September 2002
Volume 66 |
Number 9
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PRACTICE MANAGEMENT
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Survey of Hospital Administrators
About Anesthesia Coverage
Karin Bierstein, J.D.
Assistant Director of Governmental Affairs (Regulatory)
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ASA recently commissioned a survey of hospital administrators
to determine the extent and impact of the nationwide shortage
of anesthesiologists and nurse anesthetists. We confirmed that
both are severe. Information such as the facts that 59 percent
of hospitals are currently recruiting anesthesiologists and that
34 percent are supplementing the clinical practice revenues of
their anesthesia providers may be useful in some contract negotiations.
Survey Methods
The Tarrance Group, a public affairs research firm with which
ASA has worked on several occasions, sent surveys to senior-level
administrators at 957 large hospitals with at least 100 beds between
March and June 2002. Alexander A. Hannenberg, M.D., Chair of the
Committee on Economics, and Washington Office staff participated
in developing the 24 survey questions. Our contractor completed
327 interviews (34-percent response rate) by either telephone
(36-percent) or mail (64-percent). Hospital administrators were
identified through preliminary telephone calls to the entire survey
sample of hospitals.
The responses were divided approximately equally between hospitals
with 100-149, 150-249 and 250 or more beds and between the four
major regions of the country [Figure 1]. Almost three-quarters
of the hospitals use a combination of anesthesiologists and nurse
anesthetists. Anesthesiologists provide all the anesthesia care
in the other 85 hospitals (26 percent) responding to the survey.
Results
Provider shortage. The survey revealed that almost one-half
of the hospital administrators report a need for additional anesthesiologists
on staff. This is in spite of the fact that the total numbers
of both anesthesiologists and nurse anesthetists have increased
at 43 percent and 36 percent of hospitals, respectively. Of the
59 percent with anesthesia groups that are currently recruiting,
the majority (57 percent) has been recruiting for more than six
months. The supply is clearly not meeting the demand. Nearly three
in 10 administrators indicated that they expect to lose anesthesia
providers over the course of the next six months. Sixty-eight
percent have lost at least one during the last 12 months; 18 percent
have lost four or more providers. The departures are more frequently
a function of relocation to other practices than to retirement.
Eighty-three percent of hospitals have lost at least one anesthesiologist
to relocation versus 24 percent that have lost an anesthesiologist
to retirement. This would suggest that competition and better
opportunities are causing anesthesiologists and nurse anesthetists
to leave hospital positions.
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Figure
1: Hospital Size (in number of beds)
and Geographic Coverage
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The largest hospitals (250+ beds) are more likely to report that
they do not have enough anesthesia providers and that they expect
departures than are the smaller hospitals.
Economic impact.
Thirty-four percent of the responding hospital administrators
stated that they are "subsidizing the clinical practice revenues
of their anesthesia providers." Such subsidies typically
take the form of stipends for obstetric or trauma coverage, or
for medical director or O.R. management services. (The survey
of hospital contracts conducted by Genie Blough, MBA, CMPE, and
Shena Scott, MBA, CMPE, and reported in the "Practice Management"
column in the August 2001 NEWSLETTER indicated that 58
percent of the 153 practices responding received stipends. The
Tarrance survey terminology and respondent sample probably explain
the difference; 7 percent indicated that they were "unsure.")
Fifty-one percent of the hospitals have had to supplement their
anesthesia staff with locum tenens providers or temporary personnel.
In locations with a high proportion of government payers (e.g.,
Medicare, Medicaid, CHAMPUS/Tricare), which usually pay a good
deal less for anesthesia services than do private carriers, the
cost of the locum tenens personnel is probably significantly greater
than the collections for their services. The same may well be
true in the case of the 94 percent of nurse anesthetists who are
employed by the hospitals, the anesthesiologists, or a combination
of the two.
Impact on access to care. Nearly 30 percent of the administrators
feel that the low Medicare payment levels for anesthesia are having
an impact on Medicare patients' access to surgical care at their
hospitals. Approximately the same percentage reports that the
wait time for surgery (for all patients) has increased over the
past five years based on the availability of anesthesia care.
