With the implementation of the AMA (American Medical Association) E/M (Evaluation and Management) documentation guidelines for office and outpatient visits in 2021 (and the pending 2023 E/M guideline changes for emergency department, inpatient, outpatient, nursing facility, and home/residence visits), there has been confusion about when to assign / capture a diagnosis code for E/M services.

Per the ICD-10-CM Section IV. Diagnostic Coding and Reporting Guidelines for Outpatient Services Guideline J, we should code all documented conditions that coexist:

Code all documented conditions that coexist at the time of the encounter/visit and that require or ...

(Based on the July 7, 2022 Proposed Rule)

Rate and Conversion Factors

With the budget neutrality adjustments and the required statutory update to the conversion factor for CY 2023 of 0% and the expiration of the 3% increase in PFS payments for CY 2022, the proposed CY 2023 PFS conversion factor is $33.08, a decrease of $1.53 (4.4%) to the CY 2022 PFS conversion factor of $34.61.

Updated Medicare Economic Index (MEI) for CY 2023

CMS is proposing to rebase and revise the MEI cost share weights for CY 2023 as well ...

Today’s vendor technology is no longer siloed into a specific classification. For example, an ALIF (anterior lumbar interbody fusion) device used to be just an ALIF.  Today, that same ALIF can be used as a spacer, lumbar stand-alone assembly, or an ALIF with buttress assembly.

Assigning pricing to the assembled device is a challenge as vendor’s will typically request a much higher price than average for ALIFs that can be used as assemblies.

Where do you start?

Review your current pricing.

• If you don’t have construct/component pricing, calculate your average cost for an ALIF ...

Today’s vendors now offer specific implant technology that can no longer be categorized into a single specific implant classification. For example, a cervical spacer used to be just a cervical spacer. Today, that cervical spacer may be cleared for use by the FDA and classified as either a:

• Cervical Spacer or Cage (requiring supplemental fixation)
• Cervical Stand-Alone Device – Cage

The two constructs above should have the same price; however, the cervical stand-alone assembly (Cage + Plate + Screws) pricing will be higher.  Ergo, negotiating contracts and pricing for complex implants such as these can be challenging.

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Engaging surgeons to assist in contracting for their implants has long been a challenge for most hospitals. Historical feedback from surgeons ranges from “it’s not my problem” to “I’ll just take may cases across the street if I cannot use my vendor of choice.”   Presently, organizations may now offer surgeons co-management, value-based, and gainsharing arrangements, as well as other forms of contractual alignments with hospitals. These new business models have proven useful in bringing better balance to the surgeon-hospital relationships vs the traditional surgeon-vendor relationship.

So, how do you engage your surgeons?

Prior to meeting with ...

The Pinnacle Real Estate Group consists of a combination of professionals who use their extensive experience in both valuation and transaction services within the healthcare real estate industry to guide clients through multiple types of arrangements in a time-efficient and cost-effective manner.

This Newsletter covers recent activity and conditions specifically impacting the national healthcare real estate market and those who are learning how to succeed in it.  The Pinnacle Real Estate Group has compiled the following current market information from sources such as CoStar, CBRE, and HREI.

Healthcare Real Estate Transactions

Amazon’s Latest Deal Marks ...