Hal Nelson – Revenue Optimization Strategies for Anesthesia Providers | This Week in Surgery Centers
Here’s what to expect on this week’s episode. 🎙️
🎙️ As more cases migrate from inpatient to outpatient settings, there is more opportunity than ever for anesthesia groups to partner with surgery centers and bring in serious dollars.
While the migration of cases is exciting, anesthesiologists need to ensure they are well-versed in billing and charting requirements to understand how to optimize revenue.
Hal Nelson, CANPC, MSN Healthcare Solutions’ Vice President of Anesthesia Services, joins us on This Week in Surgery Centers to share five revenue optimization strategies for anesthesia providers.
3️⃣ Tip 1: Patient ASA Classification: The classification system is subjective, so anesthesia groups need to rank patients consistently during their pre-anesthesia assessment. Insurance companies pay higher for a classification of 3 or above.
🛑 Tip 2: Anesthesia Start/Stop Times: Do not limit yourself to OR time only. The start time is when the anesthesia provider begins preparing the patient for the induction of the anesthetic either in the operating room or the equivalent area, which can be the pre-op/holding area. You might be leaving out 5-10 minutes of billable time for every case.
👩⚕️ ️Tip 3: Charting Procedural & Diagnosis Information: You never want to chart the procedure solely based on what was planned. Instead, you need to review the EMR or ask the surgeon at the end of the case what was actually performed so that you are getting paid for all the clinical work completed.
💰 Tip 4: Perioperative Anesthesia Services: There are many things that anesthesiologists do outside of the OR that are billable and reimbursable. Provide a list of clinical events that occurred outside of the OR to your billing company and ask how you can make sure they are reviewed and you are adequately paid.
🗣️ Tip 5: Pre-op H&Ps: Suppose the pre-anesthesia assessment and the surgical H&P are separate and distinct documentation-wise, and you are screening for both. In that case, you might be able to bill for an Evaluation and Management code.
Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details.
Episode Transcript
0:00
welcome to this week in surgery centers if you’re in the ASC industry then
0:06
you’re in the right place every week we’ll start the episode off by sharing an interesting conversation we had with
0:11
our featured guests and then we’ll close the episode by recapping the latest news impacting surgery centers we’re excited
0:18
to share with you what we have so let’s get started and see what the industry’s been up to [Music]
0:27
hi everyone here’s what you can expect on today’s episode Hal Nelson is the
0:33
vice president of anesthesia services at MSN Healthcare Solutions and he joins us
0:38
this week to share five Revenue optimization strategies for anesthesia providers the tips and strategies that
0:45
he shares are incredibly helpful so that anesthesiologists can make sure that they’re collecting every dollar that
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they’ve earned these tips are also really helpful for surgery center staff so that they can understand the role
0:58
that they play as well in our news recap we’ll cover black boxes for the operating room new prior
1:04
authorization rules and changes a major revamp of the current organ transplant
1:10
system and of course end the new segment with a positive story about a nurse in Connecticut who’s awarded the magnet
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nurse of the year hope everyone enjoys the episode and here’s what’s going on this week in surgery centers
1:24
[Music] hi Hal welcome to the podcast
1:31
thank you Erica happy to be here yeah we’re excited to have you um all right tell us a little bit more
1:37
about yourself your Healthcare experience and what you’d like our listeners to know
1:42
sure so my name is Hal Nelson I’m the vice president of Anastasia compliance
1:49
for MSN Healthcare Solutions uh my background is I started on the uh the
1:54
insurance side I worked for several National Anastasia excuse me insurance companies
2:03
um from the late 80s to the early 90s then I’ve been in Billing on the billing side specifically with anesthesia since
2:10
1996. so I’ve worked with a lot of a lot of different practices a lot of
2:15
different uh models and look forward to sharing my experience
2:20
awesome and tell us a little bit more about MSN Healthcare Solutions what do you guys do
2:26
so my current employer MSN Healthcare Solutions we are a revenue cycle
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management or billing company we have a suite of services above and beyond that such as our own uh qualified
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clinical data registry or qcdr for MEPS reporting we have a pre-collection a
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patient AR pre-collection solution that we’re excited about with the company
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that we partner with and essentially we are one of the one of the only remaining
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privately held National anesthesia billing companies most of the others
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that are in this space are private Equity backed we are not the sole um the
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the owners are the gentleman who founded the company named Bo Trotter and a lot of the a lot
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of the the employees that were they were with MSN in 1996 when it started started
3:27
or actually honors as well so awesome company to work for yeah that’s great
3:34
that’s great and we knew we wanted to do an episode that focused more on the anesthesia providers world because we do
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normally talk about um surgery centers but I you know obviously they’re intertwined and
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there’s a lot that um our listeners can learn from whether they work at a surgery center or are you know part of
3:53
an anesthesia group um so we thought we you would be the perfect guest to come on and share some
3:58
tips on how anesthesia providers could optimize their revenue um to kick us off can you share a little
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bit about what the landscape looks like right now in general for anesthesia providers
4:11
sure so right now there’s a uh there’s a staffing shortage uh nationally speaking
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as I think anyone watching this podcast will realize it’s hard to get anesthesia Personnel
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because of a shortage in the marketplace that includes anesthesiologists crnas
4:31
anesthesiology assistants or AAS so that’s that’s first and foremost that’s in the background
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um also what’s happening is uh Medicare um had traditionally had a list of of
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surgeries that would only be payable in inpatient settings if you’ve been
4:50
monitoring the landscape over the last couple of years you’ve realized that Medicare has become a little more
4:56
flexible on that they have they have changed their what they call their inpatient only list to allow for a lot
5:03
of surgeries to be paid in ambulatory settings like ASCS so we’re seeing a migration of of
5:11
cases especially especially Orthopedic that are are moving from hospital venues
5:18
to Ambulatory Surgery centers and that so that creates more more opportunity
5:23
for for ASC owners and investors that creates more opportunity for Anastasia
5:29
practices that are looking to cover such locations so we’re seeing a higher
5:34
volume bottom line of outpatient ambulatory cases
5:40
compared to inpatient for certain types of surgeries
5:45
gotcha that makes sense and I think everyone can um you know understand the Staffing
5:52
shortages that are that are going on across the board but that’s interesting do you think that that covid you said
5:59
last couple years like did everything that happened with covid kind of start pushing uh more cases in the inpatient
6:04
world or you think or sorry outpatient world or do you think we’re going that route regardless
6:10
I think it has less to do with coven and it has more to do with expense and
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efficiency so if you look at if you just look at dollars and cents if you look at
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a a particular surgery that’s done in a hospital setting
