ASA Responds to Study on Anesthesia Service Contract Compensation

Norman A. Cohen, MD, and Kenneth Elmassian, DO, of the American Society of Anesthesiologists, shared the following thoughts in response to a March 30 article on anesthesia provider compensation, originally published as "Anesthesia Highest Earner of all Hospital-Based Specialties." To ensure accuracy and reader understanding, the article title was later changed to "Anesthesia Groups' Average Administrative Service Contracts Outrank Other Specialties at $773K" and several points were clarified.

As [the editors of Becker's ASC Review are] aware, the $773,309 median annual payment amount confused readers, as it appeared to be the average annual income for anesthesiologists. Instead, it was actually the average amount paid from hospitals or health systems to anesthesia groups as part of a service agreement. The payment amount was not adjusted for the size of the group nor type or quantity of services rendered.

Anesthesiologists typically work for larger groups than do other hospital-based physicians. Also, anesthesiologists typically work more hours a week than radiologists, pathologists or emergency physicians. Not adjusting for these factors weakens MD Ranger’s comparison between specialties.

In addition to management services provided by a designated anesthesia/perioperative medical director, facilities may seek coverage for relatively low volume services that also frequently have a poor payer mix. Obstetric and trauma coverage fit this description for many sites. Providing dedicated coverage is often inefficient, particularly when considering the need for 24/7 coverage. Another factor is when hospitals with disproportionately large Medicare populations result in lower patient care revenue because of the "33 percent problem," that is Medicare pays a much lower rate compared to commercial insurers for anesthesia care (33 percent) compared to other specialties (80 percent).

Also, facilities sometimes choose to run more anesthetizing locations than optimal so as to attract more surgical volume. This "field of dreams" approach sometimes succeeds, but it does create a demand for additional anesthesiologists during the ramp-up phase. As a result, anesthesia groups and facilities may enter into an agreement to provide excess clinical coverage in exchange for payments to offset at least part of the additional costs incurred.

Read more about the American Society of Anesthesiologists.

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