Anesthesia Provider Pay to Drop 60%

[Screen name]

http://online.wsj.com/article/SB10001424052970204683204574358281875211014.html

Incredibly, Congress's proposed health-care reform plan risks skimping on anesthesia. According to one of the health-care bills in Congress, H.R. 3200, the public option would reduce reimbursement for anesthesia by over 50%.

How do you think Healthcare Reform is going to effect the field of anesthesia?

From another blog:

I am shocked that no one is commenting on the potential impact of President Obama's Healthcare reform. As many of you may be aware, under the current proposals, payment of Anesthesiolgists and CRNAs will be a Medicare rates which are about 30% the level of private insurance. My state Anesthesiologist association projects that the bottom-line affect for most anesthesiologists will be a 50% cut in reimbursement. It is a foregone conclusion that in order to compete with the government option, private insurers will drop their reimbursement to the same levels as government.

Now Mr. Orzak, President Obama's budget director, states that there will be further 20% cuts in physician reimbursement in the future. This means that an Anesthesiologists or CRNAs income will be cut 60%.

Don't know if this is still active, but this tries to exempt anesthesia from the reform rates. All anesthesia providers can sign...

http://www.theanesthesiablog.com/2009/10/health-care-reform-updated-daily-well.html

[FLAreN]

Well if it makes any difference I was offered a competitive salary WITH a sign-on bonus AFTER the health care bill passed. I was hired by a private anesthesia group and not a government entity nor am I considered a hospital employee. If they were scared of the health care bill and not getting reimbursed, I definitely wouldn't have gotten a sign-on bonus. The facility is in a metro area.

[loveanesthesia]

If its legal to practice independently in some states, its obviously not unsafe to go without MD supervision and far cheaper to go with advanced practice nurses.

It is legal to practice as a CRNA without medical direction of an anesthesiologists in all the states. Medical direction by an anesthesiologist is not required anywhere for CRNAs and is very inefficient. The more efficient practice is anesthesiologists and CRNA working together independently, billing independently. Billing fraud is a huge issue in medical direction, ask any CRNA working in an ACT. It is almost impossible to keep an OR running efficiently and meet the 7 requirements to bill for medical direction. Now any individual can look for medicare billing fraud and keep a percentage of the money that they uncover.

[Screen name]

As for salary decreases, I highly doubt significant pay cuts for CRNA's or for nurses. There will come a time when hospitals will not be able to fill the "competent shoes" necessary for ICU (and other highly skilled nurses) as well as CRNA's. Moreover, if so many people eventually get this "Obamacare", hospitals will absolutely need to hire MORE people to work in these positions. All it will take will be a few deaths and resultant lawsuits by families, unions and even hospitals and you will see the political landscape quickly understand the importance of having well trained professionals. This will take place at both the federal and state levels.

The hospital I'm currently working at is CUTTING employees and REDUCING hours, especially for RN's. This is the only level 1 trauma center within about a 50-75 mile radius. I was told by an ICU RN the other day that getting a job at that hospital when I'm near graduation is going to be very hard, even with the connections and steps I've taken so far; and being placed the ICU is going to be 10x harder, despite already teching there for 6 months. Basically there are not going to be near enough slots for the two graduating RN programs in town between the two hospitals anymore. This particular hospital is already preparing for the reform. Good or bad move... I'm not sure.

Well if it makes any difference I was offered a competitive salary WITH a sign-on bonus AFTER the health care bill passed. I was hired by a private anesthesia group and not a government entity nor am I considered a hospital employee. If they were scared of the health care bill and not getting reimbursed, I definitely wouldn't have gotten a sign-on bonus. The facility is in a metro area.

BUT, no one has been effected yet. Yes, the bill made it past congress, but it still has about 8 months before the next step - so it hasn't actually passed yet. It is NOT law... and that is when we will see things begin to change. Congrats on the job though! I hope I'm as lucky! :)

[Class2011]

Hi Love, is that something new with the reporting of medicare fraud. I wonder about the particulars. Can it be done anonymously and can one be assured that anonymity will be protected. I also wonder if medicare gets swamped with so many reports that they never investigate but a small percent.

Either way, as we expand coverage, I would like to see medicare get serious about reducing fraud. It would leave more money in the system for honest providers and patients. But they also have to amend requirements that can't be met in the real world. (If that means getting rid of the ACT, I won't mind.)

[loveanesthesia]

Hi Love, is that something new with the reporting of medicare fraud. I wonder about the particulars. Can it be done anonymously and can one be assured that anonymity will be protected. I also wonder if medicare gets swamped with so many reports that they never investigate but a small percent.

Either way, as we expand coverage, I would like to see medicare get serious about reducing fraud. It would leave more money in the system for honest providers and patients. But they also have to amend requirements that can't be met in the real world. (If that means getting rid of the ACT, I won't mind.)

A billing consultant told us about it, and I think it is relatively new. Our group is not an ACT, and she said great then you don't need to worry nearly as much, because everyone bills independently and the regulations are much easier to follow that way. (you can still commit fraud if your documentation is inaccurate)

As I understand it, you must spend the time and have the expertise to provide the documentation that proves the fraud, medicare doesn't have the staff to do it, but they have created an avenue where it could be very profitable to do it on your own time. Somehow you can access to medicare billing data, and then comb through it to look for fraud. Kind of like an attorney taking a case on contingency, you may spend weeks to months and have nothing to show, or you may hit the jackpot. Some anesthesia groups have been hit with billing fraud and it is not pretty. I think it would be very time consuming and difficult, but there are some motivated people out there.