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um the the insurance companies get a uh let’s say it’s an inpatient let’s say
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it’s an outpatient surgery so the insurance company gets a bill a facility bill from the uh from the hospital they
6:39
get a professional professional bill from all of the entities that are involved in in the case surgeon
6:45
anesthesiologist Etc sometimes pathologists um and I think on the on the facility
6:52
Bill side if you compare the hospital outpatient prospective payment system
6:58
which is how Medicare for example pays uh outpatient hospitals and you compare
7:05
that to the drg grouper rate which is how Medicare pays ASCS
7:13
it’s simply less expensive in many cases to to do the same procedure in an
7:20
Ambulatory Surgery Center than it is an outpatient hospital and then if you if
7:26
you parlay that with the the the Staffing shortages um it’s you’re usually in and out
7:33
quicker uh in an ASC than you are in an outpatient hospital uh so they’re just they’re they’re
7:39
usually more if they’re typically more efficient uh it’s it’s less costly and
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again it’s not it’s not suited for all surgeries but low Acuity short duration cases uh for example uh eye cases GI
7:54
cases um now Orthopedics are are a good
7:59
candidate for outpatient surgery centers just to to mention a few yeah definitely
8:05
and you had mentioned um dollars and cents uh do you find that
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anesthesiologists typically understand the billing process and how to make sure they’re collecting every dollar that
8:18
they’ve earned well it’s one thing that uh that the
8:24
medical providers are not uh taught in in medical school uh they’re not they
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don’t really study the nuances of of billing which is a completely different
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world it’s um there’s a lot of detail to it and those
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of us that have been in it for a long time uh like to share what we know but
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to answer your question I I would say that the majority of of Anastasia uh
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Personnel uh is really not that well versed on on the billing requirements or
9:00
charting requirements and how to optimize revenue for their products yeah that seems to be the the theme that
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we’re seeing on our end as well um so that’s why we’re we’re here today
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we can give our listeners you know five real ways that that anesthesia providers
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can start to optimize that Revenue um and really understand the billing process and start collecting every
9:24
dollar and make sure they’re not leaving anything on the table um so thank you for all that background
9:29
but let’s let’s jump into to tip number one so I know you wanted to talk about patient ASA classification so what uh
9:37
what advice do you have for that one so um for those that are unfamiliar with
9:43
this term uh the the patients ASA status or classification is a
9:50
is a labeling system that uh each each anesthesia provider whether it’s a an
9:57
anesthesiologist or CRNA they’re doing the pre-anesthesia assessment with the with the patient and they’re assigning
10:04
them a risk category between one and five uh five being the highest Acuity uh
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one being the lowest Acuity now in uh in surgery center settings you’re obviously
10:17
not going to see the really sick patients those are going to be seen more in in hospital venues so for surgery
10:24
centers you’d expect to see asa1 which is
10:30
a normal healthy patient asa2 which is mild systemic disease
10:36
um ASA 3 which is a little little higher risk level but you wouldn’t expect to see
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anything higher than an ASA one through an ASA 3. so these are these are
10:48
um rankings so to speak that the the Anastasia provider gives the uh gives
10:53
the patient during the pre-anesthesia assessment which is an interview prior to the surgery now the significance of
11:00
the ASA status is that uh some insurance companies like the ones that I used to work uh with uh will
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actually pay higher for an ASA 3 or above so ASA 1 and ASA 2 the very healthy
11:15
patients no additional payment once you get to an asa3 ASA 4 ASA 5 again the
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only one that’s going to pertain to surgery centers is typically an ASA 3. you have the potential to receive
11:28
additional additional reimbursement from insurance companies for ASA three or
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above now that brings me to the issue of why is this uh even being
11:41
talked about because if you if you were to survey a hundred uh anesthesia professionals and ask them
11:49
this particular patient has the following underlying conditions Prior to
11:54
having surgery what would you what would you assess this patient as being an ASA two or an asa3 and this has actually
12:02
been confirmed through studies performed by the American Society of anesthesiologist it’s very subjective in
12:09
nature so you can have one one provider who’s saying the patients in asa2 that another
12:15
provider saying the patient is an asa3 so because there’s Revenue tied to this
12:21
potentially with a particular case you want to make sure that your practice and
12:27
all of your providers are consistent in how they how they document ASA status
12:33
for patients um it’s I’ll give you the best the best
12:38
example on this Erica is patients who are uh who are morbidly
12:46
obese so there’s a patient has a BMI status obviously every patient based on
12:51
their height and weight has a BMI score a BMI score of 40 or above uh
12:57
constitutes morbid obesity that is automatically an asa3 however if you were to ask members of a
13:05
of a practice how do you classify morbidly obese patients you’d probably have some that would say it’s an ASA II
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others that would say it’s an asa3 so because of that
13:18
you want to have consistency in your labeling of these patients uh in this in this scoring
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classification system and uh the best practice is to have an internal meeting
13:30
with your group to uh to go over common uh comorbidities or underlying
13:36
conditions decide as a group what you’re going to call these uh what you’re going to classify these as and use the ASAS uh
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tool that they is that is free uh that lists examples of
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um conditions that fall into certain ASA categories so your bottom line is you
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want to just be consistent in your in your application of these of these modifiers for billing and you want to
14:05
make sure that everyone’s charting the same way consistently okay that makes sense and we will definitely put a link
14:12
to what you had just suggested that they can refer to in the episode notes so everybody can have easy access to that
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all right let’s go to tip number two tell us about anesthesia start and stop
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times what Revenue optimization tips um are available there
14:31
so the the thing to glean from this topic is that uh anesthesia start and
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stop time has a defined uh period defined by CMS medicare the
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AMA who writes the CPT book it’s all the same there’s no variance in in what
14:51
start and stop time is um so let’s define those those two points start time is defined as when the
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anesthesia provider begins preparing the patient for the induction of the anesthetic and here’s the key the key
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takeaway here either in the operating room or the equivalent area the
15:12
equivalent area can be defined as the pre-op holding area in a surgery center
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so let’s say for a GI endoscopy patient you you are let’s say you’re sedating
