare's sustainable growth-rate formula said an answer could come today—although it won't be a permanent one.

Talking to reporters after his remarks at the American Medical Association advocacy conference in Washington, Sen. Jon Kyl (R-Ariz.) said the short-term fix could be for 10 months, 12 months or 22 months, although he did not say which of those option

CMS will re-examine ICD-10 timeline, Tavenner says

The acting head of the CMS on Tuesday signaled that the agency will extend the timeline on ICD-10 implementation.

After speaking to attendees at the American Medical Association Advocacy Conference in Washington, acting CMS Administrator Marilyn Tavenner told reporters that the CMS will "re-examine the timeframe" through a rulemaking process. She did not say when that rulemaking process will begin but said the CMS would send details about the proc

5010 Logjam Means No Pay for Physicians

A strange thing is happening as physician practices transition toward HIPAA version 5010 electronic transactions.Docs aren't getting paid.

Physicians are flooding their advocacy groups with complaints and questions about "cash flow problems." One physician broke down in tears about his inability to pay his staff."We haven't seen anything like this before," said Robert Tennant, MA, senior policy advisory at MGMA, referring to the emails from distraught doctor

2012 Medicare Conversion Factors

Recent legislative action has provided for a zero percent update to the Medicare conversion factor for services provided from January 1 through February 29, 2012.  The final rule on the Medicare Fee Schedule indicated that there would be an increase in the conversion factor for budget neutrality and this change will also be effective January 1, 2012.  The budget neutrality increase is due to CMS adoption of the RVS Update Committee recommendations for misvalued co

Anesthesia for surgical procedures is reported with CPT codes 00100- 01999.  With only a few exceptions, these codes do not specify the type of anesthesia administered.  Blocks done as part of a combined technique were never separately reportable. However, single shot nerve blocks performed pre- or intra-operatively for the intended purpose of post-operative pain controls do not represent a combined technique.  Similarly, a catheter placed pre- or intra-operatively is not part of a combined tech

Fourteen Hospitals Reach $12 Million False Claims Accord

Fourteen hospitals in New York and six other states agreed to pay more than $12 million in total to settle allegations that they submitted false claims to Medicare, the U.S. Justice Department said.

Four hospitals affiliated with Adventist Health System/Sunbelt Inc. in Florida will pay the largest sum, $3.9 million, according to an e-mailed statement today by the Justice Department. Plainview Hospital in Plainview, New York, will pay $2.3

CBO budget report shows impact of healthcare costs and aging population

The aging of the country’s population and the rise in healthcare costs will continue to be the nation’s biggest economic challenge concluded the Congressional Budget Office’s latest economic outlook, released Tuesday.

The cost of government healthcare programs will more than double by 2022 with federal spending on Medicare, Medicaid and other healthcare programs reaching $1.8 trillion – about 7 percent of the entire economy.

“T

5010 Deadline Extended, But Threat Remains, Says AMA

CMS' Office of E-Health Standards and Services (OESS) has announced a 90-day period of "enforcement discretion" for compliance with the new 5010 HIPAA transaction standards, but leading professional organizations say that is not enough.

Expressing serious concerns about the ability of physician practices and payers to make the conversion to the 5010 electronic transaction standards and ICD-10 (a new code set for medical diagnoses) in time, both

AMA presses Sebelius to halt ICD-10

The American Medical Association is taking second aim in its call to federal officials to halt the planned and federally mandated 2013 rollout of the International Classification of Diseases 10th Revision family of procedural and diagnostic codes.

This time, Dr. James Madara, the AMA's executive vice president and CEO, is appealing to HHS Secretary Kathleen Sebelius in a four-page letter dated Thursday. Related ArticlesLast week, Madara issued a similar appeal t

U.S. not-for-profit healthcare outlook remains negative for 2012

Driven by increased revenue pressures and challenges resulting from the transition to a new healthcare delivery model as a result of national healthcare reform, the outlook for the U.S. not-for-profit healthcare sector remains negative for 2012, says Moody's Investors Service in a new report.

In the report, "U.S. Not-For-Profit Healthcare Outlook Remains Negative for 2012," Moody's outlines expectations for the fundamental credit con

A 2012 forecast for anesthesiology

2012 will be an important year for the health care profession. With a growing aging population, physicians will be needed more than ever to care for patients. In particular, the number of patients who undergo surgical procedures will increase, along with the demand for physicians such as anesthesiologists.

