Payers, patients and partners are demanding better outcomes, and evolving healthcare paradigms are begging for greater anesthesia engagement. If you have been following this series, then you already know that the perioperative surgical home (PSH) is the answer to the call and the future of our specialty. What you may not know is how easy it can be as an anesthesiologist to make a contribution.
Stationing an anesthesiologist in the preoperative clinic is magic. The presence of anesthesia medical knowledge is magic to the preoperative nurses, magic to the patients and magic to the surgeons. Preoperative clinic nurses need support and direction when complicated patients present. Surgeons need the ability to obtain an anesthesia consult and patients truly need reassurance sooner than three minutes before surgery that the entire surgical continuum is engaged for their benefit.
Anesthesia offers major value to all of these people. The fact that we selflimit our presence to three minutes before surgery sends the message that we are unengaged. As anesthesiologists, we know nothing could be farther from the truth. We each have spent years developing the skills needed to spot trouble. Too often, though, we’re spotting it too late in the process and off-loading the medical issues, responsibility and leadership.
It is now time to translate our intuitive anesthesia preoperative skills into more objective assessments, management and leadership. The PSH provides the practice platform by which to lead the entire surgical process and continuum. The anesthesia preoperative appointment uses the same skills you have honed for years. It consists of a directed anesthesia history and physical, risk stratification and management. You already know how to assess a patient and past medical record, so I’ll save the lecture. What’s new and improved is the use of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to objectify and augment your professional intuition and communicate the information effectively to others.
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We highlight changes to the 2017 CPT® Standard Codebook that are of special interest to anesthesia and chronic pain practitioners. We encourage you to review these changes carefully and contact your ABC Vice President or Director with any questions.
As part of our continuing efforts to keep you informed of developments that could have an impact on your practice, we present the following summary of coding and reimbursement changes for 2017, along with related documentation reminders.
Every year, the American Medical Association updates the CPT® Standard Codebook with new codes, deletions and revisions to the descriptions of certain procedures. These changes are critical to surgeons and other specialists and may have relevance to anesthesia providers in specific situations. Generally, chronic pain physicians need to pay closest attention to these updates. No changes were made to the Anesthesia CPT® codes and only minimal changes were made to the ASA 2017 CROSSWALK®. The anesthesia basic value has been revised in a few procedures.
The most significant code changes that impact anesthesia providers are the following:
Codes 62310, 62311, 62318 and 62319 have been eliminated. These are very common codes for procedures that may be done with imaging (e.g., fluoroscopy or ultrasound). The new codes for each make a distinction between a procedure done with imaging guidance and those done without imaging guidance. The real significance of this change is that the provider must clearly document for each procedure whether or not imaging guidance is used.
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The Medicare Access and CHIP Reauthorization Act (MACRA), which replaced the perennial Sustainable Growth Rate (SGR) formula, created two options for compliance. The first path, which does not require assumption of insurance risks, is the Merit-Based Incentive Payment System (MIPS) that consolidated existing quality programs and added clinical practice improvement. The other fork in the new highway is the Alternative Payment Model (APM), with one subgroup variant being the Physician-Focused (PF-APM), in which the physician accepts some level of risk for services and expenses over which they have some control. Another subgroup variant is the Hospital-Focused (HF-APM). This article focuses on PF-APMs with an emphasis on potential multispecialty models that may provide subtle opportunities or be developed by others in the community where anesthesia may play a role. While physicians may have a wide range of experience with some MIPS elements, few physicians have any idea how APMs might apply to their practice.
Our current system is oriented toward intervention and what is possible; emerging models emphasize prevention and experientially-based minimization of avoidable complications. Modeling focuses on balancing optimization of outcomes, costs and patient satisfaction versus fragmented silos of care (e.g., particular physicians or specialties). Disconnects between the consumer (patient) and the producer (professionals) are barriers to balancing costs and utility. The current system does not value or anticipate the questions of how often it meets expectations, at what costs and relative risks. Additionally, the patient has no affirmative responsibility to optimize their personal health. And finally, the system itself is a barrier.
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