Jun 24, 2019
579
536
Status (Visible)
  1. Medical Student
For example, what is stopping an IR doc from say opening a clinic; maybe contracting with a hospital, then doing some clinical management of patients along with outpatient IR procedures? Of course, this means IR docs have to possibly separate contracts from the DR folks. And, I have heard this is happening more across the country.
 

irwarrior

10+ Year Member
Oct 19, 2008
383
184
Status (Visible)
This is becoming more and more commonplace as the hospital is becoming too expensive and CMS is looking for alternative sites.IR is prime for this as the bulk of what we do can be discharged same day.



Outpatient Prospective Payment System and Ambulatory Surgical Center final rule empowers beneficiary choices and unleashes competition to lower costs and improve innovation

Today, the Centers for Medicare & Medicaid Services (CMS) is finalizing policy changes that will give Medicare patients and their doctors greater choices to get care at a lower cost in an outpatient setting. The Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rules will increase value for Medicare beneficiaries and reflect the agency's efforts to transform the healthcare delivery system through competition and innovation. These changes implement the Trump Administration's Executive Order on Protecting and Improving Medicare for Our Nation's Seniors, and will take effect on January 1, 2021.

"President Trump's term in office has been marked by an unrelenting drive to level the playing field and boost competition at every turn," said CMS Administrator Seema Verma. "Today's rule is no different. It allows doctors and patients to make decisions about the most appropriate site of care, based on what makes the most sense for the course of treatment and the patient without micromanagement from Washington"

In this final rule, CMS will begin eliminating the Inpatient Only (IPO) list of 1,700 procedures for which Medicare will only pay when performed in the hospital inpatient setting over a three-year transitional period, beginning with some 300 primarily musculoskeletal-related services. The IPO list will be completely phased out by CY 2024. This will make these procedures eligible to be paid by Medicare when furnished in the hospital outpatient setting when outpatient care is appropriate, as well as continuing to be payable when furnished in the hospital inpatient setting when inpatient care is appropriate, as determined by the physician. In the short term, as hospitals face surges in patients with complications from coronavirus disease 2019 (COVID-19), being able to provide treatment in outpatient settings will allow non-COVID-19 patients to get the care they need.

In addition to putting decisions on the best site of care in the hands of physicians, allowing more procedures to be done in an outpatient setting also provides for lower-cost options that benefit the patient. For example, thromboendarterectomy (HCPCS code 35372) is a surgical procedure that removes chronic blood clots from the arteries in the lung. If this procedure is performed in an inpatient setting, a patient who has not had other health care expenses that year would have a deductible of about $1500. In contrast, the copayment for this procedure for the same patient in the outpatient setting would be about $1150. Patient safety and quality of care will be safeguarded by the doctor's assessment of the risk of a procedure or service to the individual beneficiary and their selection of the most appropriate setting of care based on this risk. This is in addition to state and local licensure requirements, accreditation requirements, hospital conditions of participation (CoPs), medical malpractice laws, and CMS quality and monitoring initiatives and programs.

Beginning January 1, 2021, we are adding eleven procedures to the ASC covered procedures list (CPL), including total hip arthroplasty (CPT 27130), under our standard review process. Additionally, we are revising the criteria we use to add surgical procedures to the ASC CPL, providing that certain criteria we used to add surgical procedures to the ASC CPL in the past will now be factors for physicians to consider in deciding whether a specific beneficiary should receive a covered surgical procedure in an ASC. Using our revised criteria, we are adding an additional 267 surgical procedures to the ASC CPL beginning January 1, 2021. Finally, we are adopting a notification process for surgical procedures the public believes can be added to the ASC CPL under the criteria we are retaining.

CMS is announcing that it will continue its policy of paying for 340B-acquired drugs at Average Sales Price (ASP) minus 22.5% after the July 31, 2020 decision of the Court of Appeals for the D.C. Circuit upholding the current policy. This policy lowers out-of-pocket drug costs for Medicare beneficiaries by letting them share in the discount that hospitals receive under the 340B program. Since this policy went into effect in 2018, Medicare beneficiaries have saved nearly $1 billion on drug costs, with expected Medicare beneficiary drug cost savings of over $300 million in CY 2021.