This demand raises an important issue. A 2010 study by the RAND Corporation found a shortage of 3,800 anesthesiologists and 1,282 nurse anesthetists. If curren

House and Senate Conferees Begin 'Doc Fix' Discussions

House and Senate negotiators have begun meeting to address the Medicare “doc fix”.  Under a statute enacted in December, a scheduled 27 percent Medicare pay cut for physicians was deferred until the end of February.  The statute also extended a number of provisions for hospitals, nursing homes and ambulance service providers.  Several members of the conference committee are seeking a long-term solution to the Medicare sustainable growth rate

CMS Announces 5010 Changes for Non-Specific Procedure Codes

CMS announces that anesthesia codes that include the phrase “not otherwise specified” in their code descriptors (procedure codes 00100 through 01996) do not meet the criteria of a non-specified procedure code and do not require a description to be supplied in the SV101-7/SV202-7 data elements.  Anesthesia procedure code 01999, “Unlisted anesthesia procedure(s)” meets the requirements of a non-specified code and continues to require addit

MGMA urges HHS to take immediate action on 5010-related payment delays

The Medical Group Management Association yesterday urged the U.S Department of Health and Human Services to take immediate action to help alleviate payment disruptions that have occurred due to the transition to HIPAA 5010.

“Should the government not take the necessary steps, many practices face significantly delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or even the prospect of c

Execs list financial challenges as biggest concern

Hospital executives’ daunting tasks ahead are well-reflected in a new survey showing that financial challenges, healthcare reform, safety and quality, and government mandates continue to be the biggest issues confronting hospitals.

The annual survey, conducted by the American College of Healthcare Executives, asked community hospital CEOs to rank 10 issues in order of relative concern, and the issue of financial challenges was by far the biggest c

US Healthcare Hits $3 Trillion Dollars

What we have today is really just the beginning of a long and winding investment in Healthcare Reform.  Have we tamed the cost beast with real legislation – or is it just legislation around the edges?  Here’s why.

1. National Healthcare Expenditure – or NHE. Costs are “out-of-control” because our NHE is really $3 trillion – this year.  Actually, NHE for 2012 is probably closer to $2.7 trillion but there’s this nagging bookkeeping accrual of about $300 billion

AMA chief asks Boehner to stop ICD-10

Dr. James Madara, executive vice president and CEO of the American Medical Association, has asked House Speaker John Boehner to stop the federally mandated implementation upgrade in October 2013 of the International Classification of Diseases 10th Revision of diagnostic and procedural codes "and to call on stakeholders to assess an appropriate replacement for ICD-9."

Madara’s letter echoes a resolution that the AMA's House of Delegates passed in November to re

Hospitals hiring doctors to get ready for reform

Hospitals made disastrous decisions in the 1990s in hiring doctors. Now, they’re again buying physician practices — saying better management will make the difference this time. 

In the early 1990s, many hospitals across the country started buying doctors’ practices. The purchases often proved to be disasters. Many doctors were not nearly as productive as employees as they were in their own practices so hospitals abandoned the idea.

Now, hospitals are

How hospitals are gaining leverage over physicians

Most hospital managers have never had the power to exert leverage over their most valuable resource, the physician, who, after all, admits the patients who make the hospital’s economic existence possible in the first place.

1. The economic powers of hospitals are shifting from those who provide care – to those who pay for it – government and business.

2. This shift is forcing hospital administrators and medical staff to discuss how to use hospitals

Doc groups: Shift money to scrap SGR

Physician organizations are asking Congress to use money that had been projected to be spent on the wars in Iraq and Afghanistan to pay for a permanent alternative to the sustainable growth-rate formula used to calculate Medicare payments to doctors.

Using excess baseline projections for Overseas Contingency Operations amounts to "cleaning the books" and will allow the elimination of a "flawed budget gimmick," physician organizations stated in a letter signed b

Medicare Cuts Could Slash 278K Hospital Jobs, Warns AHA

Medicare funding cuts under consideration by Congress could cost the nation's hospitals $61.4 billion over the next decade, forcing them to trim their payrolls of nearly 278,000 jobs, the American Hospital Association said this week.

The reimbursement reductions detailed in H.R. 3630 would take funding from hospitals and use it to cover the deficit created by the extensions of the Social Security tax holiday and unemployment benefits, and by

CMS healthcare spending report doesn't account for bigger picture

Growth in U.S. health spending remained slow in 2010 and the health share of the gross domestic product was unchanged from 2009, the Centers for Medicare and Medicaid Services has reported. But a nationally recognized economist is saying the federal agency is overlooking the bigger picture.

Karen Davis, president of the Commonwealth Fund and former deputy assistant to the U.S. secretary for health policy, wrote in a blog on Thursday

CBO: Medicare cost-cutting programs haven’t worked

Programs designed to cut Medicare spending and improve the quality of healthcare have mostly failed, according to the Congressional Budget Office.