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the patient in in pre-op holding and you so you’re giving some sedation uh and
15:34
then you’re moving that patient over to the to the surgical suite for their their procedure time can start prior to
15:43
entering the operating room or the or the surgical Suite area it can actually
15:48
begin in pre-op holding as long as you have noted that you have administered
15:54
sedation and that you were continuously present with that patient so where a lot
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of groups lose money unfortunately just not knowing what the the obscure billing rules are is they uh
16:07
they’ll they’ll their start time will be or entry time and their stop time will be or departure
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time they’re they’re leaving in in some cases they’re leaving three four five minutes of pre-op time three four five
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minutes of of pack you time where they were actually physically present with the patient Beyond uh just the the
16:30
operative uh Suite uh yep number of minutes and just in closing on that so I
16:37
talked about start time what that is defined as stop time is defined as the patient is stable and is turned over to
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a recovery room personnel which is typically outside of the or again so if
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you’re if you’re limiting yourself to procedure room time only you’re probably leaving uh anywhere between five and ten
16:58
minutes uh of billable time on the table for each case uh give or take yeah I
17:05
that would add up pretty quickly one last comment real quick on the on
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the uh on the time issue we’ve actually seen some um some facilities where the the
17:19
anesthesia providers understand what the rules are for for start time but it’s a
17:24
logistical problem because they can’t actually hit the start button until they get to the procedural room so in other
17:31
words they’re if they’re not able in pre-op holding to hit to hit a button
17:37
that that starts the their anesthesia time they have to wait until they they enter the room so that that can be you
17:44
know that can be addressed through talking to your EMR vendor and just finding out how do we get how do we get
17:51
the ability to actually hit that button and start time when we’re actually beginning sedation and pre-op holding
17:58
yeah
18:03
yeah yeah I would imagine okay that makes sense all right shifting to tip number three
18:09
charting procedural and diagnosis information what’s uh going on there
18:15
so uh as as a as anesthesia claims go
18:21
your your payment is directly tied to the the complexity of the surgery that
18:27
was that was performed so your your Anastasia reimbursement is based on what
18:34
the surgeon did um so uh charting uh charting accurately
18:40
uh sometimes requires if if this information is not already captured
18:45
through your your electronic medical record or your anesthesia information management system
18:52
uh if if the surgical specificity is not already being populated there by the
18:58
surgeon or the surgical tech it’s important that you actually document everything that the surgeon did
19:05
sometimes that requires asking the surgeon what they’re billing for what they’re coding for at the end of the
19:11
case uh but you’re I think that the most important thing to know about this is
19:18
you never wanted to chart the procedure based on the plan procedure because as
19:23
we all know uh the planned procedure can can change a Midstream so patients
19:30
coming in for a certain procedure uh the the surgeon actually ends up doing
19:36
something a little bit different that needs to be documented to make sure that you are getting paid for the clinical
19:43
work that you are doing um as a as an anesthesiologist for example or a nurse anesthetist yeah so
19:51
yeah very important to document um exactly what the surgeon did
19:58
um the uh there are a number of of surgeries that depending upon what you
20:04
write down it it impacts how you are paid for example someone’s doing a knee
20:09
or shoulder scope very common ASC procedure so arthroscopy you write down
20:15
the planned procedure which is knee scope or shoulder scope what actually ends up happening by the the surgeon the
20:22
orthopedic surgeon is they end up doing a knee arthroscopy with a medial
20:28
meniscectomy or they end up doing a shoulder arthroscopy with a rotator cuff
20:33
repair by writing down that additional documentation it yields an additional one to two units
20:40
per case for your same anesthetic that’s being provided just by providing greater
20:46
granularity in the procedural description yeah and if you had to guess
20:53
what percentage of cases vary versus what’s planned versus what actually takes place
21:02
um in a surgery center setting I would say that um what’s written down on the
21:07
board uh for for what the patient’s being what the room is being booked for uh how often that actually changes is is
21:16
probably not as frequent as in a hospital setting uh so I don’t I don’t know an exact uh percentage but I can
21:24
give you another example which is a common in ASCS which is uh colonoscopies
21:30
you know that uh the the age of uh screening uh recommended age of screening has gone down from 50 to 45 so
21:37
you’re seeing a lot more uh patients getting screened at a younger age a
21:43
patient comes in again plan procedure versus what actually happened at the end of the case patient comes in for a uh
21:51
for a screening colonoscopy it’s a Medicare patient
21:56
um the the GI endoscopist actually really does a polypectomy so they remove
22:03
found polyps if that’s not documented by the anesthesia provider the practice is
22:09
losing one unit per case now what’s a what’s a unit defined as well for Medicare it’s about 20 20 something
22:16
dollars per case uh 20 20 something dollars per unit low 20s for private
22:21
insurance is higher but that’s the the level of uh of specificity and your
22:28
procedural description it needs to include screening colonoscopy with polypectomy and this can be achieved
22:35
simply by not writing down the procedure before the case starts and ever looking at it again but at the end of each case
22:42
revisiting that and making sure that no modifications are needed if you write
22:47
down at the end of the case exactly what the surgeon did you’ll be assured that your billers will will be able to
22:55
collect uh what you should be getting for that particular case
23:01
got it makes sense all right tip number four peri-operative
23:06
anesthesia services Superior operative uh anesthesia
23:12
Services is really defined more as services that are performed outside of
23:17
the operating room so in a in a surgery center setting this is uh
23:25
quite frankly this is really more suited for for Hospital uh locations but I’ll
23:31
just mention it on here because some of your listeners may work in both in ASC and a hospital setting uh but
23:37
perioperative Services would be defined as things that are again outside of the
23:44
outside of the or area so things like epidural blood patches for a uh for
23:53
obstetrical patients a difficult IV starts that are not uh
23:58
where you’re being asked to come place a an IV for a patient
24:04
tee Services which are more synonymous with cardiac cases in in hospital settings there are a lot of things that
24:11
anesthesiologists do outside of the operating room that are billable and
24:17
reimbursable by insurance companies the issue is are they being charted and are
24:23
they being actually identified and sent to the billing company for uh to go out
24:30
on a claim so perioperative services and another one is is post-operative pain
24:36
rounds again Hospital settings so not ASC setting but uh patient a patient has
24:43
surgery on day one on day two the the Anastasia provider rounds on that
24:49
patient and does a does a brief pain progress note that too is is outside of
24:54
the operating room but it is billable and payable uh by insurance companies who are medically necessary so just to
25:02
give some examples there are a lot of political things that that you may do that you may not realize are billable
25:08
which actually are so it’s always best practice to consult with your your
25:15
billing company and to say hey these are all the things that we are these are all the clinical events that are occurring
25:21
for our practice some of them are in the or some of them are outside of the or and make sure that there’s a a way to
25:28
