18 things to know about anesthesia

1. In May 2014, there were 30,060 anesthesiologists working in America, according to the U.S. Bureau of Labor Statistics.

Demographics

The following are based on the Locum Tenens Compensation & Employment Report 2014: Anesthesiology.

2. Board certified — 84 percent

3. Male — 84 percent

4. Hospital-employed — 37 percent

5. Group practice — 25 percent

6. Regional breakdown

  • Northeast — 30 percent
  • Southeast — 19 percent
  • Midwest — 22 percent
  • Southwest — 12 percent
  • West — 17 percent

Compensation

The following are based on the Medscape Anesthesiologist Compensation Report 2015.

7. Compensation — $358,000; ranking fourth highest-paid specialty

Compensation based on employment

8. Self-employed —$410,000

9. Employed — $318,000

Compensation based on practice setting

10. Office-based single-specialty group practice — $429,000

11. Hospital — $359,000

12. Outpatient clinic — $316,000

Anesthesia market

13. The U.S. general anesthesia drugs market is expected to experience rapid growth, according to a MarketsandMarkets report. Currently valued at $1.6 billion, the market is expected to reach $2 billion by 2020, growing at a CAGR of 3.8 percent. Major players operating in the market include AstraZeneca, Baxter and Hikma Pharmaceuticals.

14. The global anesthesia devices market is expected to grow at a CAGR of 7.47 percent from 2015 to 2020, according to a Market Research Store analysis. An increasing number of surgical procedures will drive the market, but a lack of trained anesthesiologists will be an obstacle to growth. The major players include Covidien, Dragerwerk, GE Healthcare and Phillips Healthcare.

Independent anesthesia practices

15. With hospitals buying up physician practices left and right, anesthesia practices must decide whether independence or employment will yield better futures. According to Mark F. Weiss' blog post, "Anesthesia Group Mergers, Acquisitions and (Importantly) Alternatives," on Anesthesia Business Consultants, anesthesia practices only have their future cash flow to offer in sale.

If anesthesiologists don't want to relinquish their private practice freedom in a sale, they can fight. Practices should strengthen relationships with all facilities to which they provide services, leaving no doubt that its anesthesiologists are the best. The focus of relationship-building should not only encompass more hospitals, but outpatient surgery centers as well. Bigger doesn't necessarily mean better, but it does mean power. Practices should also consider merging forces with other anesthesia practices to leverage better payer contracts.

CMS's Comprehensive Care for Joint Replacement program

16. CMS's proposed a program in July 2105 that would bundle the payment for joint replacement surgeries. The Comprehensive Care for Joint Replacement program makes hospitals responsible for the financial care of patients 90 days after discharge. If approved, this program would affect most hospitals. Hospitals may share CCJR savings or penalties with physicians by agreement.

According to Tony Mira's blog post on Anesthesia Business Consultants, anesthesiologists should secure their spots in this new initiative, as this is only the first of many proposals to "link provider profits with costs and quality metrics." Anesthesiologists are central players in joint replacement cases and the most successful in bundled payments will focus on providing exceptional postoperative care for patients.

The economics of anesthesia — Measuring objective metrics

17. To remain competitive, anesthesiologists will adopt tools and technology that increase productivity and quality. According to Jody Locke's blog post, "Why Utilization and Productivity Metrics Matter," on Anesthesia Business Consultants, smart anesthesia practices are using data to assess individual provider productivity and staffing models. Instead of sitting back and letting surgeons and hospitals run the show, anesthesia practices can offer insight on how to increase operating room efficiency by analyzing their own billing data.

By establishing a strong line of communication with hospitals, anesthesia practices educate stakeholders about what makes a profitable practice. This communication will benefit both parties, as anesthesia practices will be more likely to see problems from an administration's viewpoint.

Reimbursing anesthesia practices — SGR "fix"

18. Republican Congressman and anesthesiologist, Andy Harris, MD, started the conversation that led to the SGR "fix," the Medicare Access and CHIP Reauthorization Act of 2015, or H.R.2. This legislation was signed into law on April 16, 2015. Anesthesiologists receive about 31 percent of commercial payment when billing Medicare, according to Tony Mira's "The SGR 'Fix' in the Context of Anesthesia Practice" blog post on Anesthesia Business Consultants.

H.R.2 essentially increases the conversion factor determined by the SGR at 0.5 percent every year to 2019. This will increase physician reimbursement yearly, and from 2020 to 2025, the conversion rate will be 0 percent to level reimbursement.

H.R.2 will create the Merit-based Incentive Payment System in 2019, which will rate healthcare providers based on "quality," "clinical practice improvement activities" and "meaningful use of electronic health records." These scores will affect reimbursement rate.

"Anesthesiologists will need to reevaluate their current efforts to comply with quality measurements, data protection and value performance. They will need to look at current and potential relationships with other providers and ensure such relationships account for the potential decline in reimbursement in the long term," wrote Mr. Mira in his blog post.

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