The findings are a blow to existing Medicare projects as well as a key goal of the healthcare reform law.

There is widespread support, in Congress and among economists, for the broad ideal that Medicare would save money if it paid for better outcomes instead of more procedures. But 20 years of trying to

Raising Medicare Age Would Save $148 Billion, CBO Says

The federal government could save $148 billion over 10 years by increasing Medicare eligibility two years to age 67, the Congressional Budget Office reported on Tuesday.

The projected savings are lower than CBO’s March estimate of $162 billion, but the earlier calculation did not include the premiums that seniors must pay into the program. A CBO official said that a senator requested the additional analysis of increasing the Medicare and Socia

10 state attorneys general file brief supporting individual mandate

The state attorneys general of 10 states and the District of Columbia have filed a legal brief that backs the authority of Congress to require that all Americans buy minimal health insurance. With the friend-of-the-court or amicus brief filed Jan. 13, these state attorneys general have thrown their support behind the federal government in the coming battle before the Supreme Court that the individual mandate does not violate the

L.A. doctor gets 8 years for Medicare fraud

A Los Angeles doctor will be serving time in federal prison for his role in what prosecutors are describing as a "massive" Medicare fraud.

Prosecutors say Dr. Alexander Popov has been sentenced to eight years and one month in prison after he was convicted in July of healthcare fraud and conspiring to commit healthcare fraud.

During his trial, prosecutors told jurors that while Popov, 47, was co-owner of a Sacramento, Calif., clinic, he was responsible for

20% of Healthcare Dollars Spent on 1% of Population

In 2009, 1% of the nation's civilian population required healthcare spending that was slightly greater than in 2008, an increase from 20.2% to 21.8% of $1.26 trillion in treatment dollars, according to the latest Statistical Brief from the federal Agency for Healthcare Research and Quality.

That indicates that more than $1 in every $5 healthcare dollars went to treat one out of every 100 people. The annual mean expenditure was $90,061 for those i

Briefs Filed in Supreme Court Case on Health Reform Law's Constitutionality The first briefs have been filed with the Supreme Court as part of its review of split circuit court decisions on the constitutionality of the health reform law’s individual mandate.  In its brief, the Obama administration argued that Congress has the authority under the commerce clause of the U.S. Constitution to require individuals to obtain health insurance or pay a fine.  The government said that the mandate “plays a

In NJ Single-Room Surgeries to Operate Under Same Rules as Hospitals, Ambulatory Centers

The Legislature on Monday approved a bill giving the state Department of Health oversight over all surgeries performed in New Jersey. The health agency already licenses and inspects operating rooms in hospitals and ambulatory surgery centers. By wide margins, lawmakers voted to include single-room surgical practices under the purview of the agency.

The measure has the support of the large ambulatory surgery ce

Health spending growth stayed slow in 2010: CMS

U.S. healthcare spending grew 3.9% in 2010, reaching a total level of $2.6 trillion and following the slower-growth trend seen in 2009, according to the annual report on national health expenditures published in the journal Health Affairs.

The rate of spending in 2010 increased only 0.1 percentage point faster than in 2009 (3.8%), a year that had the lowest rate of increase in the 51-year history of the annual report, according to economics analysts

More than 9 Million US Adults Lost Heath Coverage During Recession

An estimated 9.3 million American adults lost health insurance coverage as a result of increased unemployment during the recession of 2007-09, according to a newly published study by researchers at Cornell, Indiana and Carnegie Mellon universities.

The study, titled “The Impact of the Macroeconomy on Health Insurance Coverage: Evidence from the Great Recession," was published online by the National Bureau of Economic Research. Auth

FDA and Partners Working to Prevent Surgical Fires

The Food and Drug Administration (FDA) is building a coalition of public and private healthcare organizations to prevent a medical error — the surgical fire. A surgical fire is a fire that occurs in, on or around a patient undergoing a medical or surgical procedure.  An estimated 550 to 650 surgical fires happen every year in U.S. operating rooms. Some of the fires cause disfiguring second- and third-degree burns. If the fire occurs in the patien

Joint Commission Releases Alert on Healthcare Worker Fatigue

The link between healthcare worker fatigue and adverse events is well documented, prompting The Joint Commission to issue a new Sentinel Event Alert: Healthcare worker fatigue and patient safety . The Alert urges greater attention to preventing fatigue among healthcare workers and suggests specific actions for healthcare organizations to mitigate the risks.