get the note that you’re charting for whatever service you’re doing to the biller to make sure that they’re not
25:35
just looking at a surgery schedule and saying okay we’ve reconciled all of your cases we’ve captured everything that you
25:41
did you really can’t say that unless you’re looking at all of the perioperative services as well right
25:49
yeah I guess just going back it kind of reminds me of what you’re talking about with the start and stop times like don’t
25:54
don’t sell yourself short on all these these different things that you’re doing and time that you’re spending with
25:59
patients um all right our final tip here pre-op
26:04
hnps so pre-op hmp so that’s essentially the
26:10
history and physical that you you’d expect a a surgeon to do prior to uh to
26:17
to doing a case it’s a it’s so it’s similar to the um the pre-anastasia
26:22
assessment you’re you’re evaluating the patient prior to surgery and sometimes
26:28
admitting the patient in a hospital setting uh pre-op H P’s
26:34
um have become more popular in the anesthesia realm uh because it kind of
26:42
falls into the category of perioperative medicine it’s it’s outside of the operating room uh it’s been proven that um when you
26:50
have someone screening patients prior to their surgery especially um with uh with medical personnel
26:59
evaluating patients prior to their case it has uh it has been shown that it will
27:05
lower cancellation rates and improve clinical outcomes by by having a perioperative
27:12
clinic especially involving uh anesthesiologists to assess these uh these patients uh
27:21
pre-procedure yeah or crnas so uh what
27:26
this means is uh you’re you’re not just doing your your pre-anesia assessment
27:31
you’re doing something more comprehensive you’re evaluating the patient uh before their case you’re
27:38
sometimes Consulting with other medical professionals on things of concern and
27:44
it allows for a practice as long as and I want to specify this as long as the
27:51
the uh the pre and the pre-anesthesia assessment and the surgical H and P
27:58
uh are are separate and distinct documentation wise uh one one document
28:05
can’t serve for both but if you are in anesthesia provider and you are working
28:10
with your facility it’s saying the ASC to screen these patients prior to them
28:15
being seen if you have a separate document with which is a a pre-operative
28:21
history and physical to be used for uh or efficiency purposes and and then you
28:28
have a separate a separate anesthesia record that contains your your pre-anesthesia assessment
28:35
um you can bill for an evaluation and management code if it is considered to
28:42
be a patient at risk you wouldn’t necessarily be able to bill for every single patient that you saw because that
28:49
is uh that is included in the surgeon’s Global fee but if you are doing this for
28:56
the cert the facility and the patient is identified as a a potentially at-risk
29:03
patient you’ve you’ve done a you’ve performed an evaluation and Management Service
29:08
uh separate and distinct from your uh from your anesthesia event uh that could
29:14
be filled out to Insurance examples of this commonly seen are you
29:21
will sometimes see podiatrist or oral surgeons that don’t do their own their
29:26
own uh their own surgical hmps in certain venues where Anastasia performs
29:32
that task uh and and we’ve certainly seen it with other other Specialties as
29:38
well so that’s something to consider uh and again this would really apply to
29:43
to ASCS and into non-asas alike perfect thank you
29:49
all right last question here we do this every week with our guests what is one thing anesthesia groups can do this week
29:56
to improve uh the the one thing that I always go
30:02
back to is it just kind of revisiting this but it is to re-examine your
30:08
practice of of when you’re documenting not only the procedure but the diagnosis
30:13
on your anesthesia record uh I think what you’ll find is a lot of practices
30:20
document this at the beginning of the case and never look at it again if you if you establish a practice of of really
30:26
looking at this twice once before the case you’re putting down what the plan
30:31
procedure is and what the pre-op diagnosis is if you incorporate a second step very simple of simply looking at
30:39
the procedure looking at the diagnosis seeing if anything has changed or needs to be modified and uh and amend the
30:47
record as needed at the end of each case or add to the record at the end of each
30:52
case you will find that this allows this provides to your billers more
30:57
information uh we already talked about examples but it provides more information for the billers to submit a
31:04
correct claim and for you to be paid for the clinical work that you did without being losing revenue and being underpaid
31:13
Perfect all right Hal thank you so much for all the great advice and we appreciate you coming on
31:21
thank you Erica happy to be here [Music]
31:28
as always it has been a busy week in healthcare so let’s Jump Right In you
31:33
have likely heard of black boxes when it comes to airplanes but now they are making their way into the operating room
31:40
24 hospitals in the U.S Canada and Europe have implemented the or black box
31:46
which gathers video audio patient Vital Signs and other data in the hopes of
31:52
reducing medical errors improving patient safety and improving or efficiency
31:58
the article which was published by Becker’s ASC gives a few examples of how
32:03
these black boxes are being used in practice today the first is Duke University Hospital
32:09
they have installed these black boxes and two of their operating rooms and since doing so they said they have used
32:16
their findings to reduce the amount of time it takes to prepare an or for the
32:21
next procedure um they also are considering using the box as a teaching tool for training
32:27
nurses and then over at the University of Texas Southwestern Medical Center they’re
32:33
using five black boxes to understand the characteristics of a high performing or
32:38
team which is really interesting now of course with the good comes the
32:43
bad some do worry that the black boxes could be used to kind of point the
32:48
finger and and punish doctors if something goes wrong or even be used in malpractice lawsuits but since the data
32:56
is completely de-identified and some of it the majority of it is deleted after 30 days to protect privacy it doesn’t
33:04
seem to be a huge concern for most and nothing like this has come up yet
33:10
um and I think the more data points we can collect and analyze hopefully the better the patient’s outcome will be so
33:17
I’m excited to see what other findings come from this new technology
33:22
our next story comes from the Wall Street Journal and it’s all about the
33:27
dreaded paperwork that drives everyone in healthcare crazy the paperwork required by Health
33:33
insurers to get many medical procedures or tests done is getting rolled back a
33:38
bit which is hopefully music to everyone’s ears United Healthcare the
33:43
largest Health insurer in the U.S said it would cut its use of the prior auth process starting in the third quarter of
33:50
2023. so simply put it plans to remove many procedures in medical devices from
33:57
its list of services that require that prior auth sign off
34:02
um now prior authorization has long been a source of frustration among doctors it
34:08
actually creates such an administrative headache for some and can be so burdensome that many practices in
34:13
hospitals employee staff dedicated just to dealing with the paperwork and then
34:18
for patients in an AMA survey of a Thousand and One doctors last year 94
34:24
said the prior auth process delayed care in some cases and what’s even scarier
34:31
one-third said the process led to a serious adverse event for patient
34:36
because care was delayed um so the Signet group another huge
34:41
insurer plans to do the same as United Healthcare and has been removing the requirement for about 500 services and
34:49
devices since 2020. so while we haven’t found a perfect solution yet providers seem to be
34:56
listening and have gotten the ball rolling to help ease the burden that is prior authorization
35:03
Switching gears to a more somber but also hopeful Story the US is planning to
35:09
do a major revamp of the current organ transplant system as 17 people sadly
35:15
pass every day waiting for organ transplants in the U.S alone
35:20
around 140 sorry 104 000 people in the United States are on the wait list for
35:27
an organ transplant and experts say the current system is ineffective and also
35:32
lacks equality uh different groups of people based on race and also geographic
35:37
