Recommended

Awareness Of Stroke Risk Factors And Warning Si...

Posterior Reversible Encephalopathy Syndrome Fo...

Safety Of Single Entity Hydrocodone Extended Re...

Evaluation Of Balance And Walk And Their Relati...

Sickle Cell Disease In Sub-saharan Africa: Mole...

0 votes
Anesthesia And Physician Payment Reform
Author: David R Sinclair, David A Lubarsky, Michael M Vigoda, David J Birnbach, Eric A Harris, Vicente Behrens, Richard E Bazan, Steve M Williams, Kristopher Arheart, Keith A Candiotti
Publisher: MARTÍN SÁNCHEZ BERTA
10 pages
One time payment: €0.00
Required subscription: Free
Type of publication: Article
ISBN/ISSN: 1178-2390
DOI: 10.2147/68671
Follow this publisher

Share this publication:

Description:

Background: The purpose of this study was to propose a new crosswalk using the resource-based relative value system (RBRVS) that preserves the time unit component of the anesthesia service and disaggregates anesthesia billing into component parts (preoperative evaluation, intraoperative management, and postoperative evaluation). The study was designed as an observational chart and billing data review of current and proposed payments, in the setting of a preoperative holing area, intraoperative suite, and post anesthesia care unit. In total, 1,195 charts of American Society of Anesthesiology (ASA) physical status 1 through 5 patients were reviewed. No direct patient interventions were undertaken.

Results: Spearman correlations between the proposed RBRVS billing matrix payments and the current ASA relative value guide methodology payments were strong (r=0.94–0.96, P,0.001 for training, test, and overall). The proposed RBRVS-based billing matrix yielded payments that were 3.0%±1.34% less than would have been expected from commercial insurers, using standard rates for commercial ASA relative value units and RBRVS relative value units. Compared with current Medicare reimbursement under the ASA relative value guide, reimbursement would almost double when converting to an RBRVS billing model. The greatest increases in Medicare reimbursement between the current system and proposed billing model occurred as anesthetic management complexity increased.

Conclusion: The new crosswalk correlates with existing evaluation and management and intensive care medicine codes in an essentially revenue neutral manner when applied to the market-based rates of commercial insurers. The new system more highly values delivery of care to more complex patients undergoing more complex surgery and better represents the true value of anesthetic case management.

Select a payment method