An article in the November 2007 issue of The Joint Commission Journal on Quality a

9 Ways to Prevent Fatigue-Related Errors in Healthcare

“We understand that fatigue has been a contributing factor in many adverse events that we analyze – the Joint Commission reviews some 900 sentinel events every year; fatigue has played a role in many of these," says Ana McKee, the commission's executive vice president and chief medical officer who helped prepare the alert.

According to the alert, "the healthcare industry has been slow to adopt changes, particularly with regard to nursing" to

The 5010 Requirement for Additional Information When the CPT Code Includes the Phrase “Not Otherwise Specified”

ASA representatives have held discussions with X12 and CMS in regard to the 5010 requirement that claims with CPT codes that include the "not otherwise specified" phrase in their descriptors include an additional narrative description. This phrase is much more common in the anesthesia codes than elsewhere in CPT and, as such, the requirement has had a significant impact on 5010 testing

The Centers for Medicare & Medicaid Services released its 121-page proposed rule designed to reveal potential conflicts of interest between drug, biological and medical device companies and the physicians and teaching hospitals that prescribe and use them.

The proposed rule, also called the Physician Payment Sunshine Act, which was required by Section 6002 in the Affordable Care Act, would mean about 150 manufacturers of drugs, or biologics, 1,000 makers of medical devices or medical supplies, an

Campaign to cut waste: Vice President Biden announces Department of Justice recovered a record $5.6 billion in fraud in 2011

Department of Health and Human Services takes new steps to prevent Medicare fraud.

As part of the Obama Administration’s Campaign to Cut Waste, Vice President Biden today announced significant progress in cracking down on fraud, including that the U.S. Department of Justice (DOJ) recovered more than $5.6 billion in fraud government-wide in 2011, a 167 percent increase in rec

Donald Berwick resigned as administrator of the Centers for Medicare and Medicaid Services in December. Berwick explains why he thinks much of the spending in the U.S. health care system is wasted, and the need to reform Medicare and Medicaid to improve coordination of care.

NEAL CONAN, HOST: Until the beginning of this month, Donald Berwick served as administrator for the Centers for Medicare and Medicaid Services. Dr. Berwick's nomination got caught up in the partisan politics that accompany pa

Doc groups sound off on pay cut delay

While relieved that the scheduled 27.4% Medicare payment cut has been postponed for about two months, physician organizations were in no mood to celebrate the recent short-term deal that will extend payroll tax cuts and postpone slashing payments to doctors for two months.

"With this brief reprieve from the massive 27% cut to Medicare payments," said Dr. Peter Carmel, president of the American Medical Association, in a statement posted on the AMA website. "Con

Cutting healthcare cost with bundled payments proves difficult

Bundling payments to providers as a means to cut healthcare costs is proving harder to do than originally anticipated, according to a new study from non-profit research organization Rand Corp.

The Rand study examined the first three years of one of the major efforts to test the concept of bundled payments: The PROMETHEUS Payment project launched by the Health Care Incentives Improvement Institute. Results of the study will be published

House approves two-month payroll tax extension

A vote to extend the payroll tax cut and avert a 27.4 percent Medicare pay cut for physicians was approved today.

After a week of continual criticism from all quarters, House Speaker John Boehner (R-Ohio) announced Thursday evening that he has agreed to accept the two-month temporary deal approved by the Senate last weekend. The House and Senate passed the deal Friday morning.The two-month deal keeps the payroll tax at its current 4.2 percent level in

Obama pushes two-month freeze on doc pay

President Barack Obama on Thursday stood firm in his position that House members pass the Senate's short-term extension of a payroll tax holiday that would also avert a 27% cut in Medicare physician reimbursement by placing a two-month freeze on payments to the nation's doctors.

“This is not just my view,” Obama said during a news conference at the White House. “Just a few hours ago, this is exactly what the Republican leader of the Senate said we should do

Democrats press Boehner to set vote on tax cut, SGR

Congressional Democrats on Wednesday would not say if the House or Senate has plans to introduce a stand-alone bill to avert a looming 27.4% Medicare physician payment cut if federal lawmakers can't agree on a payroll tax cut bill that includes a two-month freeze on payments to the nation's doctors.

During a call with reporters, Sens. Charles Schumer (D-N.Y.), Bob Casey (D-Pa.) and Rep. Chris Van Hollen (D-Md.) repeated a message that Senate Majo

House rejects Senate tax measure; doc pay cut looms

Lawmakers raise prospect of stand-alone SGR bill The threat of a 27.4% cut to Medicare physician payments Jan. 1 became more real Tuesday after the House of Representatives voted 229-193 on a motion to disagree with a Senate-amended version of a House payroll tax cut bill that would have placed a two-month freeze on payments to the nation's doctors.

