Archive for November, 2010

What are the Costs vs Benefits to the ICD-10?

23 Nov

The most recent medical coding, or International Classification of Diseases, is ICD-10. It was endorsed by the 43rd World Health Assembly in May 1990 and was started to be used in WHO Member States in 1994. But it’s not until 2013 that we will see these revisions in the U.S.

So, how does the ICD-10 differ from the ICD-9 set of codes currently in use in the U.S.? The ICD-10-CM codes are very different. All codes in ICD-10-CM are alpha-numeric. There can be as many as seven alpha-numeric characters. This means that billing software programs must be changed to accommodate the additional digits. This also means more extensive medical billing coder training.

While there won’t be much change in how the physician does his or her documentation in the medical records, the translation process into ICD coding will change. The newer codes will provide more detailed information about the patient’s condition.

It’s interesting to see some of the data comparing what ICD-10 will cost versus what it can save hospitals and healthcare providers. The RAND Science and Technology Policy Institute did a cost/benefit analysis of implementing ICD-10. What they found was that providers will incur costs for computer reprogramming, training coders, physicians, and code users, and for the initial and long-term loss of productivity among coders and physicians.

The cost of sequential conversion (10-CM then 10-PCS) is estimated to be between $425 million and $1.15 billion in one-time costs. There will also be between $5 and $40 million lost in yearly productivity.

But there are benefits as well, many benefits that RAND sees coming from the new detail provided in ICD-10. And, as you will see, they far outweigh the costs.

– More accurate payments to hospitals for new procedures is believed to save $100 million to $1.2 billion.

– There are also benefits from fewer rejected claims, which may be $200 million to $2.5 billion.

– But wait there’s more… in the form of $100 million to $1 billion in fewer exaggerated claims.

– The identification of more cost-effective services and direction of care to specific populations would result in $100 million to $1.5 billion.

– There are also untold benefits that would come from better disease management and better directed preventive care.

In light of these enormous changes coming into effect many anesthesiologists are even more likely to benefit from outsourcing their billing to a medical billing company that specializes in providing anesthesia billing services.


Regional Anesthesia Superior to General Anesthesia in Melanoma Surgery

15 Nov

According to research presented at the American Society of Anesthesiologists (ASA) 2010 Annual Meeting recently held in San Diego, California, regional anesthesia gives melanoma patients their best chance for survival.

More specifically, when regional anesthesia is used during lymph node dissection, there is a better long-term prognosis than when using general anesthesia.

“We have good information from animal studies, and our understanding of the tumor [is telling us] that we should expect surgery [to be] risky for our patients,” Gerhard Brodner, MD, PhD, professor of anesthesiology at Fachklinik Hornheide in Muenster, Germany.

The researchers conducted a retrospective study using the medical records of 273 patients who underwent inguinal lymph node dissection after the diagnosis of primary malignant melanoma of the leg. The patients received either spinal or general anesthesia.

There were 52 patients who were given spinal anesthesia (bupivacaine 0.5%) and 221 patients who were given general anesthesia, which was either a balanced anesthesia with sevoflurane and sufentanil (n = 118) or as total intravenous anesthesia with propofol and remifentanil (n = 103). The analysis revealed that patients who received spinal anesthesia had a better survival rate over 10 years than those receiving general anesthesia.

The session’s moderator, Daniel Sessler, MD, professor of outcomes research at The Cleveland Clinic in Ohio, says that there have been a series of retrospective studies on the effects of regional and general anesthesia which have come up with mixed results in different tumors.

While Dr. Brodner says that anesthesiologists “should avoid everything that could harm the balance between the immune system and tumor cells,” Dr. Sessler says that “We really need to wait for prospective data. This is an intriguing theory, but it’s absolutely not a basis for altering practice. There’s good basic science, and strong animal data to support it. It’s the human data that we’re having problems with.”


16 States That Have Opted Out of Doctor Anesthesia Supervision

08 Nov

In the last post, we discussed the debate over allowing nurse anesthetists to administer anesthesia to patients without a doctor’s supervision. While that debate rages on, let’s take a closer look at the first five states to opt out of the federal requirement for doctor supervision of anesthesia provision:

1. Iowa – In 2001, the Centers for Medicare & Medicaid Services published its rule granting state governors the ability to opt out of the supervision requirement. Less than a month after that news, Iowa became the first state to take them up on the offer. At that time, 91 of 118 Iowa hospitals relied exclusively on Certified Registered Nurse Anesthetists (CRNAs) to provide anesthesia care.

2. Nebraska – The second state to opt out of the physician supervision requirement, Nebraska did so in February 2002. Nebraska Governor Mike Johanns sent a letter to CMS saying “it is in the best interest of the State’s citizens to exercise this exemption.”

3. Idaho – In March 2002, the state’s governor, Dirk Kempthorne, told Idahoans that their state would opt out of the physician requirement as a way of benefiting “Idaho’s citizens, rural communities and hospitals.”

4. Minnesota – In April 2002, Minnesota’s outspoken and colorful governor
Governor, Jesse Ventura, informed CMS in April 2002 that his state would opt out of the federal physician supervision requirement, saying his office consulted with medical and nursing boards, the attorney general and various other parties.

5. New Hampshire – Rounding out the first five states to opt out of the federal doctor supervision requirement is New Hampshire. Opting out in June 2002, Governor Jeanne Shaheen claimed that not doing so “may severely limit the ability of rural hospitals to treat emergencies and provide other services that require anesthesia care.”

The most recent state to opt out of the physician supervision requirement is Colorado. Just this past September, Colorado Governor Bill Ritter announced that his state would opt out following the controversial study published in the August 2010 issue of Health Affairs which claimed patients were not harmed when CRNAs provided anesthesia without physician supervision.

The other 10 states to opt of the supervision requirement were New Mexico, Kansas, North Dakota, South Dakota, Washington, Oregon, Alaska, Wisconsin, California, and Colorado.

California’s situation is particularly interesting since both the California Society of Anesthesiologists and California Medical Association filed a motion that sought to have Governor Schwarzenegger’s letter withdrawn. While the motion was denied this month, the CSA and CMA are considering further actions to appeal the ruling.


Doctors Fight to Retain Anesthesia Oversight in New Jersey

01 Nov

In New Jersey, there is a dispute going on between doctors and the state’s health department over the fact that the state is now allowing nurse anesthetists to sedate patients in hospitals without having a doctor present. Many doctors are angered by this move.

Currently, the rules require nurse anesthetists to work under direct supervision of an anesthesiologist. However, that is set to change now that the state health department is proposing to let the nurses work unassisted – they just need to be able to reach a doctor if necessary.

According to the rule change it “potentially would allow the anesthesiologist to be out of the office on a golf course” said Roger Moore, an anesthesiologist and previously president of the New Jersey State Society of Anesthesiologists.

On the other side, you have nurse anesthetists who support the change.

“The argument that nurse anesthetists are undereducated is not supported by the data,” said Jamie Eisenberg, president of the New Jersey Association of Nurse Anesthetists Inc.

They cite a study that revealed no signs of complication or risks in 14 states with similar rules allowing nurses to provide anesthesia.

But doctors like Barry Gleimer, president of the Orthopedic Surgeons of New Jersey, have their doubts. He cites personal experience from an arthroscopy procedure he was involved with 10 years ago where he says the nurse anesthetist didn’t notice that the patient had turned blue.

“We’ve all been in the OR, when a nurse anesthetist reaches the end of her ability to treat the patient,” said Dr. Gleimer, an osteopath. “At that point, she hollers for an anesthesiologist to get her out of deep water.”