location are served differently and then wealthier folks have the means to travel where organs are available
35:46
um a little history the current system was built in the 80s and then desperately needs to be revamped
35:52
according to several different in the article the United Network for organ
35:58
sharing has been the sole manager of the nation’s organ transplant System since 1986 and the group has essentially
36:06
operated as a Monopoly ever since the new plan would split up responsibilities
36:11
between the existing Network and the government and create an independent board of directors as well as produce an
36:18
online dashboard that would give the public more information on on the process as a whole but also organ
36:25
retrieval wait list outcomes and demographic data on recipients it seems
36:30
to be a thread throughout that there’s just no transparency right now or accountability from the family and
36:37
Family’s perspective and those who are on the wait list so unfortunately they didn’t give a time frame for when the
36:43
changes would be implemented but I hope for the patients and families that they are able to roll out changes very soon
36:50
and very quickly and to end our News segment on a positive note today we are recognizing
36:57
Michelle Santoro who was honored with a magnet nurse of the Year award she works
37:03
at the Yale New Haven Hospital heart and vascular center and recently she identified a dangerous issue that
37:10
disconnected thousands of cardiac patients worldwide from an external monitoring device platform after a
37:18
vendor performed a software update she has developed uh you know in
37:23
addition to that she has also developed a cardiac monitoring database set up to identify potentially life-threatening
37:30
arrhythmia she fixed a gap in the follow-up for patients with remote cardiac monitoring devices and then she
37:37
also pioneered a new process to prepare patient skin for surgical procedures she
37:42
was recognized for her Innovation and passion and as a hero who has saved thousands of lives
37:49
and that news story officially wraps up this week’s podcast thank you as always for spending a few minutes of your week
37:56
with us make sure to subscribe or leave a review on whichever platform you’re listening from I hope you have a great
38:02
day and we’ll see you again next week
38:07
[Music] why are you keeping me
welcome to this week in surgery centers if you’re in the ASC industry then
0:06
you’re in the right place every week we’ll start the episode off by sharing an interesting conversation we had with
0:11
our featured guests and then we’ll close the episode by recapping the latest news impacting surgery centers we’re excited
0:18
to share with you what we have so let’s get started and see what the industry’s been up to [Music]
0:27
hi everyone here’s what you can expect on today’s episode Hal Nelson is the
0:33
vice president of anesthesia services at MSN Healthcare Solutions and he joins us
0:38
this week to share five Revenue optimization strategies for anesthesia providers the tips and strategies that
0:45
he shares are incredibly helpful so that anesthesiologists can make sure that they’re collecting every dollar that
0:52
they’ve earned these tips are also really helpful for surgery center staff so that they can understand the role
0:58
that they play as well in our news recap we’ll cover black boxes for the operating room new prior
1:04
authorization rules and changes a major revamp of the current organ transplant
1:10
system and of course end the new segment with a positive story about a nurse in Connecticut who’s awarded the magnet
1:17
nurse of the year hope everyone enjoys the episode and here’s what’s going on this week in surgery centers
1:24
[Music] hi Hal welcome to the podcast
1:31
thank you Erica happy to be here yeah we’re excited to have you um all right tell us a little bit more
1:37
about yourself your Healthcare experience and what you’d like our listeners to know
1:42
sure so my name is Hal Nelson I’m the vice president of Anastasia compliance
1:49
for MSN Healthcare Solutions uh my background is I started on the uh the
1:54
insurance side I worked for several National Anastasia excuse me insurance companies
2:03
um from the late 80s to the early 90s then I’ve been in Billing on the billing side specifically with anesthesia since
2:10
1996. so I’ve worked with a lot of a lot of different practices a lot of
2:15
different uh models and look forward to sharing my experience
2:20
awesome and tell us a little bit more about MSN Healthcare Solutions what do you guys do
2:26
so my current employer MSN Healthcare Solutions we are a revenue cycle
2:32
management or billing company we have a suite of services above and beyond that such as our own uh qualified
2:40
clinical data registry or qcdr for MEPS reporting we have a pre-collection a
2:49
patient AR pre-collection solution that we’re excited about with the company
2:55
that we partner with and essentially we are one of the one of the only remaining
3:01
privately held National anesthesia billing companies most of the others
3:07
that are in this space are private Equity backed we are not the sole um the
3:14
the owners are the gentleman who founded the company named Bo Trotter and a lot of the a lot
3:21
of the the employees that were they were with MSN in 1996 when it started started
3:27
or actually honors as well so awesome company to work for yeah that’s great
3:34
that’s great and we knew we wanted to do an episode that focused more on the anesthesia providers world because we do
3:40
normally talk about um surgery centers but I you know obviously they’re intertwined and
3:46
there’s a lot that um our listeners can learn from whether they work at a surgery center or are you know part of
3:53
an anesthesia group um so we thought we you would be the perfect guest to come on and share some
3:58
tips on how anesthesia providers could optimize their revenue um to kick us off can you share a little
4:04
bit about what the landscape looks like right now in general for anesthesia providers
4:11
sure so right now there’s a uh there’s a staffing shortage uh nationally speaking
4:17
as I think anyone watching this podcast will realize it’s hard to get anesthesia Personnel
4:25
because of a shortage in the marketplace that includes anesthesiologists crnas
4:31
anesthesiology assistants or AAS so that’s that’s first and foremost that’s in the background
4:37
um also what’s happening is uh Medicare um had traditionally had a list of of
4:44
surgeries that would only be payable in inpatient settings if you’ve been
4:50
monitoring the landscape over the last couple of years you’ve realized that Medicare has become a little more
4:56
flexible on that they have they have changed their what they call their inpatient only list to allow for a lot
5:03
of surgeries to be paid in ambulatory settings like ASCS so we’re seeing a migration of of
5:11
cases especially especially Orthopedic that are are moving from hospital venues
5:18
to Ambulatory Surgery centers and that so that creates more more opportunity
5:23
for for ASC owners and investors that creates more opportunity for Anastasia
5:29
practices that are looking to cover such locations so we’re seeing a higher
5:34
volume bottom line of outpatient ambulatory cases
5:40
compared to inpatient for certain types of surgeries
5:45
gotcha that makes sense and I think everyone can um you know understand the Staffing
5:52
shortages that are that are going on across the board but that’s interesting do you think that that covid you said
5:59
last couple years like did everything that happened with covid kind of start pushing uh more cases in the inpatient
6:04
world or you think or sorry outpatient world or do you think we’re going that route regardless
6:10
I think it has less to do with coven and it has more to do with expense and
6:16
efficiency so if you look at if you just look at dollars and cents if you look at
6:21
a a particular surgery that’s done in a hospital setting
6:26
um the the insurance companies get a uh let’s say it’s an inpatient let’s say
6:31
it’s an outpatient surgery so the insurance company gets a bill a facility bill from the uh from the hospital they
6:39
get a professional professional bill from all of the entities that are involved in in the case surgeon
6:45
anesthesiologist Etc sometimes pathologists um and I think on the on the facility
6:52
Bill side if you compare the hospital outpatient prospective payment system
6:58
which is how Medicare for example pays uh outpatient hospitals and you compare
7:05
that to the drg grouper rate which is how Medicare pays ASCS
7:13
it’s simply less expensive in many cases to to do the same procedure in an
7:20
