AANA Urges Medicare to Consider Hospital Anesthesiology Efficiency Measures
The AANA has recommended that Medicare consider the costs of various anesthesia delivery models and of hospital anesthesia subsidies per anesthetizing location as part of quality measures intended to capture the efficiency of hospital anesthesia services.
The June 21 letter, signed by President Janice Izlar, CRNA, DNAP, stated, "The Agency may want to consider the costs of meeting the seven medical direction steps as part of the anesthesiology spending and cost-efficiency measure. Under the medical direction practice model, the medical directing anesthesiologist must complete seven steps in order to bill for this modality. The Agency has clearly stated that medical direction is a condition for payment for anesthesiologist services and not a quality standard."
The AANA discussed the ways that the requirements associated with anesthesiologist medical direction claims contribute to healthcare cost growth, noting specifically the requirement that the anesthesiologist be "present at induction." "For every minute spent waiting for an anesthesiologist to arrive and be present at induction, some of the costliest resources in the hospital are wasted. The clock is running on the surgeon, circulating nurse, scrub tech, and nurse anesthetist waiting in the operating room. Waiting costs cascade throughout the day, postponing the surgery schedule to require overtime and on-call staff, delaying the surgeon's rounds to affect patient care and discharge of the patient from the healthcare facility. Waiting costs also add opportunity costs, diverting needed resources from other patient care," continued the letter.
The letter also recommends including the cost per anesthetizing location as part of the proposed anesthesiology measure since hospitals pay an average of $160,096 per anesthetizing location to anesthesiology groups, and increasing the weight placed on clinical process of care measures, such as the Surgical Care Improvement Project (SCIP) measures, under the hospital value based purchasing program.