As part of the agency's Patients Over Paperwork Initiative, which is aimed at reducing burden for healthcare providers, CMS is establishing a simple updated methodology to calculate the Overall Hospital Quality Star Rating (Overall Star Rating). The Overall Star Rating summarizes a variety of quality measures published on the Medicare.gov Care Compare tool (the successor to Hospital Compare) for common conditions that hospitals treat, such as heart attacks or pneumonia. Along with publicly reported data on Care Compare, the Overall Star Rating helps patients make better-informed healthcare decisions. Veterans Health Administration hospitals will be added to CMS' Care Compare, which will help veterans understand hospital quality within the VA system. Overall, these changes will reduce provider burden, improve the predictability of the star ratings, and make it easier for patients to compare ratings between similar hospitals.

In response to stakeholder feedback about the current methodology used to calculate the Overall Star Rating, CMS is not finalizing its proposal to stratify readmission measures under the new methodology based on dually eligible patients, but will continue to study the issue to find the best way to convey quality of care for this vulnerable population.

Finally, in order to address the ongoing public health emergency, CMS is finalizing a new requirement for the nation's 6,200 hospitals and critical access hospitals to report information about their inventory of therapeutics to treat COVID-19. This reporting will provide the information needed to track and accurately allocate therapeutics to the hospitals that need additional inventory to care for patients and meet surge needs.

For a fact sheet on the Calendar Year (CY) 2021 OPPS/ASC Payment System final rule (CMS-1736-F), please visit: https://www.cms.gov/newsroom/fact-sheets/cy-2021-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0

The proposed rule can be downloaded at: https://www.cms.gov/files/document/12220-opps-final-rule-cms-1736-fc.pdf
 

Tiger100

2+ Year Member
Mar 11, 2017
226
201
Status (Visible)
  1. Attending Physician
For example, what is stopping an IR doc from say opening a clinic; maybe contracting with a hospital, then doing some clinical management of patients along with outpatient IR procedures? Of course, this means IR docs have to possibly separate contracts from the DR folks. And, I have heard this is happening more across the country.

The answer to your question: Nothing. They can do it IF they are geographically flexible.

Otherwise simply put, there is not enough business for all IRs to do so in a certain geographic location. In other words, may be a fraction of IRs can do that. But the majority are going to work in the hospital setting or as a part of DR group.

Ask yourself another question: What is stopping an IC or VS doc from say opening a clinic and ...? the answer is the same: Nothing.
But in practice about half of VS or IC are hospital employees. Simply put, they can not all do it. Otherwise, they should be stupid to be on call every other night or so.

Also never ever take the power of hospital systems for granted. In some markets like most of Northeast, Big cities in Texas and Ohio true private practice is almost gone across the board. There is no room for most fields to open their own practice.

I don't know your level of training. But when you want to get a job especially in big and mid size cities, the market forces are not in your favor. Most doctors want to work in big and mid size cities and the market forces won't let you CHOOSE the way you want to practice.

My 2 cents.
 
  • Like
Reactions: 1 users
About the Ads

NDcienporciento100

2+ Year Member
Feb 3, 2019
325
139
This is becoming more and more commonplace as the hospital is becoming too expensive and CMS is looking for alternative sites.IR is prime for this as the bulk of what we do can be discharged same day.



Outpatient Prospective Payment System and Ambulatory Surgical Center final rule empowers beneficiary choices and unleashes competition to lower costs and improve innovation

Today, the Centers for Medicare & Medicaid Services (CMS) is finalizing policy changes that will give Medicare patients and their doctors greater choices to get care at a lower cost in an outpatient setting. The Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rules will increase value for Medicare beneficiaries and reflect the agency's efforts to transform the healthcare delivery system through competition and innovation. These changes implement the Trump Administration's Executive Order on Protecting and Improving Medicare for Our Nation's Seniors, and will take effect on January 1, 2021.

