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Threats to Our Prosperity. Alexander A. Hannenberg, M.D. First Vice President American Society of Anesthesiologists Tufts University School of Medicine Newton-Wellesley Hospital Newton, MA. Median Compensation for Selected Medical Specialties. Woo B. N Engl J Med 2006;355:864-866.

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Threats to our prosperity

Threats to Our Prosperity

Alexander A. Hannenberg, M.D.

First Vice President

American Society of Anesthesiologists

Tufts University School of Medicine

Newton-Wellesley Hospital

Newton, MA


Median compensation for selected medical specialties
Median Compensation for Selected Medical Specialties

Woo B. N Engl J Med 2006;355:864-866


Areas of concern
Areas of Concern

  • Demographics

  • Recalibrated Hospital DRG Payments

  • Rapid Growth Anesthesia Services

  • Shift to Quality-Based Payment


Unprecedented lift in anesthesia work value
Unprecedented Lift in Anesthesia Work Value

$16.19$55.00 = 29.4%

2008 Best Case Scenario

$20.19$55.00 = 36.7%


Medicare eligible population growth

Sources: Projections of the Population by Age are taken from the January 2004 Census Internet Release. Historical data are taken from "65+ in the United States," Current Population Reports, Special Studies, P23-190 Data for 2000 are from the 2000 Census and 2002 data are taken from the Census estimates for 2002.)

Medicare Eligible Population Growth

millions


Dependency on hospital support academic anesthesia departments
Dependency on Hospital SupportAcademic Anesthesia Departments

Tremper KK et al Anesth Analg 2006;102:517–23


Shifting profit from surgery to medicine
Shifting Profit from Surgery to Medicine?

Margin

Utilization

Rebasing Medicare DRGS (Healthcare Advisory Board)

Cost


Drg adjustments 2007 ipps
DRG Adjustments2007 IPPS



Specialty supply demand residency enrollment 1999 2007
Specialty Supply & DemandResidency Enrollment 1999-2007

JAMA 9/6/2000; 9/5/2007


Crna workforce 1989 2005
CRNA Workforce1989-2005

Grogono 2004




Responses to rapid growth
Responses to Rapid Growth

  • Medical Necessity Requirements

  • Payment Reduction

    • Less Complex Typical Patient / Service

    • Advanced Technology / Pharmacology

  • Non-Coverage Determination

  • Service-Specific SGR Calculation

    •  Volume  Annual Update



Anesthesia for all endoscopy
Anesthesia for All Endoscopy

-2002 Endoscopy volume per CDC

-Anesthesia Fee = 5 Base + 3.74 Time Units

Medicare CF $17.76

Non Medicare CF $50


Aetna may 2006
Aetna: May 2006

CANCELLED

ASA 1-2: No payment in office setting

ASA 1-2: Payment at Sedation Service fee in facility

ASA 3-4: Base+Time Methodology

All: Manual Submission & Review


Shift to quality based payment
Shift to Quality-Based Payment

  • Medicare PQRI 2008: $1.35 Billion

  • California IHA: $55 Million --> 200 groups

  • Massachusetts BCBS: $190 Million

  • Medicaid: 43/50 Programs


Opportunities for p4p revenue
Opportunities for P4P Revenue

  • 1 of 74 PQRI Measures available to anesthesiologists

  • 2008: 140 Measures

    • 2 Measures for OR Practice

    • 2 Measures for ICU Practice



Anesthesiology medicare commercial ratio 2007 update
Anesthesiology Medicare:Commercial Ratio2007 Update

$16.19$55.00 = 29.4%

Bierstein K ASA Newsletter Jul07


Medicare payment increase
Medicare Payment Increase

  • RUC Recommended 32% Work Value Increase

  • Work = 77.2% of Anesthesia CF

  • Maximum Impact --> $4.00 Increase (2008)

    • 32% x 0.772 x $16.19

    • $16.19 --> $20.19

  • Other Factors

    • Budget Neutrality ($0.33)

    • Practice Expense ($0.19)

    • SGR Reduction ($1.95)

  • Expected Range: $20.19 - $17.72


American society for gastrointestinal endoscopy
American Society for Gastrointestinal Endoscopy

Guidelines for the use of deep sedation and anesthesia for GI endoscopy

“The routine assistance of an anesthesiologist for average risk patients undergoing standard upper and lower endoscopic procedures is not warranted and is cost prohibitive.”

Gastrointest Endoscopy 56:613, 2002







Incentive explosion blue cross blue shield of massachusetts
Incentive ExplosionBlue Cross Blue Shield of Massachusetts

Boston Globe 5/10/06


Fee increases for quality incentives
Fee Increases for Quality Incentives

Blue Cross Blue Shield Massachusetts 5/29/06



Variation anesthesia for gi endoscopy

2%

40%

Variation: Anesthesia for GI Endoscopy

Anthem-Wellpoint 2004