Other articles in Summer 2006
Second Annual MGMA/ASA Cost Survey For Anesthesia Practices Released
Shena J. Scott, MBA, FACMPE
Immediate Past President, Medical Group Management Association Anesthesia Administration
We are pleased to announce the recent publication of the MGMA Cost Survey for Anesthesia Practices: 2005 Report Based on 2004 Data, conducted in conjunction with the American Society of Anesthesiologists (ASA). In response to input from ASA members on the survey committee and feedback received following the publication of last year's inaugural survey, this year's report has expanded certain sections to more easily benchmark different practice sizes and styles (compare "apples" to "apples") and has added several new items, such as a comparison of malpractice premiums and limits.
MGMA AAA members joke that comparing "apples" to "apples" is somewhat of an oxymoron in reference to anesthesia practices. If you have seen one anesthesia practice, you have seen one anesthesia practice; if you have seen ten anesthesia practices, you have seen ten and chances are there was little about them that was the same. With differences in each practice, finding common ground for benchmarking is challenging at best. There are many variables that must be taken into account - private versus academic practice (more on this later); staffing model; payer mix; case mix; trauma versus no trauma; group size; hospital size; patient population; pain versus no pain; critical care versus no critical care; the list goes on. One of the difficulties in constructing survey instruments is devising a questionnaire that asks enough questions to allow the data to be "sliced and diced" in enough meaningful ways but not to make the process too cumbersome so as to discourage participation. Participation is critical to providing meaningful survey data.
The survey team was pleased with the participation and the number of ways we were able to separate the data for 2005. Usable responses were up 13% from the 2004 survey. The booklet has six different sections of tables for anesthesiology practices: all practices, small (less than 10 physician) practices; medium (11-30 physicians) practices; large (31 or more physicians) practices; by staffing model (physician only, less than one anesthetist per physician, and more than one anesthetist per physician); by level of government payer mix (30% or less, 31- 49%, 50% or more); and number of trauma centers (none versus one or more). There is also a separate section for anesthesia practices with pain management, which will be addressed later in this article.
Each section contains up to 29 different tables (depending on the distribution of responses). MGMA guidelines do not allow publication of data with less than ten responses. As such, some tables could not be populated. Hopefully, greater participation in the future will solve this problem. In addition to the ever-popular stipend data, these tables include staffing, cost and financial data on an aggregate basis, per physician, as a percent of medical revenue, per case, per ASA unit, per facility and, newly added this year, per anesthetizing location. The survey team is especially excited about this latest addition because we believe it can mitigate some of the variables relating to staffing model.
Staffing model permeates so many aspects of an anesthesia practice that it can be difficult to make comparisons without taking note of its impact at every juncture. For example, one of the "key findings" listed in the front section of the report is that the number of physician units per physician varies by practice size, with the smallest practices indicating the highest number (13,577) and the medium (10,198) and larger (10,143) practices significantly lower. A closer examination reveals that the staffing models for the three groups are significantly different. The respondents in the small group section had a median of 6.27 FTE physicians and 9.39 anesthetists ("anesthetist heavy"), while the medium group has a relatively equivalent distribution of provider types with a median of 19.38 FTE physicians and 17.5 anesthetists. The respondents in the large practice group reflected a median of 40 FTE physicians and 17 anesthetists ("physician heavy"). Is this a reflection of a trend by practice size or simply the particular respondents who participated in this year's survey? Although the answer is not necessarily clear, what is clear is the way it will muddy the waters when attempting to make comparisons by group size.
The addition of statistics by anesthetizing location was an effort to cut through some of these problems and provide general benchmarks which are not impacted by staffing model. Among other things, this year's survey includes data for expected number of units, and revenue, per anesthetizing location. This data should provide a meaningful way for people to compare the productivity of their practices against a norm. For example, while revenue per unit comparisons can indicate how a poor payer mix at a facility is hurting your practice, it cannot address utilization or efficiency issues. While the survey does include questions about utilization, last year's responses indicated that many people seemed to be approximating these numbers rather than providing actual data. Some members of the survey committee have been active in working with key software vendors to provide reports that will allow this data to be accurately tracked and we are hopeful that we will soon be able to report actual utilization statistics, rather than estimates. In the meantime, looking at units per anesthetizing location should provide a measure of how the efficiency of the practice or facility compares with others. Revenue per anesthetizing location will capture all of these factors and reveal where a facility might be excelling or falling short in terms of all factors, including payer mix and operating room efficiency.
Two focus areas for improving next year's survey are academic practices and pain management. The survey committee was disappointed that, once again, only nine (9) academic practices participated. As explained earlier, this precluded the survey team from being able to provide a separate set of tables for academic practices. Since academic practices are so inherently different than private practices, the decision was made simply not to include the data for these nine practices, even in the "all practices" section. We have enlisted some academic leaders to help encourage participation and are most hopeful that the "third time will be the charm" and that we will be able to include separate academic tables in the 2006 report.
The other area of focus for 2006 is pain management. Although the 2005 survey does include a set of tables for anesthesiology practices with pain management (divided into columns by percent of pain management cases in the total case mix - less than 10% and 10% or greater), the problem is that the volume of anesthesiology cases relative to pain management cases is so great in most practices that it is difficult to discern meaningful differences. The pain management numbers are often lost amidst the anesthesia numbers. As such, the committee believes that the best way to expand this critical area of the survey will be to put together a separate pain management section in the anesthesia survey and have integrated practices provide separate sets of anesthesiology and pain management data. This change will allow practices to look at pure anesthesiology and pure pain management data to benchmark themselves against appropriate norms.
In summary, the more participation we are able to garner in these survey instruments, the more meaningful the data becomes. Survey data is critical to all of us as we conduct our day to day businesses. Greater participation means more opportunities to "slice and dice" the data. As such, we encourage you to become familiar with the survey instruments and structure the financials of your practice in a way that makes it easy for you to participate. Please talk to your administrator, practice management advisor or billing company about participating in the survey on your behalf. Participants in the survey receive a free copy, so if you have not done so in the past, please plan to participate in the future. MGMA members will receive a copy in the mail. ASA members will have a link through their website to the MGMA website where you can download a pdf format or complete the survey online. Please plan to help your practice, your colleagues and your specialty by participating in this important project.