1 / 18

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

gillespie-hehir
Télécharger la présentation

Should Anesthesiology Enter the RBRVS? Implications for Academé

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related