"President Trump's term in office has been marked by an unrelenting drive to level the playing field and boost competition at every turn," said CMS Administrator Seema Verma. "Today's rule is no different. It allows doctors and patients to make decisions about the most appropriate site of care, based on what makes the most sense for the course of treatment and the patient without micromanagement from Washington"

In this final rule, CMS will begin eliminating the Inpatient Only (IPO) list of 1,700 procedures for which Medicare will only pay when performed in the hospital inpatient setting over a three-year transitional period, beginning with some 300 primarily musculoskeletal-related services. The IPO list will be completely phased out by CY 2024. This will make these procedures eligible to be paid by Medicare when furnished in the hospital outpatient setting when outpatient care is appropriate, as well as continuing to be payable when furnished in the hospital inpatient setting when inpatient care is appropriate, as determined by the physician. In the short term, as hospitals face surges in patients with complications from coronavirus disease 2019 (COVID-19), being able to provide treatment in outpatient settings will allow non-COVID-19 patients to get the care they need.

In addition to putting decisions on the best site of care in the hands of physicians, allowing more procedures to be done in an outpatient setting also provides for lower-cost options that benefit the patient. For example, thromboendarterectomy (HCPCS code 35372) is a surgical procedure that removes chronic blood clots from the arteries in the lung. If this procedure is performed in an inpatient setting, a patient who has not had other health care expenses that year would have a deductible of about $1500. In contrast, the copayment for this procedure for the same patient in the outpatient setting would be about $1150. Patient safety and quality of care will be safeguarded by the doctor's assessment of the risk of a procedure or service to the individual beneficiary and their selection of the most appropriate setting of care based on this risk. This is in addition to state and local licensure requirements, accreditation requirements, hospital conditions of participation (CoPs), medical malpractice laws, and CMS quality and monitoring initiatives and programs.

Beginning January 1, 2021, we are adding eleven procedures to the ASC covered procedures list (CPL), including total hip arthroplasty (CPT 27130), under our standard review process. Additionally, we are revising the criteria we use to add surgical procedures to the ASC CPL, providing that certain criteria we used to add surgical procedures to the ASC CPL in the past will now be factors for physicians to consider in deciding whether a specific beneficiary should receive a covered surgical procedure in an ASC. Using our revised criteria, we are adding an additional 267 surgical procedures to the ASC CPL beginning January 1, 2021. Finally, we are adopting a notification process for surgical procedures the public believes can be added to the ASC CPL under the criteria we are retaining.

CMS is announcing that it will continue its policy of paying for 340B-acquired drugs at Average Sales Price (ASP) minus 22.5% after the July 31, 2020 decision of the Court of Appeals for the D.C. Circuit upholding the current policy. This policy lowers out-of-pocket drug costs for Medicare beneficiaries by letting them share in the discount that hospitals receive under the 340B program. Since this policy went into effect in 2018, Medicare beneficiaries have saved nearly $1 billion on drug costs, with expected Medicare beneficiary drug cost savings of over $300 million in CY 2021.

As part of the agency's Patients Over Paperwork Initiative, which is aimed at reducing burden for healthcare providers, CMS is establishing a simple updated methodology to calculate the Overall Hospital Quality Star Rating (Overall Star Rating). The Overall Star Rating summarizes a variety of quality measures published on the Medicare.gov Care Compare tool (the successor to Hospital Compare) for common conditions that hospitals treat, such as heart attacks or pneumonia. Along with publicly reported data on Care Compare, the Overall Star Rating helps patients make better-informed healthcare decisions. Veterans Health Administration hospitals will be added to CMS' Care Compare, which will help veterans understand hospital quality within the VA system. Overall, these changes will reduce provider burden, improve the predictability of the star ratings, and make it easier for patients to compare ratings between similar hospitals.

In response to stakeholder feedback about the current methodology used to calculate the Overall Star Rating, CMS is not finalizing its proposal to stratify readmission measures under the new methodology based on dually eligible patients, but will continue to study the issue to find the best way to convey quality of care for this vulnerable population.

