Reimbursement update on spine and pain cases
Same-Day Surgery Manager
Also: How to address 5 difficult situations
By Stephen W. Earnhart, MS
CEO
Earnhart & Associates
Houston, TX
For those of you who have not followed what is going on in the battles over spine and pain cases reimbursement, there is much to learn that could benefit all.
Pain case professional fee reimbursement is taking it right on the chin in 2014 - so much so that most pain practitioners are being forced to rely upon facility fee reimbursement to keep the lights on. The bottom line is that pain physicians who traditionally have performed procedures in their offices probably will be forced to start performing them, and having an ownership position, in freestanding surgery centers. The debate is raging, but based upon the number of calls we are receiving, it seems like many of these physicians are ready to build their own surgery centers or become a partner in an existing facility.
I know that many facilities are vexed at providing this service as they tend to "bottleneck" the recovery area of many facilities not designed to cope with 20 or 30 new cases coming into their center. Depending upon the sedation used for the pain patients, they can jam the recovery room with prolonged recovery time, especially for those patients who receive conscious sedation for their procedure. A further complication for these procedures is the relatively low reimbursement for many of these cases.
On the opposite side of the ledger is the "two-midnight" rule being hotly watched by many. Essentially payers are pushing that spine surgery procedures performed in a hospital must stay overnight for at least two nights (hence, Medicare's "two-midnight" rule) or they are not going to reimburse the surgeon or the hospital.
The effect is that many spine specialists are looking to doing these procedures in a surgery center, but most need to keep their patients at least one night. The equipment is expensive, and staff training is very detailed. Again, most freestanding facilities do not have the space nor the inclination to spend the money on the equipment and training.
How to address 5 difficult situations
Last month we were looking at making decisions, and I gave some suggestions on several actual scenarios. In that same vein, here are some additional questions and answers.
. It looks like a staff member slipped a vial from the anesthesia cart into his pocket. What do you do?
Answer: Because the person who saw this was not his supervisor, the best option is for that person not to confront the individual but to report what she saw to his supervisor.
. Cases are running very late, and a very busy and irate surgeon demands that you call your supervisor and let her know that he is just starting his elective case at 9:30 pm, five hours late. He is demanding to speak with her and "give her hell." What do you do?
Answer: Since this situation happened to the circulator on the "call team," the best approach is to call her and let her deal with the situation since she has more experience in dealing with situations like this one.
. You have a mandatory staff meeting scheduled for 8 a.m. At 8:15, only a few of the staff are there. What do you do?
Answer: No question here. Start the meeting without them and let them know they can find out what they missed from the ones who arrived on time. I don't know how many staff meetings I have started over the years with no one there. After a while, people learn how to use a watch.
. Your instrument rep's new boss is visiting your facility and wants to know how his rep is treating you. The rep is terrible, but he has saved you before in getting an instrument to you when you needed it. What do you do?
Answer: Part of the rep's job is to save you when you need it. Be up front with the new boss. Chance are she already has heard the truth from other facilities.
. Only one staff member can attend the upcoming surgical conference. The person most qualified to attend has only been on the job for a year. The person that assumes she will go has been there 15 years. What do you do?
Answer: I think we are all getting a little tired of staff members resting on their laurels from days past and not focusing on what is happening today. It is not fair to the qualified individual who has worked hard to qualify to go; nor is it fair to the 15-year staff member to be rewarded for something they didn't earn. Send the most qualified! [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates' address is 238 S. Egret Bay Blvd., Suite 285, Houston, TX 77573-2682. Phone: (512) 297.7575. Fax: (512) 233.2979. E-mail: [email protected]. Web: www.earnhart.com.]
