PQRS MOC Incentive Program:

From ACEP:

The Patient Protection and Affordable Care Act (P.L. 111-148) authorized an additional reporting option under the Physician Quality Reporting System (PQRS) through which physicians may be eligible for an extra incentive payment for participating in a PQRS-approved Maintenance of Certification (MOC) Program. Physicians who elect this option and satisfy the reporting criteria are eligible to earn an incentive payment equal to 0.5% of their estimated total allowed charges for covered Medicare Part B services in 2012. This incentive may be earned in addition to the 0.5% incentive payment available for satisfying the standard PQRS reporting requirements, making physicians eligible for up to a 1.0% PQRS incentive payment in 2012.   Physicians cannot receive more than one additional MOC incentive even if they complete a MOC Program in more than one specialty.

The American Board of Emergency Medicine’s (ABEM) MOC program has been vetted and approved by the Centers for Medicare & Medicaid Services (CMS) for the MOC incentive program. To qualify for the PQRS MOC incentive, ABEM diplomates must meet the annual requirements of the ABEM MOC program, complete required activities, including practice improvement activities and a patient experience of care survey, and participate in the MOC program more frequently than is required to qualify for or maintain board certification status for the calendar year.  CMS permits each qualified MOC Program to define “more frequently” as it feels is appropriate. Participation in both the PQRS and PQRS MOC Program is voluntary and ABEM certification of those who choose not to participate in PQRS in 2012 will not be affected.

Link to the ABEM MOC site.

Sedation by Non-Anesthesia Providers in ASCs: Is It Appropriate?

From Becker’s:

The American College of Emergency Physicians has a different interpretation of the Conditions of Participation, however.  ACEP’s policy states that “”The Emergency Nurses Association and the American College of Emergency Physicians support the delivery of medications used for procedural sedation and analgesia by credentialed emergency nurses working under the direct supervision of an emergency physician. These agents include but are not limited to etomidate, propofol, ketamine, fentanyl, and midazolam.” The Interpretive Guidelines to the CoPs emphasize local flexibility and in their accompanying Frequently Asked Question provide that “A hospital could use multiple guidelines, for example, ACEP for sedation in the emergency department and ASA for anesthesia/sedation in surgical services, etc.” ACEP maintains that sedation with propofol — or with any other agent used by emergency physicians — is analgesia, not anesthesia or deep sedation, and that therefore:

When two or more physicians are readily available to the emergency department, we feel it is prudent to have both present during the sedation. However, because our procedures are brief and we are able to address any airway issues, when two physicians are not available, sedation can be performed initially by an emergency physician, and once stable sedation and adequate monitoring are established, the emergency nurse can monitor the patient while the physician performs the procedure

There is, then, disagreement between the ASA and several of the organizations representing other specialties as to who may provide anesthesia and deep sedation, particularly in connection with the use of propofol. There is no disagreement over the fact that providers must be credentialed, and that the hospital must adopt policies on anesthesia credentialing.