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Economics & Payment

Enhance the value of your anesthesia practice and protect your payments for services provided.

The economic health and viability of your practice is a fundamental priority for ASA.

Health care’s economic environment has never been straightforward — consider the creation of third-party payers and the implementation of the Medicare program. Further challenges were introduced with changes to payment systems that transitioned from payments based on Usual, Customary and Reasonable (UCR) charges to the Resource-based Relative Value System (RBRVS) which created the 33% problem for anesthesiology. The environment has become increasingly complex in recent years with a shift from Fee for Service (FFS) to value-based payments.

It is vitally important for anesthesiologists to understand how they are paid, and can identify the factors influencing payment, to maximize their value to ensure fair and appropriate payment. ASA continues to prioritize efforts to support its members and their economic viability through the Economic Strategic Plan Initiative (ESPI). As part of this initiative, we curated a compendium of relevant ASA Monitor® articles to help further understanding and insights about the issues. These articles cover a wide range of topics and include both background information and practical guidance on how an anesthesia practice can enhance its value and protect and improve its payments for services provided. This collection provides a big-picture view of ASA’s previous work, accomplishments, and ongoing efforts — for the benefit of anesthesiologists.

In addition, Tom Miller’s column, The Curious Economist, offers a broader perspective of the health care economic environment, provides information that will strengthen and expand your knowledge, and help you navigate these complex challenges.

We hope you will find this compendium informative and useful.

Curated by Jeffrey T. Mueller, MD, FASA, ASA Vice President for Professional Affairs

 

33% Problem

ASA Commercial Conversion Factor Survey Results – 2023

November 2023
Gordon Morewood, MD, MBA, FASA; Thomas R. Miller, PhD, MBA; Helen Olkaba, MS; Steven Schulman, MD, MHA, FASA; Jennifer Bartlotti Telesz, MD, FASA; Jonathan Gal, MD, MBA, MS, FASA

Get Up, Stand Up – for a United ASA

July 2023
Lois A. Connolly, MD, FACHE, FASA

A Financial Model of the 100% Medicare Practice

June 2023
Johnathan Pregler, MD, FASA; Mahesh Vaidyanathan, MD, MBA; David S. Larsen, MD, FASA; Michael C. Lewis, MD, FASA; Elmer Choi, MD, PhD, MBA, FASA; Christopher J. Young, MD, FASA; Stephen E. Comess, BSN, MHSA

The 33% Problem: A Discussion With Hospital Executives

October 2022
Catlin Nalley

Medicare Payment from MACRO and MICRO Perspectives

August 2021
Sharon Merrick, MS, CCS-P

Payment Progress Series, Part 4: Committee Projects and Member Empowerment

August 2021
Catlin Nalley

Perfect Storm…or Perfect Opportunity?

August 2021
Paul Pomerantz

Payment Progress Series, Part 3: Abusive Insurer Negotiation Techniques

July 2021
Catlin Nalley

The 33% Problem: Why It Matters and What We Can Do About It

May 2021
Catlin Nalley

The 33% Problem: Origins and Actions Committee on Economics 33% Workgroup Report ASA Economic Strategic Plan Initiative—October 2020

December 2020
Johnathan Pregler, MD; Vijay Saluja, MD, MBA, FASA; Mahesh Vaidyanathan, MD; Christopher (Kit) Young, MD, FASA; Jonathan Gal, MD, FASA; Sharon Merrick, MS, CCS-P; Christopher Troianos, MD, FASE, FASA

Meeting the Challenges of Future Payment Systems

July 2019
Jeffrey T. Mueller, MD, FASA

 

Coding

Cigna Policy Change on Modifier QZ Payment

April 2023
Helen Olkaba, MS

2023 Payment Changes for Anesthesia and Pain Services

February 2023
Helen Olkaba, MS

Show Me (More) Than the Money! What You Need from Your Billing Partner in 2022 and Beyond

May 2022
James Lineberger, PhD, MHA, FACMPE, FACHE

Medicare Payment from MACRO and MICRO Perspectives

August 2021
Sharon Merrick, MS, CCS-P

Perfect Storm…or Perfect Opportunity?