In that same vote, the lower chamber requested a conference, which would allow the House and Senat

Supreme Court sets dates for health reform case

The Supreme Court will hear oral arguments on the fate of the health reform law March 26-28. Attorneys will have a total of five-and-a-half hours over three days in which to argue specific questions related to the controversial law, the Supreme Court said in a Dec. 19 announcement.

The Patient Protection and Affordable Care Act, which was signed into law in March 2010, calls for greatly expanding the number of Americans who will have access to health

Senate Passes Short-Term Doc Fix, House Demands Longer-Term Deal The Senate Saturday voted 89-10 to pass a two-month “doc fix” to avert a 27.4 percent cut in Medicare physician reimbursement rates.  The short-term "doc fix" passed as part of a larger bill that extends an existing payroll tax cut and unemployment insurance benefits.  On Tuesday, in a procedural vote, the House of Representatives voted 229 to 193 to reject the Senate measure and instead demanded a House-Senate conference to work o

Americans had trouble paying medical bills in 2010

More than one in five Americans were in families with problems paying medical bills in 2010, about the same proportion as in 2007, according to a national study released today by the Center for Studying Health System Change (HSC).

Funded by the Robert Wood Johnson Foundation, HSC’s 2010 Health Tracking Household Survey found that while problems paying medical bills have stabilized in recent years, the proportion of Americans in families with medic

5 biggest issues facing doctors in 2012

The biggest issues impacting doctors in 2011 are going to be dogging them into 2012 says the Physicians Foundation, a nonprofit organization that supports physicians.The foundation’s Physicians Watch List for 2012, released earlier this week, identifies five key areas the organization believes will have the biggest impact on doctors next year.

They are:

1. The changing nature of medical practices. As operating practices becomes increasingly more challenging,

ASA Urges CMS Revise Proposed Rule Changes on Conditions of Participation and More

ASA formally addressed the Centers for Medicare & Medicaid Services’ (CMS) proposed rule changes (CMS-3244-P & CMS-9070-P) related to hospital and critical access hospital conditions of participation and ambulatory surgery center emergency equipment. Additionally, due to strong lobbying by ASA, the remarks thanked CMS for maintaining the current federal physician supervision safety standard for anesthesia services.

Beginning Jan. 1, 2012, the Centers for Medicare & Medicaid Services (CMS) will begin three demonstration projects aimed at eliminating Medicare fraud, waste, and abuse  The first of these, the Recovery Audit Prepayment Review, will allow Medicare recovery audit contractors (RACs) to review claims that historically result in high rates of improper payments before they are paid. The reviews will focus on seven states with high populations of fraud- and error-prone providers (Fla., Calif., Mich.,

Reps. Brian Bilbray (R-Calif.) and Anna Eshoo (D-Calif.) have introduced legislation that would require the Medicaid program to reimburse all providers—including nursing facilities, hospitals and community health centers—in a timelier manner.

The bill, known as the Fair Pay to Medicaid Providers Act would extend to these healthcare providers a provision that requires Medicaid to reimburse 90% of claims to physicians in 30 days and the remainder within 90 days, according to Eshoo's office.

“This is

Doctor's letter of recommendation implicated him in colleague's malpractice suit. 

Careful what you say - and don't say - in the next letter of recommendation you're asked to write. A Louisiana anesthesiologist was ordered to pay $8.2 million for a clinical error he didn't commit, all because he wrote glowing letters of recommendation for a colleague without disclosing the colleague's habit of diverting Demerol from his patients. In his next job, the colleague committed a serious medical error th

House Republican leaders have agreed to include a two-year extension of the current Medicare physician pay rates, including a 1% increase, in a large legislative package primarily aimed at extending an expiring payroll tax cut, according to a Republican healthcare leader.

Rep. Phil Gingrey (R-Ga.), co-chair of the GOP Doctors Caucus, said in an interview that the two-year $38 billion extension of current rates that were scheduled to drop 27.4% on Jan. 1 “was not ideal” but was better than the som

In November, ASA's membership surpassed 48,000, an increase of 12.6 percent in the last four years. This puts ASA on track to achieve the Strategic Plan's goal of 50,000 members by the end of 2013.