[Class2011]

Sounds like they're hoping some will make a career out of it. Perhaps debt collecting/medical billing companies would like that line of work.

I was imagining more on the line of whistle blower laws and rewards (which from what I understand don't protect the individual well at all).

Either way, the best ways to reduce fraud are 1) making it easier to be honest then to cheat, which means having realistic reporting requirements 2) making it more likely that cheats will be caught.

[RN1980]

all this is mute. private insurance rates will soon be so astronomical that nobody will be able to aford them and will have to switch over to obamacare for financial survival. this mean a reduced reimbursement for both hospital employed anesthesia providers and private practice doc's. i fully agree with paindocs rationale for only accepting cases that will reimburse the most, pure basic economics. but in future yrs his base patients that historically was covered with private insurance will have swapped over to cheaper obamacare and daily schedule may look like 90% obamacare and 3% private and 7% uncovered. obamacare, bad for you and bad for me.

[wtbcrna, MSN, DNP, CRNA]

all this is mute. private insurance rates will soon be so astronomical that nobody will be able to aford them and will have to switch over to obamacare for financial survival. this mean a reduced reimbursement for both hospital employed anesthesia providers and private practice doc's. i fully agree with paindocs rationale for only accepting cases that will reimburse the most, pure basic economics. but in future yrs his base patients that historically was covered with private insurance will have swapped over to cheaper obamacare and daily schedule may look like 90% obamacare and 3% private and 7% uncovered. obamacare, bad for you and bad for me.

I think I will listen to the AANA one of the most powerful anesthesia organizations in the country which is not predicting a cut in pay or a dramatic increase in private insurance rates. You may want to look a some neutral assessments on healthcare before spouting pure speculations on here. http://moneywatch.bnet.com/economic-news/article/health-care-reform-summary-who-wins-and-who-loses/406279/

[RN1980]

my information is from our revnue management and insurance billing managers along with other personel that deal with insurance issues on a dailey basis with regards to collecting fee and other reimbursements. do you really think that private insurance companies will not have to dramatically increase premiums in order to offset x number of former clients that have jumped ship to obamacare. what will this rate increase do to the remaining groups of people or employers that are barely able to meet their insurance group payments right now? it will make them jump to obamacare and buy into it.

[wtbcrna, MSN, DNP, CRNA]

my information is from our revnue management and insurance billing managers along with other personel that deal with insurance issues on a dailey basis with regards to collecting fee and other reimbursements. do you really think that private insurance companies will not have to dramatically increase premiums in order to offset x number of former clients that have jumped ship to obamacare. what will this rate increase do to the remaining groups of people or employers that are barely able to meet their insurance group payments right now? it will make them jump to obamacare and buy into it.

Do you really think a couple of people at your work know more than one of the largest anesthesia organizations in the country or economists around the US?

This is nothing more than fear mongering which the republicans are basing their whole campaign on right now. You should at least provide some solid facts/links if you are going to make outrageous comments like these. By the way people with large company plans weren't going to be able to switch to the gov't option anyways. It was meant mostly for people without insurance and small business owners.

By the way is this the public option that you are talking about?

http://www.nytimes.com/info/public-health-insurance-option/

"The Endgame

In early March, House and Senate leaders settled on a strategy that involved having the House pass the Senate bill along with a "sidecar'' of compromises and fixes that the Senate could pass under reconciliation -- which did not include a public option. On March 22d, the House passed both measures.

When the "sidecar'' landed back in the Senate, Democrats resisted a late, last round of pressure from liberal advocates to include the public option in the legislation, saying they were willing to take their winnings and call it a day. The public option, they said, could wait for another day, another vote, another fight-even though the parliamentary process playing out on the Senate floor gave them a rare chance to enact it with a simple majority, a chance unlikely to come around again soon."

[Jdog19s]

As I understand it, people who already have insurance no matter how expensive it may be are not eligible for Obamacare. Only those without current insurance and only about 30 million of the 45 million in need are to be covered. These are the same 30 million people that currently no one, including anesthesia, is getting reimbursed for- thus we raise the cost of everyone else who receives our services. So, its doubtful now that we actually greatly increase the number of people giving us some sort of reimbursement, compared with no reimbursement, is going to drop our pay- and definitely not by such extremes as 60%-

[suarc]

I have read most of the replies on the post and am completely amazed. I can understand the concern expressed in regards to salaries of the CRNA's because we all have bills to pay and families to support.

However I am shocked no one seems to appreciate the help that this bill will provide to those who are not as fortunate as to make 60k a year yeah we all worked hard to get where we are, but everyone's circumstances in life is merely that "their circumstance". As care giver's who hopefully went into the field for what they could do to help others first and financial stability second some of these replies seem self indulgent.

Secondly, the figures and numbers expressed are highly skeptical to say the least, as evidenced by the post by wtbcrna and based of what I read in the monthly journal released by the AANA who strongly support the "Health Reform Bill". This is one of the few countries that it appears we seek to be MD's, nurses, or CRNA's for profit first instead of to spread healthier practices to our fellow americans through education and expceptional care. Just in case anyone was unaware you already take a cut in pay, when you pay that increasing insurance coverage amount caused from the misuse of ER's and etc. At least with this bill eventually those who are able to afford insurance will be required to cover themselves, decrease the costs for those struggling to maintain coverage and those who are unable will be given the assisstance they need. Hopefully the next step will be to promote prevention and maybe we will become a healthier country, afterall what good is 180k if you die from a MI!