The Ineffectiveness of our ASA Board

[BLADEMDA]

You already know that basing private health plan payment rates on the Medicare Fee Schedule would bankrupt your practice. We do not know of any anesthesia practice that has ever been forced to accept 100% of the Medicare conversion factor, but there are some groups that have agreed to 150% or other multiples of Medicare.

http://www.anesthesiallc.com/index.php/publications/communique?id=434

---

Members don't see this ad.

 

[BLADEMDA]

With the dawn of Medicare’s resource-based relative value units system in the late 80s, anesthesia reimbursement faced a reduction of 40%. This cut wasn’t felt keenly at first, as the majority of providers were working at hospitals and were well-compensated. Only a small percentage of those they served were Medicare patients. With the rise in both Medicare patients and private payors who reimbursed even less per unit than Medicare patients, anesthesia groups began to flounder financially. While this was happening, surgery centers were rising in popularity, taking some of the better-paying cases from the hospitals. As a result, hospital-based anesthesia groups were left with a devastating reality: a blend of poor payors and less customers than they’d started with.

To make up for the decline in reimbursement, anesthesia groups took on less employees and the workload increased for their providers. With less anesthesia providers being hired, this led to a shortage in job offerings in the anesthesia market, which in turn brought on a lower amount of graduating residents. The amount of Ambulatory Surgery Centers (ASCs) had grown aggressively, offering anesthesia providers a smaller workload and higher compensation thereby wooing them away from their hospital jobs. In order to retain the anesthesia providers, hospitals were forced to provide higher compensation.

The Birth of Anesthesia Subsidies

In order to atone for the decline in reimbursement and the increase in workload, anesthesia providers needed to find a way to fill the deficit. Providers were being forced to cover more cases and increase their costs with no way to make up the balance. Around the year 2000, anesthesiology departments began requesting subsidies from their hosting hospitals. Hospitals were forced to pay for the coverage because, in refusing, they would be leaving operating rooms potentially uncovered. Over next decade, the percentage of hospitals paying anesthesia subsides would skyrocket from 15% to their current level at 75%. The average subsidy paid to an anesthesia group practice would grow to it’s current level of 1.5 million dollars annually.

DAWN OF THE AMC

These huge subsidies have led to the birth of AMCs which are now proliferating the nation. The AMC has much better contracts with private payers allowing them to reduce or eliminate the hospital subsidy. Many groups with subsidies are being forced to accept a reduction or face elimination entirely.

http://www.lifelincanesthesia.com/thought-leadership/anesthesia--subsidies--a-brief-history/

 

[chocomorsel]

Thanks Blade for that little history lesson.
I can not believe CRNA's were making 35,000 a year!!! So did their demand increase once the docs started going to the surgicenters so as to increase their pay to the current levels?

Very huge difference in pay!!

 

[vector2]

was looking for some references about anesthesia billing and came across these lovely slides from a CRNA's presentation

http://www.mana.us/wp-content/uploa...andout-Basics-of-Anesthesia-Reimbursement.pdf

 

[sevoflurane]

was looking for some references about anesthesia billing and came across these lovely slides from a CRNA's presentation

http://www.mana.us/wp-content/uploa...andout-Basics-of-Anesthesia-Reimbursement.pdf

 

[sevoflurane]

This is why I don't work with them and train AAs.

My previous group kicked them out and went back to MD only. Everyone was happier.

 

[Psai]

was looking for some references about anesthesia billing and came across these lovely slides from a CRNA's presentation
http://www.mana.us/wp-content/uploa...andout-Basics-of-Anesthesia-Reimbursement.pdf

I liked the part where they wanted extra letters on their name so bad that they started putting the names of states for maximum letterage

 

[chocomorsel]

This is why I don't work with them and train AAs.

My previous group kicked them out and went back to MD only. Everyone was happier.

The group I work with now did the same. Turns out on an hourly basis, they were more expensive than docs. But they have now been hired by the competing group who recently sold out to an AMC. Gonna be a lot more mid levels brought to this town now.

 

[drdan4]

ASA doesn't care about most Anesthesiologists. They are self serving. Most are Academic and happy to see AMCs proliferate and Private Salaries/benefits equilibriate to ****ty Academic levels.

To protect the rest of us, form the Anesthesia Preservation Society (ASAP). Clear goals:

1) Annihilate AMCs:. Money grubbing Middle Men that skim of the top and feed Wall Street. We lose, Salaries drop, benefits stink and the CrNA loving AMCs will happily watch you scramble to protect your license as you prevent incompetent locum CRNAs from killing patients.