August 2021
Paul Pomerantz

HHS/CMS Ongoing Efforts to Reduce Improper Medicare Payments

February 2021
Sharon K. Merrick, M.S., CCS-P

Patient Relationship Modifiers and 2020 MIPS

February 2020
Sharon K. Merrick, M.S., CCS-P

Coding Update for 2020

December 2019
Sharon K. Merrick, M.S., CCS-P

Speaking the Same Language: Why Understanding E/M Services Is Important to Anesthesiologists

August 2018
Sharon K. Merrick, M.S., CCS-P

Potentially Misvalued Codes

February 2018
Sharon K. Merrick, M.S., CCS-P

 

Commercial fees research

ASA Commercial Conversion Factor Survey Results – 2023

November 2023
Gordon Morewood, MD, MBA, FASA; Thomas R. Miller, PhD, MBA; Helen Olkaba, MS; Steven Schulman, MD, MHA, FASA; Jennifer Bartlotti Telesz, MD, FASA; Jonathan Gal, MD, MBA, MS, FASA

Commercial Fees Paid for Anesthesia Services – 2022

October 2022
Stanley W. Stead, MD, MBA, FASA; Sharon K. Merrick, MS, CCS-P

Prepare to Participate in the 2022 Commercial Conversion Factor Survey

April 2022
Stanley W. Stead, MD, MBA, FASA; Sharon Merrick, MS, CCS-P

Physical Status and Qualifying Circumstances

December 2021
Sharon Merrick, MS, CCS-P

ASA Survey Results: Commercial Fees Paid for Anesthesia Services – 2021

October 2021
Stanley W. Stead, MD, MBA, FASA; Sharon K. Merrick, MS, CCS-P

Payment Progress Series, Part 3: Abusive Insurer Negotiation Techniques

July 2021
Catlin Nalley

ASA Survey Results for Commercial Fees Paid for Anesthesia Services - 2020

October 2020
Stanley W. Stead, MD, MBA, FASA; Sharon K. Merrick, M.S., CCS-P

ASA Survey Results for Commercial Fees Paid for Anesthesia Services - 2019

October 2019
Stanley W. Stead, MD, MBA, FASA; Sharon K. Merrick, M.S., CCS-P

ASA Survey Results for Commercial Fees Paid for Anesthesia Services - 2018

October 2018
Stanley W. Stead, MD, MBA, FASA; Sharon K. Merrick, M.S., CCS-P

 

Cost of education and training

Resident Compensation – Who Funds Us and What Is Our Value?

October 2023
Eric Reilly, DO

Is It Worthwhile to Do a Fellowship After Residency?

September 2023
Devin Van Gorden

Finding Residency Positions for Americans Who Train Abroad

September 2023
Tracey Straker, MD, MS, MPH, CBA, FASA

2023 Residency Match: Anesthesiology Is One of the Most Competitive Specialties

August 2023
Jennifer A. Rock-Klotz, MBA; Thomas R. Miller, PhD, MBA

Market Concentration in Health Care

June 2021
Thomas R. Miller, PhD, MBA

Assessing ROI in Education and Training

April 2021
Thomas R. Miller, PhD, MBA

The Economic Barriers to Becoming an Anesthesiologist

July 2020
Jeffrey T. Mueller, MD, FASA

 

Covid economic relief

Covid’s Economic Impact on Your Practices: 2020, 2021 and Beyond

June 2020
Sharon K. Merrick, M.S., CCS-P

 

Perioperative surgical home

Reinventing Anesthetic Care Through Education and PSH Model at UT Health Science Center in Houston

November 2022
Madeline Talbot

A More Efficient, Accessible, and Team-Friendly PSH

September 2022
Christopher Steel, MD

Loma Linda University Health Enhances Care and Outcomes with PSH Learning Collaborative

July 2022
Catlin Nalley

PSH Myths Worth Busting: 10 Years of Change and 6 Misconceptions

July 2022
Rob Shakar, MD, FASA

Tampa General’s PSH Implementation Results in Significant Hospital Improvement

April 2022
Kelly Wolfgang

A Decade of Corporate Support for ASA’s Perioperative Surgical Home Drives Continued Success

