“If
you build it, he will come.”
From “Field of Dreams,” 1989.
 n
speaking with many different providers and groups,
there is an impression in the clinical community
that anesthesia practices are being asked to cover
more sites — either in existing facilities
or in new facilities — without equivalent
increases in cases or billed units. The result is
that clinical productivity, as measured as work
done by each anesthetizing site or by each individual
anesthesiologist, has subsequently decreased over
the last several years. But is this really the case?
‘The
Cost Survey for Anesthesia and Pain
Management Practices 2007 Report Based
on 2006 Data’ (Item # 6732) is
available now!
ASA members can view the report from
the ASA Web site using the link www5.mgma.com/ecom/Default.aspx?action=INVProduct
Details&args=2672&tabid=138.
To order the report, please call (877)
275-6462. To receive your discounted
affiliate pricing, tell the customer
service representative that you are
an ASA member.
Each year for this report, MGMA surveys
the MGMA and ASA memberships to obtain
the most recent anesthesiology and pain
management group revenue, staffing and
operating cost data. In this year’s
report, the MGMA ‘Cost Survey
for Anesthesia and Pain Management Practices
2007 Report Based on 2006 Data,’
one will find complete data on staffing
ratios, medical revenue, staff costs,
total operating costs, revenue after
operating costs, provider cost and net
practice income or loss. Accounts receivable,
payer mix, collection percentages, financial
ratios and balance sheet information
are also included as well as information
on anesthetizing location, treatment
location, revenue per unit, physician
time units and anesthesia case data
such as number of cases, revenue and
charges. Segments include “per
physician,” “per case,”
“as a percent of total medical
revenue” and “per anesthetizing
location.” Further, new to this
year’s report, the results are
also reported separately for “anesthesiology
with pain management” and “pain
management” only. |
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In 2005, Medical Group Management Association
(MGMA), in conjunction with ASA, developed a survey
that was designed specifically to address the needs
of anesthesia and pain management practices. The
most recent document, the “Cost Survey for
Anesthesia and Pain Management Practices 2007 Report
Based on 2006 Data,” includes data from more
than 160 anesthesiology and pain management groups.
It has a tremendous amount of staffing, revenue
and cost data. The report contains several categories,
including by group size and staffing model: “physician-only,”
“greater than one CRNA/AA per physician”
(mostly or all anesthesia care team) or “less
than one” (mix of physician only and anesthesia
care team). For more information and how to order,
please see the box to the right.
The report illustrates clinical productivity in
several ways. Cases, total ASA units billed and
time units billed are normalized per anesthetizing
location as well as per full-time equivalent (FTE)
physician. Although “per FTE physician”
measurements may be confounded when comparing productivity
between groups with different staffing models1,2,
break-out data by staffing model categories reduce
these problems.
The exploration of clinical productivity trends
as reported in the cost report highlights that no
matter what measurement is used, clinical productivity
decreased. In the “all anesthesia groups”
category, the median total and time units billed
per anesthetizing location decreased 12.9 percent
and 21 percent, respectively, from 2004 to 2006
[Figure 1]. Similarly, units billed per FTE physician
diminished in all three staffing categories, with
Figure 2 illustrating the medical care team staffing
groups. Most notably, the median number of anesthetizing
sites rose by 15 percent, and the median encounters
per site fell by 10 percent [Figure 3].
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Although the survey results cannot empirically state
that increases in the number of anesthetizing locations
are the sole cause, the results support the hypothesis
that provider workload has not increased at the
same rate as the number of sites that groups must
cover. To survive economically, groups are forced
to negotiate compensation from the facility for
staffing the additional sites.
Finally, clinical productivity is only one aspect
of the cost report. We encourage more groups to
participate in the next anesthesia group survey
(sent out in spring 2009) to continue to provide
the anesthesiology community with accurate and valuable
economic data and benchmarks. Additionally, if you
complete a survey, you get a free copy of the report!
| The 2008 ASA Conference on Practice
Management will be held January 25-28,
2008 in Tampa, Florida. The conference
will cover topics on the pros and cons
of hospital employment, quality initiative,
Medicare policies, negotiating with hospitals
and anesthesia workforce. More information
and registration materials can be found
on the ASA Web site under the “Practice
Management” link www.ASAhq.org/Washington/pmhomepage.htm. |
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References:
1. Abouleish AE, Prough DS, Barker SJ, et al. Organizational
factors affect comparisons of clinical productivity
of academic anesthesiology departments. Anesth
Analg. 2003; 96:802-812.
2. Abouleish AE, Prough DS, Whitten CW, et al. Comparing
clinical productivity of anesthesiology groups.
Anesthesiology. 2002; 97:608-616
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Amr
Abouleish, M.D., M.B.A., is Professor, Department
of Anesthesiology, University of Texas Medical
Branch, Galveston, Texas. |
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Todd
B. Evenson, M.B.A., is survey analyst, Medical
Group Management Association (MGMA) national
office and lead analyst, Cost Survey of Anesthesia
and Pain Products. |
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