Anesthesia Managed Care Contract Rates Edge Upwards
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 the highest percentage of managed care business, the second highest, and the third, fourth and fifth highest percentages across all 871 valid responses. The average percentage of managed care business represented by Contract #1 is 20.4%, ranging down to 3.4% for Contract #5. Table 1 in the Newsletter article is a more complete version of the following:
| 2013 National Managed Care Anesthesia Conversion Factors | ||
|---|---|---|
| Contract #1 | All Contracts | |
| Mean | $70.33 | $71.69 |
| Median | $66.00 | $67.61 |
| High | $250.40 | $250.40 |
| Number of Responses |
223 | 871 |
The data are segmented by four geographic regions corresponding to the Medical Group Management Association’s state groupings: Eastern, Midwestern, Southern and Western. As has been true for the most CF factors, practices in the Eastern region reported the highest numbers, and Western practices reported the lowest:
| Eastern | Midwestern | Southern | Western | |
| Mean | $76.17 | $71.06 | $69.28 | $68.17 |
| Median | $72.00 | $65.31 | $65.93 | $64.00 |
High and low CFs, as well as 25th and 75th percentile values for the four regions, appear in Table 5 of the article. Response rates were not sufficient to allow publication of state-level data. There is an opportunity here that we hope will be taken up by some of the state societies of anesthesiology.
It is interesting to compare the regional CF differences with annual compensation. California and Hawaii reported the lowest averages, but the highest incomes in Medscape’s latest survey, based on 2012 data from nearly 22,000 physicians, came from the North Central States (for all specialties). In this survey, orthopedics, cardiology, radiology, gastroenterology and urology all reported higher average compensation than anesthesiology.
Source: Medscape, Anesthesiologist Compensation Report: 2013
ASA used regression analysis to determine the effect of geography, case volume, number of anesthesiologists and nurse anesthetists and payer percentage on CFs. Not surprisingly, practice size and location as well as the relative bargaining strength or weakness of the managed care payers play important roles. It is even more obvious that anesthesiologists practicing in the care team mode generate more anesthesia units than do their colleagues who personally perform their cases (17,396 vs. 9,714 units per FTE physician—subject to considerable variation between regions).
ASA fields the survey electronically every year, soliciting responses through email, committee listservs, newsletters and the website. Whether the responses are representative of the specialty is an open question, but the overall consistency of the survey results from year to year, since it was initiated in the mid-1990s, supplies a measure of credibility. We encourage every anesthesiologist to make sure that his or her group submits a response (only one!) when the survey comes out again next June.