March 2022
David M. Brouhard, MD, FASA

Newton-Wellesley Hospital’s SPAN Clinic Optimizes Patient Care Through PSH Model

March 2022
Kelly Wolfgang

The Future is Now: Anesthesiologists Need to Own the Perioperative Process

November 2021
Matthew Dellaquila, MD, MBA, FASA

Mayo Clinic Sees Tangible Gains from Project OASIS Practice Optimization

November 2021
Gordon Glantz

ASA Model Helps Florida’s Lee Health Optimize Perioperative Surgical Care

November 2021
Chuck Holt

Payment Progress Series, Part 4: Committee Projects and Member Empowerment

August 2021
Catlin Nalley

New Hanover Regional Medical Center Shares Successful PSH Program Insights

April 2021
Rob Shakar, MD, FASA; Kim Duggan, MHA, BSN, RN-C

Bellin Health Partners standardizes surgical process with perioperative surgical home

January 2021
Saied Assef, MD; Cindy Suplinski, APNP, ACNS-BC; Ashlee R. Ames, MD, FAAP, FACP, FHM; David M. Brouhard, MD, FASA

Jamaica Hospital Medical Center Sees Benefits with Perioperative Surgical Home Model

November 2020
Jolynn Tumolo

The Complementary Relationship Between the PSH and ERAS

March 2020
Lauren Beck, M., Carol Lee, RN, BSN, Maxime Cannesson, MD, PhD, Nirav Kamdar, MD, MPP, MBA

APMs: Time to Scan the Horizon

August 2019
Sharon K. Merrick, M.S., CCS-P

Meeting the Challenges of Future Payment Systems

July 2019
Jeffrey T. Mueller, MD, FASA

Quality Management and APMs

June 2017
Roseanne Fischoff, MPP; Zach Hochstetler, MPP, MBA

 

practice management considerations

Medicaid: Safety Net or Medical Albatross?

December 2023
Chris D. Glover, MD, MBA, FASA; Jonathan Gal, MD, MBA, MS, FASA; Benjamin L. Antonio, DO, MBA, MA, MSc; Jennifer Bartlotti Telesz, MD, FASA; Harendra Arora, MD, MBA, FASA

Be the Solution: How Anesthesiologists Offer Short- and Long-Term Solutions to Workforce Challenges

November 2023
Mary Dale Peterson, MD, MSHCA, FACHE, FASA

Drug Shortages: How ASA Is Helping Members Navigate an Uncertain Road Ahead

November 2023
Steven Gayer, MD, MBA, FASA; Matthew Goldan; Elizabeth Rebello, RPh, MD, FASA, FACHE, CPPS, CMQ

Resident Compensation – Who Funds Us and What Is Our Value?

October 2023
Eric Reilly, DO

ASA-AHA Partnership to Promote the Value of Anesthesiologists to Health Care Executives

September 2023
Mary Dale Peterson, MD, MHA, FACHE, FASA

Payer for Administration, Education, and Innovation in Anesthesiology

May 2023
Deepak Gupta, MD

The Revenue Sky Is Falling – Are Hospitals the Safety Net?

April 2023 supplement
Amr E. Abouleish, MD, MBA, FASA; Elmer Choi, MD, PhD, MBA, FASA; Jonathan S. Gal, MD, MS, MBA, FASA; Johnathan Pregler, MD, FASA; Shena J. Scott, MBA, FACMPE; Michael B. Simon, MD, MBA, FASA

Geographic Monopolization of Physician Practices and Health Care Systems: Implications for Anesthesiology

April 2023 supplement
George Tewfik, MD, MBA, FASA; Sonya Pease, MD, MBA, FASA; Michael B. Simon, MD, MBA, FASA; Lindsay Sween, MD, MPH; Krishnan S. Ramanujan, MD; Debbie Chi Mokuolu, MD

How Business Will Disrupt Health Care

April 2023 supplement
Christopher A. Steel, MD; Stuart Solomon, MD; Ronald G. Pearl, MD, PhD, FASA; Roya Saffary, MD, FASA; Smitha Arekapudi, MD, MBA, ScM, FASA

Create Your Value Proposition Before You Need It

January 2023
Phillip J. Richardson, MD, MBA, FASA, CPE, FAACD, FACHE; Shena J. Scott, MBA, FACMPE

Hospitals Under Pressure: Showcase How Anesthesiologists Control Costs and Maximize Financial Health

