Should Anesthesiology Enter the RBRVS? Implications for Academ

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Should Anesthesiology Enter the
RBRVS?Implications for Academé

• Lydia A. Conlay, M.D., Ph.D., M.B.A.
• Professor and Chairman
• Department of Anesthesiology

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C M S

• See - A - Mess

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Should Anesthesiology Enter the RBRVS?

• Potential benefits to Academé
• Potential benefits to the specialty independent
  of Medicare
• Winners and Losers

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Medicare (and Medicaid) Disproportionately
Represented in Academic Practice
34 Medicare
40 Medicare
8 Medicaid
20 Medicaid
56 Private
40 Private
Private Practice 2004 MGMA Cost Report (2003
data)
Academic Practice Tremper et. al. Anesth Analg
96432,2003
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Potential Benefits for Academé

• Improving Conversion Factor
• Expanding the ASA code set
• Emphasizing pre-operative and post-operative care

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Benefits for AcademéImproving the Conversion
Factor

• Standard
• Conversion Factor

• Anesthesia
• Conversion Factor
• 18.23

37.55
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Benefits for AcademéImproving the Conversion
Factor

• Standard
• Conversion Factor

• Anesthesia
• Conversion Factor
• 18.23

37.55
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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

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Potential Benefits to AcademéExpanding the
Code Set

• 250 codes in ASA Relative Value Guide
• gt5,000 surgical CPT codes
• Each ASA code represents many CPT codes
• Procedures bundled in each ASA code

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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

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Building Block Methodology


RVU Service A
RVU Total
RVU Service B
For Anesthesiology



RVU
E M
E M
Pre-operative
Postoperative
Intraoperative
Complexity
Time
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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




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WINNERS
LOSERS

• Medicare
• (and Medicaid)
• More complex
• Pre Post-op

• Contracts gt (37 x 1.3) 48/ unit
• Less complex
• Longer cases

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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

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Population, millions
Figure 4. Aging trend of US population
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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

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