As both colonoscopy rates and use of anesthesia during gastrointestinal endoscopies are projected to increase in the coming years, the overall cost of colonoscopy screening programs will be closely scrutinized by payers and policy makers. Liu, Waxman, Main and Mattke made the quoted prediction in their article Utilization of Anesthesia Services During Outpatient Endoscopies and Colonoscopies and Associated Spending in 2003-2009 (JAMA. 2012;307(11):1178-1184).  This study involved a retrospective analysis of claims data for a 5% representative sample of Medicare fee-for-service patients (1.1 million adults) and a sample of 5.5 million commercially insured patients during the six year period 2003-2009.  The authors determined that overall, the proportion of anesthesia services delivered to low-risk (ASA physical status 1 or 2) patients was more than two-thirds in the Medicare population, and more than three-quarters among the commercially insured population.  Over the six-year period, annual payments for anesthesia services among Medicare patients almost doubled in...

The latest court decision in the eight-year whistleblower litigation against Tuomey Healthcare System in Sumter, South Carolina, giving rise to perhaps the largest amount of damages—$276,767,260—ever awarded against a community hospital, provides an opportunity to review some Stark law.  The September 30 order and opinion from the federal district court also demonstrates some compliance strategies to be avoided, notably shopping around for the most obliging legal advice. Tuomey was faced, in 2003, with a new, competing ambulatory surgical center (ASC).  Fearing that it would lose cases to the ASC, the hospital entered into employment contracts with 19 surgeons and gastroenterologists.  The contracts contained the following terms: Part-time employment covering only outpatient procedures, which the physician was required to perform at Tuomey facilities; Initial salary based on the previous year’s collections; Productivity bonus of 80% of collections; Incentive bonus of up to 7% of productivity bonus; All malpractice premiums (not just for...

The most authoritative information on managed care (commercial) contract rates for anesthesia services has just been updated.  The ASA Survey Results for Commercial Fees Paid for Anesthesia Services -2013 appears in the October issue of the ASA Newsletter. The national average managed care contractual conversion factor (CF) was $71.69, based on valid responses from 223 practices in 44 states and Washington, D.C.  This represents a 5.52% difference over the comparable figure for 2012, $67.94. Because of the way the survey responses are leveraged and the data reported, however, we caution against assuming that contract increases have averaged more than five percent.  The “national average managed care contractual CF” is an average of averages.  The survey requests CFs for five of each group’s largest managed care contracts, along with the percentage of their commercially-insured patient population that each contract represents.  This permits ASA to report means and percentiles for the contracts representing...

This post was written by: Aman Mahajan, MD Chair, Department of Anesthesiology, University of California, Los Angeles, CA Jody Locke, CPC Vice President of Anesthesia and Pain Management Services, ABC Background It is often suggested that an anesthesiology department should have more complete and readily accessible data about the clinical care provided in the operating rooms and the delivery suite than any other department of the facility; but how often is this actually the case? Anesthesia providers review and document enormous amounts of clinical detail and critical events for every patient they see, but little of this information is actually captured in a way that allows for its logical indexing and retrieval. Most anesthesia groups and their billing services have been so focused on the data necessary to calculate a charge and generate a claim that they have virtually ignored what is potentially the most valuable of information of all. The...

The decisions that anesthesiologists and pain medicine specialists must make are more fundamental and consequential than ever as we enter the final months before implementation of Obamacare in January 2014. Adding staff, adding locations or even altering income distribution systems are easy decisions in comparison, especially since they lend themselves to well-defined quantitative analysis. Creating and selecting options that involve the very nature and identity of groups is much more challenging. Three of the articles in this issue of the Communiqué explore different aspects of the answer to the question, “How do we secure our future?” The broadest view and the most basic recommendations are to be found in Will Latham’s article Strengthening Your Anesthesiology Group. Mr. Latham proposes two steps groups can take to reduce the pervasive environmental uncertainty: strengthen group governance and, with a more predictable decision-making process in place, develop a group-endorsed strategic plan. From defining the group’s...