Here is an interesting article I read in the Chicago Tribune and wanted to share with our readers

By RICARDO ALONSO-ZALDIVAR Associated Press and Chicago Tribune  Picking a specialist for a delicate medical procedure like a heart bypass could get a lot easier in the not-too-distant future. The government announced Monday that Medicare will finally allow its extensive claims database to be used by employers, insurance companies and consumer groups to produce report cards on local doctors -- and im

He is an interesting article I read that I thoughtour readers might be interested in

Feds to allow use of Medicare data to rate doctorsBy RICARDO ALONSO-ZALDIVAR Associated Press and Chicago Tribune  Picking a specialist for a delicate medical procedure like a heart bypass could get a lot easier in the not-too-distant future. The government announced Monday that Medicare will finally allow its extensive claims database to be used by employers, insurance companies and consumer groups to produce re

I am writing this today because many anesthesia departments are going to be having a holiday office party.  Beware an office party is not just another party.  In today’s work world career success largely depends on interpersonal relationships.  This means what you and your guest say and do at the office party can influence your workplace image.  This applies whether you are the boss or a staff worker.    

If you are a boss then make sure your comments are in tune with your company’s economic realt

The blog today is about how physician and therefore anesthesia reimburse is being cut for many state Medicaid programs.  Fourteen states and the District of Columbia cut Medicaid physician pay for fiscal year 2011, down from 20 states in fiscal 2010. But continuing state budget deficits could lead to more new fee cuts than those already adopted for fiscal 2012, according to the Kaiser Family Foundation.The foundation's 11th annual survey of state Medicaid programs concluded that continued Medica

The Centers for Medicare and Medicaid Services intends to take a bigger bite out of fraud and abuse by strengthening its monitoring and analytics capabilities to prevent and detect suspicious activities.  CMS will conduct enrollment and medical claims analytics using cutting-edge methods to keep the bad actors out of Medicare, share that information with Medicaid and prevent the payment of fraudulent claims instead of chasing it down afterwards, said Dr. Peter Budetti, CMS deputy administrator f

In the past the government often relies on whistle-blowers and the False Claims Act to get at more complicated and subtle forms of fraud and abuse, and in healthcare allegations are often based on violations of the anti-kickback statue and the restrictions on physician self referral know as the Stark Law.  The Justice Department credits the False Claims Act with returning 16.8 billion to HHS since 1986, when Congress reinvigorated the Civil War ear statue.  The CMS is now hard at work creating a

ICD-10 and Version 5010 Implementation   

The International Classicization of Disease (ICD) owned and published by the World Health Organization (WHO) is the international standard diagnostic classification for diseases, signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease.  ICD-10 is the latest in a series of classifications dating as far back as the 1850’s and was endorsed by the 43^rd World Health Assembly in May 1990.  

The ICD-10 coding sy

Update on Electronic Health Records and Meaningful Use for anesthesia providers.

Anesthesiologists need the Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator (ONC) to make modifications to the Electronic Health Records Incentive Program Stage 1 meaningful use requirements.  In current form, the vast majority of anesthesiologists will be eligible to participate but not able to successfully meet Stage 1 meaningful use requirements or receive Stage 1 incentive pay

CMS Kicks Off Second Year of Medicare Compliance Newsletters  CMS has initiated the second volume of its Medicare Quarterly Compliance Newsletters, one year after the launching the inaugural edition of the publication. The newsletters are designed to offer providers guidance on avoiding common Medicare billing and general errors.

These educational newsletters are designed to help providers understand the major findings identified by Medicare administrative contractors (MACs), recovery auditors, p

CMS faces formidable ICD-10 challenges, but opportunities, toThink your challenges are daunting when it comes to implementing ICD-10? Put things in perspective by imagining the Mount Everest the Centers for Medicare & Medicaid Services has to climb.

“Given the extent to which the code set is built into many business and operating processes and systems, the size of CMS operations, and the complexity of its systems,” the challenges CMS faces are formidable, says a report published last week from th

Medicare chief Don Berwick steps down in standoff with GOP senators over his confirmation  By Associated Press

WASHINGTON — The point man for carrying out President Barack Obama’s health care law will be stepping down after Republicans succeeded in blocking his confirmation by the Senate, the White House announced Wednesday.

Medicare chief Don Berwick, a Harvard professor widely respected for his ideas on how to improve the health care system, became the most prominent casualty of the political wa

Medicare chief Don Berwick steps down in standoff with GOP senators over his confirmation  By Associated Press

WASHINGTON — The point man for carrying out President Barack Obama’s health care law will be stepping down after Republicans succeeded in blocking his confirmation by the Senate, the White House announced Wednesday.

