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Payment Reductions in Academic Anesthesia

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. Medicare Teaching Reductions. Part of 1992 Medicare Fee Schedule Rule

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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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