Destroy CRNAs:. You tried to have your cake and eat it too. It's not going so well. The Monster cannot be controlled. Plenty of Older Anesthesiologists looking for daytime work/no call and lots of mommy trackers. No new grad or young attending should take a supervision job out of residency, can't believe I even have to say that.

Abolish Company Model:. Filthy, Greedy GI guys/Surgeons low ball Anesthesiologists, take our billing while we do all the work and take all the risk. Bastards can do their own sedation or supervise their own CRNAs.

Jealous Nurses, Backstabbing Surgeons, Unreasonable Administrators, Clueless Patients...Let's face it , if there was any field that needed a Strong Society to protect us, Anesthesia was it.

Instead we got the impotent ASA.

 

[Man o War]

ASA doesn't care about most Anesthesiologists. They are self serving. Most are Academic and happy to see AMCs proliferate and Private Salaries/benefits equilibriate to ****ty Academic levels.

To protect the rest of us, form the Anesthesia Preservation Society (ASAP). Clear goals:

1) Annihilate AMCs:. Money grubbing Middle Men that skim of the top and feed Wall Street. We lose, Salaries drop, benefits stink and the CrNA loving AMCs will happily watch you scramble to protect your license as you prevent incompetent locum CRNAs from killing patients.

Destroy CRNAs:. You tried to have your cake and eat it too. It's not going so well. The Monster cannot be controlled. Plenty of Older Anesthesiologists looking for daytime work/no call and lots of mommy trackers. No new grad or young attending should take a supervision job out of residency, can't believe I even have to say that.

Abolish Company Model:. Filthy, Greedy GI guys/Surgeons low ball Anesthesiologists, take our billing while we do all the work and take all the risk. Bastards can do their own sedation or supervise their own CRNAs.

Jealous Nurses, Backstabbing Surgeons, Unreasonable Administrators, Clueless Patients...Let's face it , if there was any field that needed a Strong Society to protect us, Anesthesia was it.

Instead we got the impotent ASA.

I would add "immediately stop all training of CRNAs by anesthesiologists".
That would drastically change the trajectory of the AANA.
If you really think about it, it's nuts that we continue to contribute to their education in any way, shape, or form. CRNAs already gripe that they're getting shut out of cardiac cases, learning lines and blocks, peds cases, etc. They would be really screwed if we cut them off completely.
I understand some are making money off of them so it's in their best interest, but I'd be willing to bet those anesthesiologists are in the minority by far at this point.

 

[joestern2025]

ASA doesn't care about most Anesthesiologists. They are self serving. Most are Academic and happy to see AMCs proliferate and Private Salaries/benefits equilibriate to ****ty Academic levels.

To protect the rest of us, form the Anesthesia Preservation Society (ASAP). Clear goals:

1) Annihilate AMCs:. Money grubbing Middle Men that skim of the top and feed Wall Street. We lose, Salaries drop, benefits stink and the CrNA loving AMCs will happily watch you scramble to protect your license as you prevent incompetent locum CRNAs from killing patients.

Destroy CRNAs:. You tried to have your cake and eat it too. It's not going so well. The Monster cannot be controlled. Plenty of Older Anesthesiologists looking for daytime work/no call and lots of mommy trackers. No new grad or young attending should take a supervision job out of residency, can't believe I even have to say that.

Abolish Company Model:. Filthy, Greedy GI guys/Surgeons low ball Anesthesiologists, take our billing while we do all the work and take all the risk. Bastards can do their own sedation or supervise their own CRNAs.

Jealous Nurses, Backstabbing Surgeons, Unreasonable Administrators, Clueless Patients...Let's face it , if there was any field that needed a Strong Society to protect us, Anesthesia was it.

Instead we got the impotent ASA.

While we are at it "DESTROY ALL WHO OPPOSE US" read comic books much?

 

[zero0]

While we are at it "DESTROY ALL WHO OPPOSE US" read comic books much?

I like it. Put this guy in charge of the PR campaign.

Seriously though guys, do whatever you can to distance yourself from CRNAs. I won't ask you to rock the boat where you work, but at least maybe when those recruiters contact you, immediately ask if you will have to teach or supervise CRNAs. If they say "yes," hang up. Start getting the point across any way you can.