December 2022
Mary Dale Peterson, MD, MHA, FACHE, FASA; Mike Schweitzer, MD, MBA

Responses to 2 Workforce Questions from Curious Readers

November 2022
Thomas R. Miller, PhD, MBA

The Trillion Dollar Six-Pack of Publicly Traded Health Insurance Companies

May 2022
Thomas R. Miller, PhD, MBA

Show Me (More) Than the Money! What You Need from Your Billing Partner in 2022 and Beyond

May 2022
James Lineberger, PhD, MHA, FACMPE, FACHE

Not So Easy: Cost Analysis of Staffing Models of Anesthesia Care

May 2022
Amr E. Abouleish, MD, MBA, FASA

The Anesthesia ‘Employed’ Model: Is This Our Destiny?

May 2022
Michael B. Simon, MD, MBA, FASA

ASA Survey Results: Commercial Fees Paid for Anesthesia Services – 2021

October 2021
Stanley W. Stead, MD, MBA, FASA; Sharon K. Merrick, MS, CCS-P

Anesthesia Practice Finances, 2030

October 2021
Gordon Morewood, MD, MBA, FASE, FASA; Neal H. Cohen, MD, MPH, MS; Sharon K. Merrick, MS, CCS-P

Market Concentration in Health Care

June 2021
Thomas R. Miller, PhD, MBA

Roundtable with ASA’s Payment and Practice Management Physician Leaders

April 2021
Sharon Merrick, MS, CCS-P

Understanding Your Billing and Financial Data: Maximizing the Physician/Administrator Team

January 2020
Genie G. Blough, MPA, FACMPE; Shena J. Scott, MBA, FACMPE

Review the Past and Prepare for the Future

December 2018
Sharon K. Merrick, M.S., CCS-P

 

Quality, data reporting, alternative payment models

Tracking Intraoperative Hypotension: A Measure for Payment and Improvement Purposes

January 2024
Matthew T. Popovich, PhD; James Moore, MD

ASA-AHA Partnership to Promote the Value of Anesthesiologists to Health Care Executives

September 2023
Mary Dale Peterson, MD, MHA, FACHE, FASA

Increasing Physician Engagement: How to Be Compensated for Nonclinical Time

July 2023
Jennifer J. Yuan, MD, MBA; Jason Greenberg, MD; Phillip J. Richardson, MD, MBA, FASA, FACHE, FAACD, CPE

Get Up, Stand Up for a United ASA

July 2023
Lois A. Connolly, MD, FACHE, FASA

Aligning System Goals Through Value-Based Contracting: How Hospital Quality and Efficiency Programs and Co-Management Agreements Help Anesthesiologists Deliver, and Capture, Improved Value

April 2023 supplement
Diana C. Mosquera, MD, MBA; Jonathan S. Gal, MD, MBA, MS, FASA; Dinesh J. Kurian, MD, MBA, FASE, FASA; Steven B. Schulman, MD, MHA, FASA; Saied Assef, MD; Rob Shakar, MD, FASA

The Economics of Equitable Access to Anesthesia Care

April 2023 supplement
Diana C. Mosquera, MD, MBA; Benjamin L. Antonio, DO, MBA, MA, MSc; Larry Lindenbaum, MD; David C. Adams, MD

Prioritizing Measures and Indicators Beyond a Payment Program

March 2023
Matthew T. Popovich, PhD; Katie Wochos, MPPA

Productivity Measurement Variations in Academic vs. Clinical Settings

November 2022
Kelly Wolfgang

Summer 2022 Regulatory Affairs and Quality Measure Update

September 2022
Matthew Goldan, Claire Ostarello, Matthew Popovich, PhD

‘Quality,’ Mediocrity, and Unintended Consequences

July 2022
Karen S. Sibert, MD, FASA

Not So Easy: Cost Analysis of Staffing Models of Anesthesia Care

May 2022
Amr E. Abouleish, MD, MBA, FASA

The Anesthesia ‘Employed’ Model: Is This Our Destiny?

May 2022
Michael B. Simon, MD, MBA, FASA

Quality Reporting for 2022: Performance Threshold Raised to 75 Points

March 2022
Matthew T. Popovich, PhD

Strengthening the Foundation for Anesthesiologist Participation in the Quality Payment Program

November 2021
Matthew T. Popovich, PhD; Claire Ostarello

Payment Progress Series, Part 4: Committee Projects and Member Empowerment

August 2021
Catlin Nalley

Perfect Storm…or Perfect Opportunity?

