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Should Anesthesiology Enter the RBRVS? Implications for Academé

Should Anesthesiology Enter the RBRVS? Implications for Academé. Lydia A. Conlay, M.D., Ph.D., M.B.A. Professor and Chairman Department of Anesthesiology. C M S. See - A - Mess. Should Anesthesiology Enter the RBRVS?. Potential benefits to Academ é

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Should Anesthesiology Enter the RBRVS? Implications for Academé

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  1. Should Anesthesiology Enter the RBRVS?Implications for Academé Lydia A. Conlay, M.D., Ph.D., M.B.A. Professor and Chairman Department of Anesthesiology

  2. C M S See - A - Mess

  3. Should Anesthesiology Enter the RBRVS? • Potential benefits to Academé • Potential benefits to the specialty independent of Medicare • Winners and Losers

  4. Medicare (and Medicaid) Disproportionately Represented in Academic Practice 34% Medicare 40% Medicare 8% Medicaid 20% Medicaid 56% Private 40% Private Academic Practice Tremper et. al. Anesth & Analg 96:432,2003 Private Practice 2004 MGMA Cost Report (2003 data)

  5. Potential Benefits for Academé • Improving Conversion Factor • Expanding the ASA code set • Emphasizing pre-operative and post-operative care

  6. Standard Conversion Factor Anesthesia Conversion Factor $18.23 Benefits for Academé:Improving the Conversion Factor $37.55

  7. Standard Conversion Factor Anesthesia Conversion Factor $18.23 Benefits for Academé:Improving the Conversion Factor $37.55

  8. Good News / Bad News :The Conversion Factor • Paid at Medicare CF of $37 per RVU • Other payors would likely adopt same conversion factor (x 1.25 or 1.3, etc.) • Implications for private practice

  9. Potential Benefits to Academé:Expanding the Code Set • ≈ 250 codes in ASA Relative Value Guide • >5,000 surgical CPT codes • Each ASA code represents many CPT codes • Procedures bundled in each ASA code

  10. ASA Code 00179 – Upper Abdominal Procedures • Incisional hernia repair • Gastrostomy (temporary) • Closure of GI-tube • Biopsy of stomach • Bile duct stone extraction • Lap chole • Gastric bypass • Esophagogastric fundoplasty (Nissen, Hill) • Leveen shunt • Pancreatico-jejunostomy • Removal of pancreatic allograft • Intestinal allotransplantation

  11. “Building Block” Methodology + = RVU Service A RVU Service B RVU Total For Anesthesiology: + + = RVU E & M E & M Pre-operative Intraoperative Postoperative Time Complexity

  12. Do We REALLY HAVE TO GIVE UP TIME? • Precedents for increments of time in other CPT Codes • “Building” a RVU RVU (CPT) (average time) ? Incremental time Pre-operative RVU total Post -operative + + + =

  13. Medicare (and Medicaid) More complex Pre & Post-op Contracts > ($37 x 1.3) = $48/ unit Less complex Longer cases WINNERS LOSERS

  14. Conclusions: • Methods to “Build” a reimbursement system c/w the RBRVS • Advantages to Specialty over and above Medicare • Expanding Code Set • Valuing pre- + post- operative care • Ways to keep Time in some form • Adoption of standard Conversion Factor by other payors remains to be solved

  15. Population, millions Figure 4. Aging trend of US population

  16. Anesthesiology and RBRVS • The longer we wait, the deeper the hole • The deeper the hole, the more costly to fix • The more costly, the more difficult

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