Medicare chief Don Berwick, a Harvard professor widely respected for his ideas on how to improve the health care system, became the most prominent casualty of the political wa

CMS says new analytics are model for future fraud and abuse system

The Centers for Medicare and Medicaid Services intends to take a bigger bite out of fraud and abuse by strengthening its monitoring and analytics capabilities to prevent and detect suspicious activities.

CMS will conduct enrollment and medical claims analytics using cutting-edge methods to keep the bad actors out of Medicare, share that information with Medicaid, and prevent the payment of fraudulent claims instead of chasing it do

Supercommittee Failure Forces 2 Percent Physician Cut in 2013

Co-chairs Senator Patty Murray (D-WA) and Representative Jeb Hensarling (R-TX) of the Joint Committee on Deficit Reduction (also known as the “supercommittee”) announced that the supercommittee failed to reach an agreement on how to reduce the deficit by $1.2 trillion over 10 years.  As a result of the failure of the committee to reach an agreement, a process of automatic cuts known as sequestration is triggered.  The sequestration cut

CMS launches $1B innovation challenge

WASHINGTON – The Centers for Medicare and Medicaid Services has launched the Health Care Innovation Challenge, which will award $1 billion in grants in March to test inventive and compelling methods to deliver high quality medical care at lower costs to individuals enrolled in Medicare, Medicaid and the Children’s Health Insurance Program.

The challenge will fund projects that can start within six months. Awards will range from about $1 million to $30 million

CMS Exhorts State Medicaid Directors to Focus on Improving Delivery of Care Systems, Not Cuts

CMS officials urged state Medicaid directors to resist short-term fixes in favor of improvements in service delivery.  Speaking at a conference of the National Association of Medicaid Directors (NAMD), CMS Administrator Donald Berwick told the group that there are other ways to contain costs.  “We can reduce our ambition and cut, or we can improve our way to success.” Although some amount of cutting “is

CMS to delay enforcing 5010 compliance

The CMS has backed off—a bit—from its Jan. 1, 2012 deadline for enforcement of a rule requiring adoption of a more-robust set of claims transmission standards. The CMS announced today it will hold off until March 31, 2012, on enforcing its rule requiring hospitals, physician practices, health plans and claims clearinghouses to switch to using the ASC X12 Version 5010 standards for the electronic transmission of healthcare claims and other administrative comm

The Chicago Tribune on November 15 had an excellent article on cancer pain and how effective oncologists are at treating the patient’s pain.

Cancer doctors score low on pain management: study

Many U.S.cancer doctors say they are good at managing their patients'pain,but most failed to choose the right treatment options in a test and say that figuring out the level of pain patients have is still a major barrier to care, a survey said.

The findings, published in the Journal of Clinical Oncology, came

AMA opposes ICD-10

The American Medical Association's House of Delegates voted today "to work vigorously to stop implementation" of the International Classification of Diseases 10th Revision family of diagnostic and procedural codes, citing the healthcare industry's already full plate for changes and reforms, including the federal push for physicians to adopt electronic health-record systems. The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct b

The U.S. Supreme Court announced today it will hear a legal challenge to the Patient Protection and Affordable Care Act (PPACA), President Obama's health reform legislation Congress enacted in March 2010.

There are several issues before the Court. The most prominent is the law's mandate requiring individuals to purchase health insurance by 2014 if they do not otherwise have health care coverage through private insurers or public programs. This issue has been litigated in various courts to date. T

10 Ways to Evaluate Your Current Anesthesia Department

1. Track on-time arrivals. Late arrivals from anesthesia providers can affect OR finances as well as patient, staff and physician satisfaction. The department needs to track on-time arrivals to determine if anesthesia is delaying cases and diminishing OR efficiency. Anesthesia providers should be expected to talk to staff and physicians prior to the procedure, participate in the pre-operative exam and speak to patients about their anesthesia.

Nearly all states cut Medicaid payments as stimulus runs out

Forty-six states reduced Medicaid pay for fiscal 2012 so far, with physicians affected in 14 of them

Fourteen states and the District of Columbia cut Medicaid physician pay for fiscal year 2011, down from 20 states in fiscal 2010. But continuing state budget deficits could lead to more new fee cuts than those already adopted for fiscal 2012, according to the Kaiser Family Foundation.

