Now It’s Your Turn: Anesthesia Groups Speak Out on COVID

SUMMARY: 

The coronavirus (COVID) crisis currently assailing the citizens of the United States is not uniform in its coverage or consistent in its severity. While it is true that every state has reported residents with the ailment, some regions and cities are being hit harder than others. Only last Mondaydid Wyoming see its first fatality from the virus, while the disease has been ravaging cities like New York and New Orleans for weeks. It stands to reason then that anesthesia providers across the country are perhaps experiencing different repercussions in their practices that may result from varying levels of COVID cases in these locations.

The coronavirus (COVID) crisis currently assailing the citizens of the United States is not uniform in its coverage or consistent in its severity. While it is true that every state has reported residents with the ailment, some regions and cities are being hit harder than others. Only last Mondaydid Wyoming see its first fatality from the virus, while the disease has been ravaging cities like New York and New Orleans for weeks. It stands to reason then that anesthesia providers across the country are perhaps experiencing different repercussions in their practices that may result from varying levels of COVID cases in these locations.

A few days ago, we decided to gauge the extent to which anesthesia is being impacted by the current situation. We sent out a survey with 9 questions and received responses from 148 clients. While some clients did not choose to answer all of the questions, we received enough data to get a pretty good glimpse into what many of our readers are experiencing out there on the front lines of this national emergency. Now that the results are in, we felt it might be helpful to allow you to see what your fellow anesthesia providers are saying about the way in which COVID is affecting their practices. With that in mind, we now present the results of the survey.

The Survey Says!

The first three questions in our survey dealt with emergency intubations, with Q1 asking if the provider is being requested to perform more of these procedures. The results were as follows:

• *No – 29.9 percent
• *Somewhat More – 36.3 percent
• *Considerably More – 24.2 percent
• *Unknown as Yet – 9.5 percent

Based on the above, over 60 percent of those responding have seen an increase in the number of emergency intubation requests within their practice during the national health emergency (NHE). The next question in the survey asked if these intubations were taking longer than usual. Our clients responded as follows:

• *Yes – 19.2 percent
• *No – 16 percent
• *Not Sure – 15.3 percent

As a follow-up within Q2, clients were asked, "if "yes," is the extra time due to "prep before and disrobing after?" A substantial 49.3 percent responded in the affirmative. If you add this number to those above, you essentially reach 100 percent. Accordingly, this may be indicating that nearly 70 percent of our clients are seeing prolonged intubations, with a large percentage indicating the extended length was due to personal protective equipment (PPE) issues. This may be why 76.8 percent agreed that use of the -22 modifier was justified in these cases, in response to Q3 of the survey. You may recall that last week's alert addressed the potential use of this modifier for cases that involved substantially more time, effort or difficulty than normal.

The next two questions in the survey centered on extra time in the OR relative to anesthetic cases. The first of these, Q4, asked: "Do you find that even routine anesthetics on COVID-19 patients are taking considerably longer?" With 147 clients responding, a whopping 67.5 percent said "yes." Only 10.8 percent said "no," with 21.6 percent being unsure. The participants were then asked in Q5 to estimate the extra time their anesthesia cases were taking due to the presence of a COVID patient. Here is the breakdown as our clients see it:

• *0 to 10 Minutes 8.2 percent
• *10 to 20 Minutes 22.1 percent
• *20 to 30 Minutes 41.4 percent
• *Not Sure 24.2 percent

This means that over 71 percent of respondents are spending more time on COVID anesthetic cases than non-COVID anesthetics.

The next four questions in the survey dealt specifically with critical care or ICU issues. When asked whether or not the provider was being requested to cover ICU services (to include vent management or critical care), the response to Q6 was evenly represented, with 50 percent indicating "yes" and 50 percent saying "no." For Q7, participants were asked if the hospital had offered to pay them for ICU coverage. Only 31.1 percent answered in the affirmative. Question 8 was worded like this: "Is the hospital allowing you to bill for these services in addition to paying you for coverage?" Some 58 percent said "no." The last question in this category concerned CRNA coverage of ICU services. While 38.3 percent indicated that they were indeed using CRNAs to cover these services, 61.6 responded that they were not.

Analysis That's Actionable

So, what do these numbers tell us and what do they mean in terms of resource deployment and financial planning? One of the takeaways is that a majority of anesthesia providers are performing greater numbers of emergency intubations and that, for many, greater time is involved due to PPE and sterile disrobing. This means that a significant number of our clients may be able to reap more in reimbursement per intubation due to meeting the threshold of the -22 modifier. As we stated last week, documentation of your increased time and effort will be critical to realizing greater payment for these cases. Similarly, where significantly greater time and effort is spent on

an anesthesia case to gear up and properly gear down due to a COVID patient, you will want to document those circumstances on the medical record that the billing office receives, to include how many extra minutes were spent in such efforts and whether or not these minute fell within or without the anesthesia start and stop times.

When it comes to requests for your assistance in the management of COVID patients--especially those needing intubations or management in the ICU--you should have a conversation with you hospital's administration. What is the anticipated volume and what are the specific services your team is being asked to provide? Will the group be provided financial support for such coverage? Whether the facility is forthcoming with this kind of support or not, the group can certainly obtain payment for critical care and other stand-alone services (e.g., vent management, emergency intubation, invasive lines). You will need to document these services according to the instructions outlined in our recent alert on critical care and ensure that this documentation is received by the billing office.

While the survey results are interesting and certainly revealing, we must not forget that they represent a divergent group of providers from across the COVID landscape, where some are in the thick of it and some are on the outskirts. Each group, depending on where they are in this landscape, will need to adapt as needed to the progression or regression of the outbreak in their area. Yes, it's hard to plan for what you can't see. However, we are here with you regardless of what lies ahead. Reach out to your account executive or email us at info@anesthesiallc.com if you have questions. We are dedicated to working with you to resolve uncertainties and promote stability.

With best wishes,

Tony Mira
President and CEO