Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/568943
1 5 2 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2 0 1 5 A N E S T H E S I A A L E R T At what point do patients emerge from anesthesia? The somewhat ambiguous answer to that question recently helped save a large anesthesia group from what might have been a very costly legal decision. The crux of a False Claims Act brought by a former employee and joined by the federal government was the asser- tion that Anesthesia Associates of Kansas City (Mo.) (AAKC) had defrauded Medicare by consistently billing at the "Medical Direction" rate, rather than at the lower "Medical Supervision" rate. The allegation hinged on the fact that AAKC's anesthesiologists, who typically rotated among up to 4 operating rooms at the same time, were rarely in ORs when procedures were completed and patients were transferred to recovery. Instead, AAKC assigned a CRNA to each patient and the CRNAs typically transferred the patients to recovery, where anesthesiologists checked on them later. The key: To qualify for the Medical Direction rate, anesthesiologists directing CRNAs have to satisfy 7 condi- tions, including "personally (participating) in the most demanding aspects of the anesthesia plan, including, if applicable, induction and emergence." If anesthesiologists aren't present when procedures are completed and patients are taken out of the OR, the former employee argued, then they aren't present for "emergence," at least as its meaning is widely understood and accepted in the med- ical community. AAKC countered that emergence is a process. It begins in the OR, they said, but it extends into recovery, and different patients emerge from anesthesia at different rates. By checking on patients in recovery, it argued, its anesthesiologists satisfied DEFINING MOMENT Anesthesia Group Escapes Judgment in Emergence Case z IS EMERGENCE A PROCESS? A whistleblower suit brought under the False Claims Act centered on anesthesia billing and when patients emerge from anesthesia.