CAER-Anesthesia and Reimbursement Commission on Anesthesia Economics and Reimbursement

1. CAER-Anesthesia and ReimbursementCommission on Anesthesia Economics and Reimbursement Summary and Conclusions Essential to CRNAs in Today's Healthcare Marketplace

2. History of AANA’s CAER- Commission on Anesthesia Economics and Reimbursement CAER-Anesthesia and ReimbursementCommission on Anesthesia Economics and Reimbursement • 2007 Resolution Proposal • Fall 2007 CAER Commission Created -13 member interdisciplinary panel • Conference calls/e-mail commentary and two face to face meetings in Feb/March 2008 in Washington, DC –Presentations/testimony • CAER Report to AANA Leadership May 2008 • CAER Report Submitted and Reported to Membership AANA August 2008

3. CAER Recommendations - What does this Mean for Today’s CRNAs? CAER-Anesthesia and ReimbursementCommission on Anesthesia Economics and Reimbursement Practice Management Education • Practice Managementis a comprehensive term that encompasses all aspects of an anesthesia practice’s business operations such as: • Payer negotiations and Provider Credentialing • PHI Data gathering and Compliance • Charge Creation and Development • Procedure and Diagnosis Coding processes • Charge preparation and claim submission all formats • Cash Management and Reimbursement Analysis • Patient Accounting - Patient Contact Management • Practice Business, Credit, Security, Compliance, and Privacy Policies • Practice Performance Development, Analysis, and Reporting

4. CAER Recommendations - What does this Mean for Today’s CRNAs? CAER-Anesthesia and ReimbursementCommission on Anesthesia Economics and Reimbursement Practice Management Education • As leaders within your organizations as well as leaders in your local, state, and national professional associations, this knowledge is your source of power. • This knowledge will legitimately put you at the table so you can impact or become a decision maker. • Most importantly this knowledge displays the value of CRNAs in today’s marketplace… more than ever before…Why? …Because CRNAs are the cost effective solution.

5. CAER Recommendations - What does this Mean for Today’s CRNAs? CAER-Anesthesia and ReimbursementCommission on Anesthesia Economics and Reimbursement Alternative Anesthesia Payment and Practice Models • What is meant by an Anesthesia Delivery System? • QK/QY & QX; AA/QZ; AD/QX; or simply QZ • How would the delivery system impact cost? • Delivery System changes create opportunities for CRNAs • In the nation today –2009- what motivates Anesthesia Delivery System changes? • Further practice modeling? • The capitalistic system –like it or not- has done most of this work, paving the way to the most efficient allocation of anesthesia delivery resources. • What is meant by the term “bundling” – Impact?- Who receives the anesthesia reimbursement?

6. CAER Recommendations - What does this Mean for Today’s CRNAs? CAER-Anesthesia and ReimbursementCommission on Anesthesia Economics and Reimbursement Surveys/Studies/Data Collection • MGMA – Medical Group Managers Association of American www.mgma.comDo it yesterday. • Understand the organization and the uses of its data by hospital administrative financial professionals. • CRNA data contributions are VERY low – therefore they draw incorrect conclusions. • CRNA data contributions that are there are generally from the ACT Anesthesia Delivery Systems • What is the return to CRNAs from being a part of studies/data collection/surveys? ... A workable defense.

7. CAER Recommendations - What does this Mean for Today’s CRNAs? CAER-Anesthesia and ReimbursementCommission on Anesthesia Economics and Reimbursement Technology – Electronic Health Record • Technology and Electronic Health Records equates to data collection – plain and simple, learn the utter importance of this. • CRNA data is absolutely vital to your success • As CRNAs this will primarily be within the Peri-Operative Information System. Capture the CRNA data – irregardless of your current anesthesia delivery system. • Commit to ProtectCRNA Data–Get on the eval committees and vendor evaluation groups, be a apart of the E.H.R. process within your organization. Peri-Operative systems are just becoming reality now, so it is not too late.

8. CAER Recommendations - What does this Mean for Today’s CRNAs? CAER-Anesthesia and ReimbursementCommission on Anesthesia Economics and Reimbursement Building Relationships and Alliances • Keep your friends close and your enemies closer. • Use relationships to really education these organizations on who CRNAs are but you must go further --- Why should they care to learn about the role of the CRNA in today’s anesthesia delivery system? -Clinical skills and Cost this is why • Identify valuable alliances such as: • MGMA –Medical Group Managers Association • AHA – American Hospital Association • HFMA – Healthcare Financial Management Association • CMS – Those inside and those seasoned ‘outside’ • AMA – American Medical Association and its components • Local, state, and national political figures - Legislature

9. CAER Recommendations - What does this Mean for Today’s CRNAs? CAER-Anesthesia and ReimbursementCommission on Anesthesia Economics and Reimbursement • Take the CAER Recommendations as a challenge for all CRNAs. • A spring board for most CRNAs to research a very critical part of their career to develop a day to day working knowledge of these issues. • Success of the profession of Nurse Anesthesia depends up the firm ability of CRNAs to understand the need to become fluent and intimate with these detailed and often times comprehensive concepts, theories, and processes.

10. CAER Recommendations - What does this Mean for Today’s CRNAs? CAER-Anesthesia and ReimbursementCommission on Anesthesia Economics and Reimbursement If I had to list in order of importance to the future of the nurse anesthesia profession, my list would appear as follows: • Alternative Anesthesia Delivery Systems • Practice Management education • Technology Peri Operative Systems Development • Involvement with External Surveys/Studies MGMA • Develop a method to monitor your local marketplace, remembering who your ‘customers’ really are.* • Development of Alliances and Relationships *This is not a recommendation by CAER

11. CAER-Commission on Anesthesia Economics and Reimbursement CAER-Anesthesia and ReimbursementCommission on Anesthesia Economics and Reimbursement BCS Contact Information Lee@BCSConsult.com 888-278-4124 Lee S. Broadston President & CEO BCS, Incorporated 400 East 10th Street Waconia, MN 55387 Thank you for allowing this presentation to be a part of your spring educational meeting. Please take the time to complete and turn in your session evaluation documents. Your evaluations are very important to the success of future programs and session created by BCS.