17 facts and concepts for anesthesiologists and ASCs

Here are 17 facts and trends about anesthesiologists and anesthesia in ambulatory surgery centers.

Learn more about the surgery center industry from the experts at the Becker's 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine event, June 22-24, 2017 in Chicago. To learn more and register for the event, click here.

By the numbers
1. There are 29,220 anesthesiologists in the United States, according to the Bureau of Labor Statistics.

2. U.S. News & World Report ranked anesthesiologists at the No. 1 best paying job with the average salary at $187,200. The job market is also positive, with the unemployment rate among anesthesiologists at 1.7 percent and the field is expected to grow 21 percent through 2024, adding 71,000 new jobs.

3. Three-fourths of anesthesiologists are male, according to a LocumTenens.com report, and 83 percent are board certified. Twenty-three percent of anesthesiologists have worked on a locum tenens basis and 25 percent have spent five years or less in clinical practice.

4. Anesthesiologists in healthcare organizations receive the highest compensation, in excess of $100,000 more than office-based solo practitioners. Here is the breakdown of anesthesiologist compensation based on the Medscape Anesthesiologist Compensation Report 2016:

• Healthcare organization: $438,000
• Office-based single specialty group practice: $398,000
• Hospital: $364,000
• Office-based multispecialty group practice: $358,000
• Outpatient clinic: $338,000
• Office-based solo practice: $281,000
• Academic, research, military, government: $273,000

5. The employment status of anesthesiologists, according to LocumTenens.com, is:

• Hospital employed: 34 percent
• Group practice: 18 percent
• Academic: 22 percent

6. Somnia Anesthesia's "The Anesthesia Labor Market 2014: Trends and Analysis" report projected shortage of 3,000 anesthesiologists by 2025. The findings are based on a RAND Corp. briefing to the American Society of Anesthesiologists and are consistent with previous projections. According to the report, the regions with the most persistent anesthesiologist shortage are the Pacific West and Midwest, with the Northeast and Mountain West regions following closely behind.

The most desired states to practice anesthesia were Florida, Texas and California, which are also among the top five states where Americans prefer to live.

7. The Anesthesia Quality Institute's National Anesthesia Clinical Outcomes Registry reports the number of anesthesia cases taking place outside of the operating room increased from 2010 to 2014. In 2010, there were 5.9 million — or 28 percent of anesthesia cases — taking place outside of the operating room and that number grew to 12.4 million — or 36 percent of anesthesia cases — by 2014.

8. According to a report from the ASA Committee on Professional Liability, most anesthesiologists carry insurance policies that limit $1 million per occurrence and $3 million per year. Last year, 64 percent of companies surveyed reported that arrangement as their most common policy; 32 percent said their most common policy had higher limits. Seventy-five percent of the companies offered claims-made policies.

9. The average certified nurse anesthetist in the United States makes $160,250 annually, according to the Bureau of Labor Statistics. Montana has the highest average salary for CRNAs at $243,550, followed by New Hampshire, Wyoming, Wisconsin and California.

10. There were four major CPT coding updates for 2017, according to an Anesthesia Business consultants report. The codes distinguish whether the procedure included image guidance. The crosswalk from the old to the new codes is:

• Cervical and thoracic single shot injection (CPT 62310)
o New code with image guidance: 62321
o New code without image guidance: 62320

• Lumbar single shot injection (CPT 62311)
o New code with image guidance: 62323
o New code without image guidance: 62322

• Cervical or thoracic epidural catheter (62318)
o New code with image guidance: 62325
o New code without image guidance: 62324

• Lumbar epidural catheter (CPT 62319)
o New code with image guidance: 62327
o New code without image guidance: 62326

Key trends
Anesthesiologists are seeing several changes in their practice as healthcare moves toward value-based payment models. Vincent J. Vilasi, MD, MBA, Mid-Atlantic CEO of North American Partners in Anesthesia , discusses the key challenges and opportunities for anesthesiologists moving forward.

11. Higher acuity cases are moving to ASCs and away from hospitals. Surgeons are performing higher acuity cases in the ASC, including total joint replacements and spinal fusions. While surgeons and hospitals have a financial incentive to move cases to an ASC setting, anesthesiologists must make sure the patient selection is appropriate. It's important for anesthesiologists to guard against pushing the envelope beyond where they are comfortable with outpatient procedures. The ideal patients for outpatient procedures are otherwise healthy and will be able to return home with minimal risk of pain, nausea and bleeding.

12. Anesthesia groups are diversifying outside of hospitals. Many anesthesia groups now contract with ASCs as well as hospitals. This helps to offset the loss of commercial insurance cases migrating from hospitals to ASCs. "The anesthesia group loses those commercial cases from the hospital and the cases that backfill in that space are more complicated and often tilted towards Medicare pay rates," says Dr. Vilasi. "This can make it difficult for hospital-only anesthesia practices to remain viable while compensating staff in a competitive marketplace."

Having the infrastructure to support a nationwide network, NAPA has the ability to flex staff across multiple facilities, while smaller groups don’t have the resources to do so.

13. Anesthesiologists are becoming more involved in reducing readmissions. Anesthesiologists need to take a leadership role in patient selection for bundled patient cases. "We want to partner with our hospitals and ASCs to reduce costs. Bundled payments are eroded by readmissions or discharge to acute rehab facilities," says Dr. Vilasi. "Our partners look to us to help with patient selection, patient education and utilization of the latest anesthesia techniques to reduce length of stay, minimize postoperative pain and allow for early ambulation."

A unique differentiator for NAPA is its regional anesthesia programs which have demonstrated the ability to reduce length of stay and improve HCAHPS scores, both of which result in increased earnings for the facility. Patients receive nerve blocks and catheter placement for postoperative pain control in addition to prophylactic antiemetics to help them ambulate sooner after surgery. "We have patients doing physical therapy the day of surgery," says Dr. Vilasi. "That will help them minimize the incidence of deep vein thrombosis, pneumonia and other issues. We want them up and walking around as soon as possible."

Dr. Vilasi went on to say, "It's going to be important to partner with your facility and orthopedic surgeons to reduce costs, and regional anesthesia is one way to do that. If patients can achieve lower pain scores, less nausea, and early ambulation through the use of regional anesthesia, they'll have better outcomes."

14. Out-of-network billing for anesthesia is decreasing nationwide. California and New York recently passed legislation to guard against surprise bills and similar legislation has been introduced in three more states.

"Being out-of-network was common in the past, but it's not going to be a good policy going forward. There is greater transparency in healthcare today, and our hospital and surgeon partners are, at times, demanding that we be in-network. In addition, patients may cancel if you are out-of-network,” says Dr. Vilasi.

17. Transparency in healthcare is increasing. Insurance companies and consumer websites are rating surgeons and hospitals based on cost, quality and patient experience. Patients are often dissatisfied if they experience too much pain or nausea after the procedure, or if they receive a high bill. In some cases, surgeons may request that their anesthesiologist colleagues lower their rates so the surgeon's overall global rate is lower, earning them a higher rating with the payer. "The rating systems have led to some interesting behavior from healthcare facilities and surgical colleagues," says Dr. Vilasi.

As a larger group, NAPA is able to devote resources to collecting and analyzing data which enables the practice to enhance provider performance, increase patient satisfaction and improve clinical outcomes. "It's harder to do that in a smaller group; larger groups can devote the resources necessary to build the infrastructure to address the many requirements to be successful under government programs such as MIPS and MACRA," says Dr. Vilasi.


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