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Understanding Payment Reductions in Academic Anesthesia

Explore the impact of Medicare teaching reductions on academic anesthesia payments, strategies for reversing the rule, and the complexities of CRNA teaching regulations. Learn about payment rule impacts and negotiation approaches in this informative text.

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Understanding Payment Reductions in Academic Anesthesia

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  1. Payment Reductions in Academic Anesthesia Alexander A. Hannenberg, M.D. Chair, ASA Committee on Economics Newton-Wellesley Hospital Tufts University School of Medicine Newton, MA

  2. Medicare Teaching Reductions • Part of 1992 Medicare Fee Schedule Rule • Coincided with 29 % Conversion Factor Reduction • ASA : Delay Implementation • January 1994 • Elimination of AE Claims Modifier • 1:1 Resident Cases Considered = “Personal Administration” • 2:1 Resident Cases = “Medical Direction” • Payment Duplicates GME

  3. Medicare Impact Estimate

  4. Medicare Impact Calculations • $17,430 Lost Revenue / Resident • 3,000 Residents – O.R. Duty • $52 Million Annually • 3.6 % of $1.5 Billion Medicare Anesthesia $$

  5. Medicare Strategic Options • Reverse 1994 Rule • $ 52 Million: New Funding or All-Physician Pool Redistribution • Anesthesia Conversion Factor Budget Neutrality • 3.6 % or 60 ¢ per unit reduction for all anesthesiologists • MD vs CRNA Conversion Factor Disparity • Unsupported Residents • Regulatory Recognition • Exclusion from Teaching Payment Rules • Cost: ? Fraction of $ 52 Million • CRNA Teaching Rule Parity • Cost ????????

  6. Teaching CRNA Regulations • Full Base Units: Up to 2 Concurrent Procedures • “Face to Face” Time Units • Documentation • Faculty Present Throughout Pre/Post Anesthesia Service MCM §16003 J. 8/29/02

  7. Impact of CRNA Teaching Rule • Extent of Concurrency • Scheduling • Turnover Time • % Documented Faculty Face-to-Face Time

  8. Concurrency & Payment Impact Case 1 • 100 % Concurrent • Faculty 100% Face-to-Face + 40 % Case 2

  9. Concurrency & Payment Impact Case 1 • 100 % Concurrent • Faculty 100% Face-to-Face + 40 % Case 2 • 10 % Concurrent • Faculty 100% Face-to-Face Case 1 + 95 % Case 2

  10. Concurrency & Payment Impact Case 1 • 100 % Concurrent • Faculty 100% Face-to-Face + 40 % Case 2 • 10 % Concurrent • Faculty 100% Face-to-Face Case 1 + 95 % Case 2 Case 2 Case 1 • 80 % Concurrent • Faculty 75% Face-to-Face + 40 % Case 4 Case 3

  11. Payment Rule ImpactMedicare v Private

  12. Private Adoption of Medicare Rules • Active Cost-Savings Strategy • Adoption of Medicare Claims Modifiers • Modifiers will be HIPAA Standard Set • Use Not Required by HIPAA

  13. Medicare Payment Modifiers

  14. Implementing Victory • Modifier-Free Claims • HIPAA Compatible • Special Modifier Instructions • HIPAA Conflict • Restoration of AE Modifier • ASA Request to CMS

  15. Approaches to Negotiation • Analytical • Re: AMC Case Rate Differential • Political • AMC Negotiating Power Key: Institutional Awareness &Commitment

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