Ambulatory Surgery Center than it is an outpatient hospital and then if you if
7:26
you parlay that with the the the Staffing shortages um it’s you’re usually in and out
7:33
quicker uh in an ASC than you are in an outpatient hospital uh so they’re just they’re they’re
7:39
usually more if they’re typically more efficient uh it’s it’s less costly and
7:45
again it’s not it’s not suited for all surgeries but low Acuity short duration cases uh for example uh eye cases GI
7:54
cases um now Orthopedics are are a good
7:59
candidate for outpatient surgery centers just to to mention a few yeah definitely
8:05
and you had mentioned um dollars and cents uh do you find that
8:12
anesthesiologists typically understand the billing process and how to make sure they’re collecting every dollar that
8:18
they’ve earned well it’s one thing that uh that the
8:24
medical providers are not uh taught in in medical school uh they’re not they
8:31
don’t really study the nuances of of billing which is a completely different
8:36
world it’s um there’s a lot of detail to it and those
8:43
of us that have been in it for a long time uh like to share what we know but
8:49
to answer your question I I would say that the majority of of Anastasia uh
8:55
Personnel uh is really not that well versed on on the billing requirements or
9:00
charting requirements and how to optimize revenue for their products yeah that seems to be the the theme that
9:07
we’re seeing on our end as well um so that’s why we’re we’re here today
9:13
we can give our listeners you know five real ways that that anesthesia providers
9:18
can start to optimize that Revenue um and really understand the billing process and start collecting every
9:24
dollar and make sure they’re not leaving anything on the table um so thank you for all that background
9:29
but let’s let’s jump into to tip number one so I know you wanted to talk about patient ASA classification so what uh
9:37
what advice do you have for that one so um for those that are unfamiliar with
9:43
this term uh the the patients ASA status or classification is a
9:50
is a labeling system that uh each each anesthesia provider whether it’s a an
9:57
anesthesiologist or CRNA they’re doing the pre-anesthesia assessment with the with the patient and they’re assigning
10:04
them a risk category between one and five uh five being the highest Acuity uh
10:10
one being the lowest Acuity now in uh in surgery center settings you’re obviously
10:17
not going to see the really sick patients those are going to be seen more in in hospital venues so for surgery
10:24
centers you’d expect to see asa1 which is
10:30
a normal healthy patient asa2 which is mild systemic disease
10:36
um ASA 3 which is a little little higher risk level but you wouldn’t expect to see
10:42
anything higher than an ASA one through an ASA 3. so these are these are
10:48
um rankings so to speak that the the Anastasia provider gives the uh gives
10:53
the patient during the pre-anesthesia assessment which is an interview prior to the surgery now the significance of
11:00
the ASA status is that uh some insurance companies like the ones that I used to work uh with uh will
11:08
actually pay higher for an ASA 3 or above so ASA 1 and ASA 2 the very healthy
11:15
patients no additional payment once you get to an asa3 ASA 4 ASA 5 again the
11:22
only one that’s going to pertain to surgery centers is typically an ASA 3. you have the potential to receive
11:28
additional additional reimbursement from insurance companies for ASA three or
11:34
above now that brings me to the issue of why is this uh even being
11:41
talked about because if you if you were to survey a hundred uh anesthesia professionals and ask them
11:49
this particular patient has the following underlying conditions Prior to
11:54
having surgery what would you what would you assess this patient as being an ASA two or an asa3 and this has actually
12:02
been confirmed through studies performed by the American Society of anesthesiologist it’s very subjective in
12:09
nature so you can have one one provider who’s saying the patients in asa2 that another
12:15
provider saying the patient is an asa3 so because there’s Revenue tied to this
12:21
potentially with a particular case you want to make sure that your practice and
12:27
all of your providers are consistent in how they how they document ASA status
12:33
for patients um it’s I’ll give you the best the best
12:38
example on this Erica is patients who are uh who are morbidly
12:46
obese so there’s a patient has a BMI status obviously every patient based on
12:51
their height and weight has a BMI score a BMI score of 40 or above uh
12:57
constitutes morbid obesity that is automatically an asa3 however if you were to ask members of a
13:05
of a practice how do you classify morbidly obese patients you’d probably have some that would say it’s an ASA II
13:12
others that would say it’s an asa3 so because of that
13:18
you want to have consistency in your labeling of these patients uh in this in this scoring
13:24
classification system and uh the best practice is to have an internal meeting
13:30
with your group to uh to go over common uh comorbidities or underlying
13:36
conditions decide as a group what you’re going to call these uh what you’re going to classify these as and use the ASAS uh
13:45
tool that they is that is free uh that lists examples of
13:52
um conditions that fall into certain ASA categories so your bottom line is you
13:58
want to just be consistent in your in your application of these of these modifiers for billing and you want to
14:05
make sure that everyone’s charting the same way consistently okay that makes sense and we will definitely put a link
14:12
to what you had just suggested that they can refer to in the episode notes so everybody can have easy access to that
14:20
all right let’s go to tip number two tell us about anesthesia start and stop
14:26
times what Revenue optimization tips um are available there
14:31
so the the thing to glean from this topic is that uh anesthesia start and
14:37
stop time has a defined uh period defined by CMS medicare the
14:45
AMA who writes the CPT book it’s all the same there’s no variance in in what
14:51
start and stop time is um so let’s define those those two points start time is defined as when the
14:59
anesthesia provider begins preparing the patient for the induction of the anesthetic and here’s the key the key
15:06
takeaway here either in the operating room or the equivalent area the
15:12
equivalent area can be defined as the pre-op holding area in a surgery center
15:19
so let’s say for a GI endoscopy patient you you are let’s say you’re sedating
15:27
the patient in in pre-op holding and you so you’re giving some sedation uh and
15:34
then you’re moving that patient over to the to the surgical suite for their their procedure time can start prior to
15:43
entering the operating room or the or the surgical Suite area it can actually
15:48
begin in pre-op holding as long as you have noted that you have administered
15:54
sedation and that you were continuously present with that patient so where a lot
15:59
of groups lose money unfortunately just not knowing what the the obscure billing rules are is they uh
16:07
they’ll they’ll their start time will be or entry time and their stop time will be or departure
16:14
time they’re they’re leaving in in some cases they’re leaving three four five minutes of pre-op time three four five
16:22
minutes of of pack you time where they were actually physically present with the patient Beyond uh just the the
16:30
operative uh Suite uh yep number of minutes and just in closing on that so I
16:37
talked about start time what that is defined as stop time is defined as the patient is stable and is turned over to
16:44
a recovery room personnel which is typically outside of the or again so if
16:50
you’re if you’re limiting yourself to procedure room time only you’re probably leaving uh anywhere between five and ten
16:58
minutes uh of billable time on the table for each case uh give or take yeah I
17:05
that would add up pretty quickly one last comment real quick on the on
17:11
the uh on the time issue we’ve actually seen some um some facilities where the the
17:19
anesthesia providers understand what the rules are for for start time but it’s a
17:24
logistical problem because they can’t actually hit the start button until they get to the procedural room so in other
17:31
words they’re if they’re not able in pre-op holding to hit to hit a button
17:37
that that starts the their anesthesia time they have to wait until they they enter the room so that that can be you
17:44
know that can be addressed through talking to your EMR vendor and just finding out how do we get how do we get
17:51