August 2021
Paul Pomerantz

Ongoing Preparation for a Risk-Based Payment World

July 2021
Jeffrey T. Mueller, MD, FASA

Rescanning the Alternative Payment Model Horizon for Physician Anesthesiologists

June 2021
David P. Martin, MD, PhD, FASA; Vanessa Salcedo, MPH; Sharon K. Merrick, MS, CCS-P

MIPS Value Pathways Present Unknown Opportunities for Individuals and Groups

March 2021
Matthew T. Popovich, PhD

MIPS Reporting During the COVID-19 Pandemic

November 2020
Matthew T. Popovich, PhD

A Piece of the MIPS Pie: Improvement Activities

March 2020
Claire Ostarello; Matthew T. Popovich, PhD

Patient Relationship Modifiers and 2020 MIPS

February 2020
Sharon K. Merrick, M.S., CCS-P

APMs: Time to Scan the Horizon

August 2019
Sharon K. Merrick, M.S., CCS-P

Meeting the Challenges of Future Payment Systems

July 2019
Jeffrey T. Mueller, MD, FASA

June Proposals

June 2018
Sharon K. Merrick, M.S., CCS-P

Quality Performance Beyond MIPS

May 2018
Patrick Reilly

Quality Management and APMs

June 2017
Roseanne Fischoff, MPP; Zach Hochstetler, MPP, MBA

 

Regulatory updates, evaluation and management

Tracking Intraoperative Hypotension: A Measure for Payment and Improvement Purposes

January 2024
Matthew T. Popovich, PhD; James Moore, MD

Medicaid: Safety Net or Medical Albatross?

December 2023
Chris D. Glover, MD, MBA, FASA; Jonathan Gal, MD, MBA, MS, FASA; Benjamin L. Antonio, DO, MBA, MA, MSc; Jennifer Bartlotti Telesz, MD, FASA; Harendra Arora, MD, MBA, FASA

Drug Shortages: How ASA Is Helping Members Navigate an Uncertain Road Ahead

November 2023
Steven Gayer, MD, MBA, FASA; Matthew Goldan; Elizabeth Rebello, RPh, MD, FASA, FACHE, CPPS, CMQ

Interoperability: A Rising Health IT Priority for ASA and Federal Regulators

September 2023
Matthew Goldan; Vikas O'Reilly-Shah, MD, PhD, FASA

How the No Surprises Act Privileges Insurance Companies Over Anesthesiologists – And What ASA Is Doing About It

February 2023
Manuel Bonilla, MS; Michael W. Champeau, MD, FAAP, FASA

Summer 2022 Regulatory Affairs and Quality Measure Update

September 2022
Matthew Goldan, Claire Ostarello, Matthew Popovich, PhD

 

 

Summer 2022 Regulatory Affairs and Quality Measure Update

September 2022
Matthew Goldan, Claire Ostarello, Matthew Popovich, PhD

The Implications of Health Care Reform

June 2021
Catlin Nalley

Trends in Commercial Health Insurance and Implications for Anesthesiology

May 2021
Paul Pomerantz

HHS/CMS Ongoing Efforts to Reduce Improper Medicare Payments

February 2021
Sharon K. Merrick, M.S., CCS-P

2021: Through a Cloudy Crystal Ball

December 2020
Sharon K. Merrick, M.S., CCS-P

Office/Outpatient Evaluation and Management: Changes Ahead

August 2020
Sharon K. Merrick, M.S., CCS-P

Already Looking to 2021

April 2020
Sharon K. Merrick, M.S., CCS-P

Meeting the Challenges of Future Payment Systems

July 2019
Jeffrey T. Mueller, MD, FASA

2019: Unanswered Questions Remain

February 2019
Sharon K. Merrick, M.S., CCS-P

Speaking the Same Language: Why Understanding E/M Services Is Important to Anesthesiologists

August 2018
Sharon K. Merrick, M.S., CCS-P

June Proposals

June 2018
Sharon K. Merrick, M.S., CCS-P

2018: A Busy Year

April 2018
Sharon K. Merrick, M.S., CCS-P

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