The foundation's 11th annual survey of state Medicaid p

Wisconsin Considers Cuts to State Health Programs to Close $500 Million Shortfall

The Milwaukee-Wisconsin Journal Sentinel is reporting on the state’s efforts to lower its Medicaid program costs.  In Wisconsin, the Department of Health Services has proposed dozens of changes in the BadgerCare Plus and Medicaid programs to close a $500 million gap in the budget.  The key budget-writing committee of the legislature is expected to hold a hearing on many of the proposed changes this week.  Since Dece

Kansas Issues RFP to Solicit Contracts for Medicaid Overhaul

On Tuesday, November 8, Governor Sam Brownback announced plans for a major overhaul of the Kansas Medicaid program.  The state has issued a request for proposals from private contractors to provide comprehensive health, mental health and long-term health care services, in order to move nearly all of the state’s Medicaid recipients into private, managed care plans.  State officials say they expect to select three vendors, who will compet

Excellent article from the ASA

Changes for Anesthesia Claims Under 5010 Transaction

ASA has received a number of questions regarding changes in reporting anesthesia services after the implementation of the 5010 transaction code set standards.  The transaction code sets are mandated under the administrative simplification provisions of  the Health Insurance Portability and Accountability Act (HIPAA).  The X12 Standards Organization develops the standards for the transaction code sets.  Among many o

Bipartisan Appeal to the Super Committee – "Keep Tax Exclusion for Health Benefits"

Reps. Joe Courtney (D-CT) and Tom Cole (R-OK) are spearheading an effort to convince the members of the “Super Committee” to protect the tax exclusion for employer-subsidized health insurance, saying that any changes to the benefit would result in employers dropping or scaling back on insurance coverage for workers without a commensurate increase in wages.  The letter, signed by 146 Democrats and 14 Republicans, s

Kaiser Says Raising Medicare's Eligibility Age Will Only Shift Costs

According to an analysis conducted by the Kaiser Family Foundation, increasing the Medicare eligibility age will save money for the federal government but only by shifting costs to other payers.  The study found that some costs would shift to employers because they would have to continue to cover many of those who continued to work.  Some costs would shift to 65- and 66-year-olds, if they are no longer working, as they would hav

More than 40 times each week in the United States, a surgeon cuts into a patient or an anesthesiologist places a nerve block, only to realize that the scalpel or needle belonged somewhere else

The true incidence of wrong-site surgery may be substantially higher because these errors are generally self-reported and are not always anonymous, which may discourage reporting (Arch Surg 2010; 145:984). And the problem persists despite widespread adoption of the Joint Commission’s Universal Protocol star

CMS makes minor adjustments to rules for doc-owned hospitals

Buried deep in the CMS' "final rule with comment period" on hospital outpatient and ambulatory surgery center payments are a few tweaks to the federal rules regarding expansion of physician-owned hospitals, physician self-referral prohibitions and patient notification requirements.

Scott Christiansen, spokesman for the Physician Hospitals of America trade association, said in an e-mail that the rule doesn't contain any "real changes or s

When Medical Errors Happen, Executives Shouldn't Hide

When a provider makes a tragic mistake that harms a patient, most healthcare organization executives and their staffs are told to hide.  If they say anything, they will be more likely to be sued, they think. They don't acknowledge, disclose, or apologize. Instead, they repeat phrases like, "It will blow over," "It wasn't our fault," or "No one will find out." They advise care teams to act defensively, to avoid saying anything that will expose

4 Ways to Improve Anesthesia Quality The quality of anesthesia provision can affect patient satisfaction, quality outcomes and finances in all place of services where it is provide. Here are four ways to improve anesthesia quality.

1. Track adverse anesthesia events. Anesthesia has a long history of quality outcomes and patient safety. In most facilities, the anesthesia process happens without any safety issues or adverse events however a lack of patient safety issues is wholeheartedly positive c

Here is an excellent article from the Journal of Anesthesia Safety Foundation

The demand for anesthesia care for procedures performed outside the operating room (out-of-OR) has dramatically increased in recent years. Advances in diagnostic and interventional procedures, constraints on operating room time and costs, and the desire of patients for sedation and lack of recall, all contribute to the increase in popularity of anesthesia in remote locations. The delivery of safe anesthesia care may be

New Regulation Regarding Reporting of Anesthesia Time

As part of the transition to the 5010 HIPAA electronic claims standards, a universal system for reporting anesthesia time to all payers will go into effect January 1, 2012. This new standard will require all anesthesia time to be reported in minutes instead of units - the current norm for some commercial (private) payers. 

This change may result in some payers attempting to move from a full unit to a fractional unit payment system.  A move fro

In an effort to achieve greater health care savings and quality, the Centers for Medicare & Medicaid Services (CMS), through the Center for Medicare & Medicaid Innovation (CMMI), has unveiled a trial system that allows providers to participate in bundled payments for episodes of care.  A bundled payment combines payment for physician, hospital and other provider services into a single payment of a predetermined amount to cover all services furnished during a particular episode of care.  Under th