the ability to actually hit that button and start time when we’re actually beginning sedation and pre-op holding
17:58
yeah
18:03
yeah yeah I would imagine okay that makes sense all right shifting to tip number three
18:09
charting procedural and diagnosis information what’s uh going on there
18:15
so uh as as a as anesthesia claims go
18:21
your your payment is directly tied to the the complexity of the surgery that
18:27
was that was performed so your your Anastasia reimbursement is based on what
18:34
the surgeon did um so uh charting uh charting accurately
18:40
uh sometimes requires if if this information is not already captured
18:45
through your your electronic medical record or your anesthesia information management system
18:52
uh if if the surgical specificity is not already being populated there by the
18:58
surgeon or the surgical tech it’s important that you actually document everything that the surgeon did
19:05
sometimes that requires asking the surgeon what they’re billing for what they’re coding for at the end of the
19:11
case uh but you’re I think that the most important thing to know about this is
19:18
you never wanted to chart the procedure based on the plan procedure because as
19:23
we all know uh the planned procedure can can change a Midstream so patients
19:30
coming in for a certain procedure uh the the surgeon actually ends up doing
19:36
something a little bit different that needs to be documented to make sure that you are getting paid for the clinical
19:43
work that you are doing um as a as an anesthesiologist for example or a nurse anesthetist yeah so
19:51
yeah very important to document um exactly what the surgeon did
19:58
um the uh there are a number of of surgeries that depending upon what you
20:04
write down it it impacts how you are paid for example someone’s doing a knee
20:09
or shoulder scope very common ASC procedure so arthroscopy you write down
20:15
the planned procedure which is knee scope or shoulder scope what actually ends up happening by the the surgeon the
20:22
orthopedic surgeon is they end up doing a knee arthroscopy with a medial
20:28
meniscectomy or they end up doing a shoulder arthroscopy with a rotator cuff
20:33
repair by writing down that additional documentation it yields an additional one to two units
20:40
per case for your same anesthetic that’s being provided just by providing greater
20:46
granularity in the procedural description yeah and if you had to guess
20:53
what percentage of cases vary versus what’s planned versus what actually takes place
21:02
um in a surgery center setting I would say that um what’s written down on the
21:07
board uh for for what the patient’s being what the room is being booked for uh how often that actually changes is is
21:16
probably not as frequent as in a hospital setting uh so I don’t I don’t know an exact uh percentage but I can
21:24
give you another example which is a common in ASCS which is uh colonoscopies
21:30
you know that uh the the age of uh screening uh recommended age of screening has gone down from 50 to 45 so
21:37
you’re seeing a lot more uh patients getting screened at a younger age a
21:43
patient comes in again plan procedure versus what actually happened at the end of the case patient comes in for a uh
21:51
for a screening colonoscopy it’s a Medicare patient
21:56
um the the GI endoscopist actually really does a polypectomy so they remove
22:03
found polyps if that’s not documented by the anesthesia provider the practice is
22:09
losing one unit per case now what’s a what’s a unit defined as well for Medicare it’s about 20 20 something
22:16
dollars per case uh 20 20 something dollars per unit low 20s for private
22:21
insurance is higher but that’s the the level of uh of specificity and your
22:28
procedural description it needs to include screening colonoscopy with polypectomy and this can be achieved
22:35
simply by not writing down the procedure before the case starts and ever looking at it again but at the end of each case
22:42
revisiting that and making sure that no modifications are needed if you write
22:47
down at the end of the case exactly what the surgeon did you’ll be assured that your billers will will be able to
22:55
collect uh what you should be getting for that particular case
23:01
got it makes sense all right tip number four peri-operative
23:06
anesthesia services Superior operative uh anesthesia
23:12
Services is really defined more as services that are performed outside of
23:17
the operating room so in a in a surgery center setting this is uh
23:25
quite frankly this is really more suited for for Hospital uh locations but I’ll
23:31
just mention it on here because some of your listeners may work in both in ASC and a hospital setting uh but
23:37
perioperative Services would be defined as things that are again outside of the
23:44
outside of the or area so things like epidural blood patches for a uh for
23:53
obstetrical patients a difficult IV starts that are not uh
23:58
where you’re being asked to come place a an IV for a patient
24:04
tee Services which are more synonymous with cardiac cases in in hospital settings there are a lot of things that
24:11
anesthesiologists do outside of the operating room that are billable and
24:17
reimbursable by insurance companies the issue is are they being charted and are
24:23
they being actually identified and sent to the billing company for uh to go out
24:30
on a claim so perioperative services and another one is is post-operative pain
24:36
rounds again Hospital settings so not ASC setting but uh patient a patient has
24:43
surgery on day one on day two the the Anastasia provider rounds on that
24:49
patient and does a does a brief pain progress note that too is is outside of
24:54
the operating room but it is billable and payable uh by insurance companies who are medically necessary so just to
25:02
give some examples there are a lot of political things that that you may do that you may not realize are billable
25:08
which actually are so it’s always best practice to consult with your your
25:15
billing company and to say hey these are all the things that we are these are all the clinical events that are occurring
25:21
for our practice some of them are in the or some of them are outside of the or and make sure that there’s a a way to
25:28
get the note that you’re charting for whatever service you’re doing to the biller to make sure that they’re not
25:35
just looking at a surgery schedule and saying okay we’ve reconciled all of your cases we’ve captured everything that you
25:41
did you really can’t say that unless you’re looking at all of the perioperative services as well right
25:49
yeah I guess just going back it kind of reminds me of what you’re talking about with the start and stop times like don’t
25:54
don’t sell yourself short on all these these different things that you’re doing and time that you’re spending with
25:59
patients um all right our final tip here pre-op
26:04
hnps so pre-op hmp so that’s essentially the
26:10
history and physical that you you’d expect a a surgeon to do prior to uh to
26:17
to doing a case it’s a it’s so it’s similar to the um the pre-anastasia
26:22
assessment you’re you’re evaluating the patient prior to surgery and sometimes
26:28
admitting the patient in a hospital setting uh pre-op H P’s
26:34
um have become more popular in the anesthesia realm uh because it kind of
26:42
falls into the category of perioperative medicine it’s it’s outside of the operating room uh it’s been proven that um when you
26:50
have someone screening patients prior to their surgery especially um with uh with medical personnel
26:59
evaluating patients prior to their case it has uh it has been shown that it will
27:05
lower cancellation rates and improve clinical outcomes by by having a perioperative
27:12
clinic especially involving uh anesthesiologists to assess these uh these patients uh
27:21
pre-procedure yeah or crnas so uh what
27:26
this means is uh you’re you’re not just doing your your pre-anesia assessment
27:31
you’re doing something more comprehensive you’re evaluating the patient uh before their case you’re
27:38
sometimes Consulting with other medical professionals on things of concern and
27:44
it allows for a practice as long as and I want to specify this as long as the
27:51
the uh the pre and the pre-anesthesia assessment and the surgical H and P
27:58
uh are are separate and distinct documentation wise uh one one document
28:05
can’t serve for both but if you are in anesthesia provider and you are working
28:10
with your facility it’s saying the ASC to screen these patients prior to them
28:15
being seen if you have a separate document with which is a a pre-operative
28:21
history and physical to be used for uh or efficiency purposes and and then you