Of the nearly one-half of the respondents who have had to limit
the number of operating rooms in service or the operating hours
of any O.R.s, 73 percent have done so "frequently" or
"occasionally." Twenty-two percent indicate that their
anesthesiology departments have curtailed or eliminated services
provided outside of the O.R., such as pain management or critical
care.
Of the nearly one-half of the respondents who have had to limit
the number of operating rooms in service or the operating hours
of any O.R.s, 73 percent have done so "frequently" or
"occasionally." Twenty-two percent indicate that their
anesthesiology departments have curtailed or eliminated services
provided outside of the O.R., such as pain management or critical
care.
Conclusion
The nationwide shortage of anesthesia providers is creating serious
difficulties for hospitals and patients. Nearly one-half of hospitals
surveyed report that they do not have enough anesthesiologists
on staff; more than half are currently recruiting and a small
majority have had to resort to the use of locum tenens providers,
who may not improve the efficiency, quality or bottom line of
the anesthesia service. Administrators of the largest hospitals
are more likely to report that the numbers of both anesthesiologists
and nurse anesthetists have decreased over the past three years.
Consequently, they also indicate that wait times for surgery have
increased and that they have reduced the volume of services provided
by anesthesiologists outside the O.R. The inadequate numbers of
anesthesia providers are having the greatest impact on patients
who rely on the largest – and often busiest – hospitals
in America.
Report Payer Problems
Do you want help resolving claims disputes with third-party
payers? There is strength in numbers: the American Medical Association
(AMA) Private Sector Advocacy group has launched a national clearinghouse
for complaints against health insurers. ASA has placed the AMA/ASA
Health Plan Complaint Form in the "Members Only" section
on our Web site at , where members may download
the file and mail or fax a completed form to AMA, which will forward
a copy to us.
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REMINDER:
Don't Miss the Deadline to File for a HIPAA Extension!
• To take advantage of the extension of the
deadline for compliance with the Health Insurance
Portability and Accountability Act (HIPAA) electronic
transactions rules, go to < http://www.cms.hhs.gov/hipaa/hipaa2/ascaform.asp
>.
If you submit a compliance plan by October 15 this
year, you will have until October 16, 2003, to comply
with HIPAA's new national electronic transaction standards.
Otherwise, your electronic claims will have to be
HIPAA-compliant by October 16, 2002.
For further information, see the "Practice Management"
column in the May 2002 issue of the ASA NEWSLETTER.
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This form asks for data on the types and the severity of the
administrative and payment "hassles" that physicians
and physicians' billing offices experience on a day-to-day basis
in the managed care environment. The information will help to
identify trends and facilitate discussions to resolve hassles
encountered with third-party payers. In addition, the information
will be used to promote legislative and regulatory changes to
benefit patients and physicians.
The data received will be processed and aggregated in a secure
and confidential manner. Physician names are not requested and
will not be presented in any of the findings or reports derived
from completion of the Health Plan Complaint Form. If you have
any questions or any problems completing the form, please send
an e-mail to < HPComplaint@ama-assn.org
>. Administrative staff should log in to the ASA Web site using
their anesthesiologists' ASA member numbers.
Please join AMA and ASA in our fight against the abusive business
practices committed against patients and physicians.
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Source Materials:
• The Tarrance Report executive summary, questionnaire
and data tables may be downloaded from < http://www.asahq.org/Washington/pmdownloads.htm
>
• The AMA/ASA Health Plan Complaint Form may
be downloaded from the "Members Only" section
of the ASA Web Site < www.ASAhq.org
>. To access this section, go to "Professional
Information" and then follow the pop-up menu
to "Members Only Login."
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New e-PM Letter Posted
We have just posted Volume 2, Number 1 (August 2002) of the e-PM
Letter, at < http://www.asahq.org/Washington/Newsletters/e-pmletterv2n1.pdf
>.
We sincerely hope that you will find the new issue interesting.
We are also open to ideas for or offers of future articles. If
you or any colleagues or practice management staff would like
to receive their own announcements when new issues are posted,
have them add their e-mail addresses to the subscriber list by
sending a message with no subject and the single word "subscribe"
in the body to: < e-PM-L-request@listserv.asahq.org
>.
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