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Summer 2007


MGMA/ASA Anesthesia Cost Survey

Shena J. Scott, MBA, FACMPE
Immediate Past President, MGMA AAA and Executive Director, Brevard Anesthesia Services, PA, Melbourne, FL

Surveys, surveys, surveys…..how can they help you and how can they hurt you? As a wise person once said, “s/he who has the data rules” so you better be one of the people who has it. And you better also do your part to make it as representative as possible. The Medical Group Management Association (MGMA) Anesthesia Administration Assembly (AAA) and the American Society of Anesthesiologists (ASA) are committed to this mantra, which is why they have collaborated once again on the third annual 2006 Cost Survey for Anesthesiology Practices (based on 2005 data).

In the third version, participation has increased to 149 responses (129 usable) representing over 3400 doctors, or nearly ten percent (10%) of active ASA members. In addition, there were 64 responses (52 usable) to this year’s inaugural pain management survey, representing well over 100 pain management physicians. As participation has grown, information has been broken down into more tables. New in 2006 were both a separate set of academic tables within the anesthesiology section and a completely separate section of pain tables. Participation is key to not only ensuring the representation of the data but also in having sufficient responses to “slice and dice” it in enough ways to make it meaningful for respondents and others who would use it. With increased participation in the future, we hope to improve the number of columns within existing anesthesia tables, to add sections and tables in response to member needs, and to “grow” the pain management section.

The anesthesiology survey is divided into eleven different table groupings for each of seven different “sections” of anesthesiology practices. Within each section, tables are then broken into sub-sections (represented by columns within the table) for relevant breakpoints within that sub-section. MGMA has a policy that it will not report any statistic with less than ten (10) responses, which is why you will see some asterisks (*) populating some fields, indicating that there were insufficient responses in this sub-category to report this statistic (supporting the argument as to why increased participation allows the data to be “sliced and diced” more ways). The first number in a table indicates the “section” it represents and the numbers following the period represent the table number. Thus the data points you find in Table 1.4a should be the same data points you find in Table 5.4a (assuming there were sufficient responses to populate 5.4a), except that the group being represented in 1.4a is “all practices” responding and the group being represented in 5.4a is divided into columns based upon the staffing model of the practice.

The sections in the 2006 anesthesia cost survey book are as follows:

  1. All Practices
  2. 10 or Less FTE Physicians (small practices)
  3. 11 to 30 FTE Physicians (medium practices)
  4. 31 or more FTE Physicians (large practices)
  5. By Staffing Model — physician only, < 1 CRNA per FTE Physician (physician heavy care teams), and > 1 CRNA per FTE Physician (anesthetist heavy care teams)
  6. By Government Payer Mix (30% or less, 31 to 49%, 50% or greater)
  7. By Number of Trauma Centers
  8. Academic Only Practices

Within each section are several table groupings. Some of the important statistics you will on a per FTE physician basis are:

  • ASA units
  • Procedures
  • Charges
  • Revenue
  • Total operating cost, with and without non-physician practitioner (NPP) cost
  • NPP cost
  • Physician compensation cost
  • Physician benefit cost

You will also find many of the same statistics listed above as a percent of total medical, per anesthetizing location, per procedure type (e.g. surgical cases, labor epidurals, C-sections, other flat fees, etc.) and per ASA unit.

There is also a section revealing the number of groups who are receiving compensation from hospitals for the services they provide (often called a “stipend”) and the amount of compensation typically received. While numbers such as these can only be used as background, it is interesting to note the high percentage (57%) of groups who must now rely on such compensation in order to be able to recruit and retain providers in a marketplace that is unable to provide such compensation from more traditional sources, such as patients and third party payers. The median amount these groups report receiving from hospitals is over $1.2 MM, a fairly significant jump from the 2005 report.

In the new pain management section, you will find many of the same types of statistics broken down on a per physician and per procedure basis. From the report you will be able to discern a typical reimbursement for specific procedure types such as: new patient consults/visits; established patient visits; all other E&M visits; single shot epidurals; transforaminals; sympathetic blocks; facet joint nerve blocks; trigger point injections; nerve simulators/vertebranposty, and all other chronic pain procedures. You will also be able to understand the typical mix of consults versus procedures, staffing ratios, patients seen per day, and more.

In short, there is a wealth of information contained within these reports. Hospitals use it, managed care companies use it, and the government uses it. MGMA and ASA recognize this fact and have partnered together in an effort to provide the most comprehensive and representative sample they can for, and in representation of, anesthesiology and pain management practices. The validity of the data, and the ability to break it down into usable formats, depends on participation from all types of groups and practice styles across the country. In an effort to enhance participation, we will be moving to an “every other year” format after this year. MGMA is trying to encourage online submission in an effort to achieve a variety of goals, including: enhancing accuracy of data with built in edits, improving turnaround time, creating the ability to integrate data from this survey with data from other surveys (such as the Physician Compensation and Production Survey) down the road, and enhancing the ability to provide trending information to individual practices. Participants receive a free copy of the survey. Meanwhile, those who did not participate last year can purchase a copy of the 2006 version at a special affiliate price for ASAmembers by calling 1-877-ASK-MGMA or by visiting either www.mgma.com or the practice management section of the ASA website (www.asahq.org).