Finally, in order to address the ongoing public health emergency, CMS is finalizing a new requirement for the nation's 6,200 hospitals and critical access hospitals to report information about their inventory of therapeutics to treat COVID-19. This reporting will provide the information needed to track and accurately allocate therapeutics to the hospitals that need additional inventory to care for patients and meet surge needs.

For a fact sheet on the Calendar Year (CY) 2021 OPPS/ASC Payment System final rule (CMS-1736-F), please visit: https://www.cms.gov/newsroom/fact-sheets/cy-2021-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center-0

The proposed rule can be downloaded at: https://www.cms.gov/files/document/12220-opps-final-rule-cms-1736-fc.pdf
I have a question.
when It comes to performing procedures how does pay work? Like when you are do a revascularization of an SFA lesion and you ballon a Stenoses then you decide this lesion would be best served by using Drug coated ballon. Who pays that cost, comes out of your payment, insurance pays it?
 
Dec 11, 2020
113
93
Status (Visible)
  1. Attending Physician
I have a question.
when It comes to performing procedures how does pay work? Like when you are do a revascularization of an SFA lesion and you ballon a Stenoses then you decide this lesion would be best served by using Drug coated ballon. Who pays that cost, comes out of your payment, insurance pays it?
Outpt labs charge a global. There is incentive to use more cost efficient equipments and devices.
 
Dec 11, 2020
113
93
Status (Visible)
  1. Attending Physician
The answer to your question: Nothing. They can do it IF they are geographically flexible.

Otherwise simply put, there is not enough business for all IRs to do so in a certain geographic location. In other words, may be a fraction of IRs can do that. But the majority are going to work in the hospital setting or as a part of DR group.

Ask yourself another question: What is stopping an IC or VS doc from say opening a clinic and ...? the answer is the same: Nothing.
But in practice about half of VS or IC are hospital employees. Simply put, they can not all do it. Otherwise, they should be stupid to be on call every other night or so.

Also never ever take the power of hospital systems for granted. In some markets like most of Northeast, Big cities in Texas and Ohio true private practice is almost gone across the board. There is no room for most fields to open their own practice.

I don't know your level of training. But when you want to get a job especially in big and mid size cities, the market forces are not in your favor. Most doctors want to work in big and mid size cities and the market forces won't let you CHOOSE the way you want to practice.

My 2 cents.

this poster is correct. OBL jobs are considered unicorn jobs for many IRs.

a lot of famous IR end up getting into the OBL game after building their reputation first in academia or PP.

I heavily caution against new grad from joining OBL right after fellowship. IR has a big learning curve when you become staff and you wouldnt want that to happen while you work in an OBL where you cannot deal with complications as easily.
 

droliver

Moderator Emeritus
15+ Year Member
May 2, 2001
1,585
144
Status (Visible)
  1. Attending Physician
What kind of procedures are you imagining doing in an outpatient surgery setting not at a hospital? For a lot of procedures you need more immediate backup capability to do safely I’d assume.
 
Dec 11, 2020
113
93
Status (Visible)
  1. Attending Physician
What kind of procedures are you imagining doing in an outpatient surgery setting not at a hospital? For a lot of procedures you need more immediate backup capability to do safely I’d assume.

In an experienced hand IR procedures are exceedingly safe and we can mostly fix our own complications. I would say the most common outpatient procedures for IRs are PAD, cancer related procddures, dialysis and other access related procedure, fibroids, and varicose vein/venous congestion.
 

irwarrior

10+ Year Member
Oct 19, 2008
383
184
Status (Visible)
A growing amount of procedures are moving to same day or outpatient centers due to the ability to safely perform and discharge same day. This includes as previous poster stated (Dialysis, PAD, vein , EVLT, fibroids, prostates, TACE, even Y90, kyphoplasty, rhizotomy, pain, ESI etc). The hospital is becoming more and more challenging to get things done due to regulations (Joint commission), admitting, unionized labor force, inability to control your own schedule especially in joint labs (cardiology, Vascular surgery, VIR , neurointerventional etc). The outpatient center alleviates some of these frustrations. But , agree that most graduates may not have the experience to come out and be safe and comfortable in the OBL environment.
 
About the Ads

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.