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8 ASC MANAGEMENT 17 Facts and Concepts for Anesthesiologists and ASCs By Laura Dyrda H ere are 17 facts and trends about anes- thesiologists and anesthesia in ambu- latory surgery centers. By the numbers 1. ere are 29,220 anesthesiologists in the United States, according to the Bureau of La- bor Statistics. 2. U.S. News & World Report ranked anesthe- siologists at the No. 1 best paying job with the average salary at $187,200. e job market is also positive, with the unemployment rate among anesthesiologists at 1.7 percent and the field is expected to grow 21 percent through 2024, adding 71,000 new jobs. 3. ree-fourths of anesthesiologists are male, according to a LocumTenens.com report, and 83 percent are board certified. Twenty-three percent of anesthesiologists have worked on a locum tenens basis and 25 percent have spent five years or less in clinical practice. 4. Anesthesiologists in healthcare organizations receive the highest compensation, in excess of $100,000 more than office-based solo practitio- ners. Here is the breakdown of anesthesiologist compensation based on the Medscape Anesthe- siologist Compensation Report 2016: • Healthcare organization: $438,000 • Office-based single specialty group prac- tice: $398,000 • Hospital: $364,000 • Office-based multispecialty group prac- tice: $358,000 • Outpatient clinic: $338,000 • Office-based solo practice: $281,000 • Academic, research, military, govern- ment: $273,000 5. e employment status of anesthesiologists, according to LocumTenens.com, is: • Hospital employed: 34 percent • Group practice: 18 percent • Academic: 22 percent 6. Somnia Anesthesia's "e Anesthesia La- bor Market 2014: Trends and Analysis" report projected shortage of 3,000 anesthesiologists by 2025. e findings are based on a RAND Corp. briefing to the American Society of An- esthesiologists and are consistent with previ- ous projections. According to the report, the regions with the most persistent anesthesi- ologist shortage are the Pacific West and Mid- west, with the Northeast and Mountain West regions following closely behind. e most desired states to practice anesthesia were Florida, Texas and California, which are also among the top five states where Ameri- cans prefer to live. 7. e Anesthesia Quality Institute's National Anesthesia Clinical Outcomes Registry re- ports the number of anesthesia cases taking place outside of the operating room increased from 2010 to 2014. In 2010, there were 5.9 million — or 28 percent of anesthesia cases — taking place outside of the operating room and that number grew to 12.4 million — or 36 percent of anesthesia cases — by 2014. 8. According to a report from the ASA Com- mittee on Professional Liability, most anesthe- siologists carry insurance policies that limit $1 million per occurrence and $3 million per year. Last year, 64 percent of companies sur- veyed reported that arrangement as their most common policy; 32 percent said their most common policy had higher limits. Seventy-five percent of the companies offered claims-made policies. 9. e average certified nurse anesthetist in the United States makes $160,250 annually, according to the Bureau of Labor Statistics. Montana has the highest average salary for CRNAs at $243,550, followed by New Hamp- shire, Wyoming, Wisconsin and California. 10. ere were four major CPT coding up- dates for 2017, according to an Anesthesia Business consultants report. e codes distin- guish whether the procedure included image guidance. e crosswalk from the old to the new codes is: • Cervical and thoracic single shot injec- tion (CPT 62310) • New code with image guidance: 62321 • New code without image guid- ance: 62320 • Lumbar single shot injection (CPT 62311) • New code with image guidance: 62323 • New code without image guid- ance: 62322 • Cervical or thoracic epidural catheter (62318) • New code with image guidance: 62325 • New code without image guid- ance: 62324 • Lumbar epidural catheter (CPT 62319) • New code with image guidance: 62327 • New code without image guid- ance: 62326 Key trends Anesthesiologists are seeing several changes in their practice as healthcare moves toward value-based payment models. Vincent J. Vila- si, MD, MBA, Mid-Atlantic CEO of North American Partners in Anesthesia, discusses the key challenges and opportunities for anes- thesiologists moving forward. 11. Surgeons are performing higher acuity cases in the ASC, including total joint replace- ments and spinal fusions. While surgeons and hospitals have a financial incentive to move cases to an ASC setting, anesthesiologists must make sure the patient selection is ap- propriate. It's important for anesthesiologists to guard against pushing the envelope beyond where they are comfortable with outpatient procedures. e ideal patients for outpatient procedures are otherwise healthy and will be able to return home with minimal risk of pain, nausea and bleeding. 12. Anesthesia groups are diversifying outside of hospitals. Many anesthesia groups now contract with ASCs as well as hospitals. is helps to offset the loss of commercial insurance cases migrating from hospitals to ASCs. "e anesthesia group loses those commercial cases from the hospital and the cases that backfill in that space are more complicated and oen tilted towards Medicare pay rates," says Dr. Vilasi. "is can make it dif- ficult for hospital-only anesthesia practices to remain viable while compensating staff in a com- petitive marketplace." Having the infrastructure to support a nation- wide network, NAPA has the ability to flex staff across multiple facilities, while smaller groups don't have the resources to do so. 13. Anesthesiologists are becoming more in- volved in reducing readmissions. Anesthesi- ologists need to take a leadership role in patient selection for bundled patient cases. "We want to partner with our hospitals and ASCs to reduce costs. Bundled payments are eroded by readmis- sions or discharge to acute rehab facilities," says Dr. Vilasi. "Our partners look to us to help with patient selection, patient education and utiliza- tion of the latest anesthesia techniques to reduce length of stay, minimize postoperative pain and allow for early ambulation." A unique differentiator for NAPA is its regional anesthesia programs which have demonstrated the ability to reduce length of stay and improve HCAHPS scores, both of which result in in- creased earnings for the facility. Patients receive nerve blocks and catheter placement for postop- erative pain control in addition to prophylactic