28:28
have a separate a separate anesthesia record that contains your your pre-anesthesia assessment
28:35
um you can bill for an evaluation and management code if it is considered to
28:42
be a patient at risk you wouldn’t necessarily be able to bill for every single patient that you saw because that
28:49
is uh that is included in the surgeon’s Global fee but if you are doing this for
28:56
the cert the facility and the patient is identified as a a potentially at-risk
29:03
patient you’ve you’ve done a you’ve performed an evaluation and Management Service
29:08
uh separate and distinct from your uh from your anesthesia event uh that could
29:14
be filled out to Insurance examples of this commonly seen are you
29:21
will sometimes see podiatrist or oral surgeons that don’t do their own their
29:26
own uh their own surgical hmps in certain venues where Anastasia performs
29:32
that task uh and and we’ve certainly seen it with other other Specialties as
29:38
well so that’s something to consider uh and again this would really apply to
29:43
to ASCS and into non-asas alike perfect thank you
29:49
all right last question here we do this every week with our guests what is one thing anesthesia groups can do this week
29:56
to improve uh the the one thing that I always go
30:02
back to is it just kind of revisiting this but it is to re-examine your
30:08
practice of of when you’re documenting not only the procedure but the diagnosis
30:13
on your anesthesia record uh I think what you’ll find is a lot of practices
30:20
document this at the beginning of the case and never look at it again if you if you establish a practice of of really
30:26
looking at this twice once before the case you’re putting down what the plan
30:31
procedure is and what the pre-op diagnosis is if you incorporate a second step very simple of simply looking at
30:39
the procedure looking at the diagnosis seeing if anything has changed or needs to be modified and uh and amend the
30:47
record as needed at the end of each case or add to the record at the end of each
30:52
case you will find that this allows this provides to your billers more
30:57
information uh we already talked about examples but it provides more information for the billers to submit a
31:04
correct claim and for you to be paid for the clinical work that you did without being losing revenue and being underpaid
31:13
Perfect all right Hal thank you so much for all the great advice and we appreciate you coming on
31:21
thank you Erica happy to be here [Music]
31:28
as always it has been a busy week in healthcare so let’s Jump Right In you
31:33
have likely heard of black boxes when it comes to airplanes but now they are making their way into the operating room
31:40
24 hospitals in the U.S Canada and Europe have implemented the or black box
31:46
which gathers video audio patient Vital Signs and other data in the hopes of
31:52
reducing medical errors improving patient safety and improving or efficiency
31:58
the article which was published by Becker’s ASC gives a few examples of how
32:03
these black boxes are being used in practice today the first is Duke University Hospital
32:09
they have installed these black boxes and two of their operating rooms and since doing so they said they have used
32:16
their findings to reduce the amount of time it takes to prepare an or for the
32:21
next procedure um they also are considering using the box as a teaching tool for training
32:27
nurses and then over at the University of Texas Southwestern Medical Center they’re
32:33
using five black boxes to understand the characteristics of a high performing or
32:38
team which is really interesting now of course with the good comes the
32:43
bad some do worry that the black boxes could be used to kind of point the
32:48
finger and and punish doctors if something goes wrong or even be used in malpractice lawsuits but since the data
32:56
is completely de-identified and some of it the majority of it is deleted after 30 days to protect privacy it doesn’t
33:04
seem to be a huge concern for most and nothing like this has come up yet
33:10
um and I think the more data points we can collect and analyze hopefully the better the patient’s outcome will be so
33:17
I’m excited to see what other findings come from this new technology
33:22
our next story comes from the Wall Street Journal and it’s all about the
33:27
dreaded paperwork that drives everyone in healthcare crazy the paperwork required by Health
33:33
insurers to get many medical procedures or tests done is getting rolled back a
33:38
bit which is hopefully music to everyone’s ears United Healthcare the
33:43
largest Health insurer in the U.S said it would cut its use of the prior auth process starting in the third quarter of
33:50
2023. so simply put it plans to remove many procedures in medical devices from
33:57
its list of services that require that prior auth sign off
34:02
um now prior authorization has long been a source of frustration among doctors it
34:08
actually creates such an administrative headache for some and can be so burdensome that many practices in
34:13
hospitals employee staff dedicated just to dealing with the paperwork and then
34:18
for patients in an AMA survey of a Thousand and One doctors last year 94
34:24
said the prior auth process delayed care in some cases and what’s even scarier
34:31
one-third said the process led to a serious adverse event for patient
34:36
because care was delayed um so the Signet group another huge
34:41
insurer plans to do the same as United Healthcare and has been removing the requirement for about 500 services and
34:49
devices since 2020. so while we haven’t found a perfect solution yet providers seem to be
34:56
listening and have gotten the ball rolling to help ease the burden that is prior authorization
35:03
Switching gears to a more somber but also hopeful Story the US is planning to
35:09
do a major revamp of the current organ transplant system as 17 people sadly
35:15
pass every day waiting for organ transplants in the U.S alone
35:20
around 140 sorry 104 000 people in the United States are on the wait list for
35:27
an organ transplant and experts say the current system is ineffective and also
35:32
lacks equality uh different groups of people based on race and also geographic
35:37
location are served differently and then wealthier folks have the means to travel where organs are available
35:46
um a little history the current system was built in the 80s and then desperately needs to be revamped
35:52
according to several different in the article the United Network for organ
35:58
sharing has been the sole manager of the nation’s organ transplant System since 1986 and the group has essentially
36:06
operated as a Monopoly ever since the new plan would split up responsibilities
36:11
between the existing Network and the government and create an independent board of directors as well as produce an
36:18
online dashboard that would give the public more information on on the process as a whole but also organ
36:25
retrieval wait list outcomes and demographic data on recipients it seems
36:30
to be a thread throughout that there’s just no transparency right now or accountability from the family and
36:37
Family’s perspective and those who are on the wait list so unfortunately they didn’t give a time frame for when the
36:43
changes would be implemented but I hope for the patients and families that they are able to roll out changes very soon
36:50
and very quickly and to end our News segment on a positive note today we are recognizing
36:57
Michelle Santoro who was honored with a magnet nurse of the Year award she works
37:03
at the Yale New Haven Hospital heart and vascular center and recently she identified a dangerous issue that
37:10
disconnected thousands of cardiac patients worldwide from an external monitoring device platform after a
37:18
vendor performed a software update she has developed uh you know in
37:23
addition to that she has also developed a cardiac monitoring database set up to identify potentially life-threatening
37:30
arrhythmia she fixed a gap in the follow-up for patients with remote cardiac monitoring devices and then she
37:37
also pioneered a new process to prepare patient skin for surgical procedures she
37:42
was recognized for her Innovation and passion and as a hero who has saved thousands of lives
37:49
and that news story officially wraps up this week’s podcast thank you as always for spending a few minutes of your week
37:56
with us make sure to subscribe or leave a review on whichever platform you’re listening from I hope you have a great
38:02
day and we’ll see you again next week
38:07
[Music] why are you keeping me
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