Archive for the ‘Anesthesia Practice Management’ Category

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.”


Billing Codes Increase in 2013, Threaten to Slow Billing Process

25 Oct

According to the New England Journal of Medicine, overhead and billing expenses take up as much as 43 percent of a doctor’s annual revenue. When you consider the fact that insurance companies will not always make it easy on you to have your claims paid, it makes it that more daunting. But, when 2013 rolls around, the challenge gets tougher. In fact, you will have 155,000 reasons to consider hiring a medical billing company to handle your claims.

Published by the World Health Organization (WHO), The International Statistical Classification of Diseases and Related Health Problems (ICD-9) currently contains 17,000 billing codes to choose from in order to classify diseases and a wide variety of symptoms, causes, and other variables. But, all that will change on October 1, 2013, when the number of codes will increase to an astounding 155,000 under the ICD-10.

As one might suspect, more codes means longer billing processes. Coders will need to increase their knowledge of anatomy, physiology, and medical terminology. They will also need to work more closely with doctors to work out the kinks in the new coding process.

The United States is late to the game, so to speak, with implementing the ICD-10. Other countries that have been under the latest coding guidelines for years have reported significantly longer turnaround time on their accounts receivable.

But if the transition is handled effectively, those bumps in the road should be short-term. If nothing else, the pending coding changes underscores the value of outsourcing your medical billing needs to a medical practice management company.


Apps for Anesthesia, Anesthesiologists

04 Oct

Last week, the Stanford Anesthesia Informatics and Media Lab (AIM) released StanMed, their new iPad application that was designed as an educational tool in the critical care student clerkship at the School of Medicine. This is how the app is described at the iTunes preview page:

StanMed is an iPad app designed to be used by Stanford medical students, residents, fellows and faculty. We intend StanMed to be used in the classroom and at the bedside. StanMed will provide clinically useful educational modules, tutorials, videos, podcasts and cognitive aids to help facilitate learning at the point of care.

While the application is free, at the moment it’s only available to Stanford University affiliates with valid SUNet IDs. However, exceptions can be made if you are an educator or member of the press. If you’re interested in learning more about the app, you can email them with your request to access the application at

The Principal Investigator of AIM is Larry Chu, MD., Assistant Professor of Anesthesia, Stanford University School of Medicine.

There are other anesthesia apps to choose from as well. One example is iAnesthesia: Case Logs. This app was designed for easy caseload tracking. Here are some of the touted features:

– The iPhone automatically syncs case data to the secure CaseLog Database

– Stores all of your anesthesia case log data in one convenient and organized location

– Even if you forget your iPhone, you can enter anesthesia case log data online quickly and easily

– You have 24-hour access to your data.

And then there is the popular Epocrates for the iPhone. Epocrates is the most popular mobile drug reference resource used by healthcare providers at the point of care. According to the description in the Apple Store, “physicians choose Epocrates 3 to 1 as their point of care drug reference of choice.”

In a recent press release, MBA Medical Business Associates announced an increased focus and capital investment in services and technology to support anesthesiologists. In an effort to improve the efficiency of anesthesia billing and the availability of information for anesthesiologists MBA  developed a custom designed practice management system which includes a smart phone application, an internet portal, and a computer-based program.

This practice management solution for anesthesia was designed around the ability to import patient and case information from the hospital while also offering an interface for physicians to enter additional case information independent from the hospital system.  The equally-important second objective of this initiative was to provide physicians remote access to all pertinent information about their cases through the physician interface. Aside from providing valuable reporting capability, this would also allow providers to confirm that their services have been billed correctly and ultimately get paid correctly.