Town Hall The Time for Action is Now June 29 2021 Housekeeping For this broadcast your camera and microphone have been disabled We encourage you to interact with other participants in the Chat located at the bottom of the broadcast window ID: 997785
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1. The Future of Anesthesiology Payment Town Hall: The Time for Action is Now! June 29, 2021
2. HousekeepingFor this broadcast, your camera and microphone have been disabled. We encourage you to interact with other participants in the Chat, located at the bottom of the broadcast window.Submit questions to the panel using the Q&A box at the bottom of the broadcast window, not through the Chat.If you have technical issues, please close your browser and restart the webinar – or perhaps move closer to your router.We are recording this broadcast today and will be adding the full video to the ASA website to view on demand or share with your colleagues within the next 24-48 hours.asahq.org
3. DisclaimerAs a reminder, the items we discuss today are provided for informational purposes only and do not constitute medical or legal advice. As always, you should consult with your own medical and legal counsel.asahq.org
4. Panelistsasahq.org
5. Overview and History of the ASA Payment Progress InitiativeJeffrey T. Mueller, MD, FASAVice President for Professional Affairs
6. Motivation for Payment Progress InitiativeSecuring adequate payment for anesthesiology services is becoming increasingly more challenging!Payment Progress Initiative Goal:Ensure equitable current and future payments to anesthesiologists through the development of measures and models that capture and express the value of what anesthesiologists do; Right historical wrongs in government payment models; Direct and influence policy to uphold the economic viability of the specialty.asahq.org
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8. Payment Progress Initiative’s Areas of FocusThe Medicare 33 Percent problem directly or indirectly impacts the three areas of focus.Direct ImpactMedicare Potential Expansion of Medicare eligibility “Public Option”Use of Medicare rates as a benchmark for out of network payment ratesIndirect ImpactInadequate insurance networks driving out-of-network billingSurprise medical billsasahq.org
9. Medicare Conversion Factor – With and Without Inflation Adjustments and Commercial Anesthesia Conversion FactorCPI Inflation Calculator Source: U.S. Bureau of Labor Statistics
10. In Depth Work In Each Focus Area33 Percent ProblemJohnathan Pregler, MDChair of the 33% Problem WorkgroupMedicare Public OptionNeal Cohen, MD, MPH, MSChair, Section on Professional PracticeSurprise Medical BillsMichael Champeau, MD, FASAASA First Vice Presidentasahq.org
11. Committee on Economics 33% Problem Workgroup Johnathan Pregler, MDMedical Director of Operative Services, UCLA HealthClinical Professor of Anesthesiology
12. Workgroup ChargeIncrease our members' understanding of the 33% Problem enabling them to more effectively negotiate their Private Payer Fee for Service (FFS) contracts and make them more prepared to claim fair/appropriate payment in both public and private sector APMs and Value-based Payment methods.asahq.org
13. Workgroup Membersasahq.orgJohnathan Pregler, MD, ChairBenjamin Antonio, DO, MBAJana McAlister, CAAStephen Comess, BSN, MHSAVijay Saluja, MD, MBA, FASAJonathan Gal, MD, MBA, MS, FASAMarc Steurer, MD, MHATal Levy, MD, MBAMahesh Vaidyanathan, MDMichael Lewis, MD, FASAEric Werner, MD, FASADavid Martin, MD, PhD, FASAChristopher (Kit) Young, MD, FASA
14. 33% ProblemMedicare values anesthesia services at less than 33% of commercial insurance payments, while valuing other specialty services at 80% of commercial rates.Confirmed by U.S. Government Accountability Office (GAO) reportsASA annual commercial conversion factor surveysasahq.org
15. Action Itemasahq.orgStanley W. Stead, MD, MBA, FASA Sharon K. Merrick, MS,CCS-P: ASA Survey Results for Commercial Fees Paid for Anesthesia Services-2020. ASA Monitor. October 2020, Vol 84, 1-29.2021 Survey in field until July 9, 2021Please participate!!!!!!!www.asahq.org/advocacy-and-asapac/fda-and-washington-alerts/washington-alerts/2021/06/2021-asa-conversion-factor-survey
16. 33% Workgroup: Accomplishments to Dateasahq.orgOrigins and Actions PaperResponse to U.S. Government Accountability Office’s October 2020 ReportLead off article in ASA Payment Progress Series
17. The 33% Problem: Origins and ActionsFull analysis into:How the problem came to be, ASA previous steps and successes in addressing it, andRecommendations on future actions ASA can consider. Details submitted for AC/EC considerationasahq.org
18. Response to October 2020 GAO ReportExpressed appreciation that GAO confirmed that Medicare payments are significantly lower than private payer payments for physician anesthesiologists’ services – and that the gap is widening.Offered additional details that support the case that Medicare undervalues anesthesia care.Provided arguments that commercial payment is set at an appropriate market rate and represents a more accurate valuation of anesthesia care.Countered GAO conclusion that the payment disparity is due to “strong negotiating position”.asahq.org
19. Corrections have been made but still more to doIncreasingly challenging environmentAging populationMedicare expansionBudget constraintsOther specialties strengthening their efforts to increase payment for services their members performFurther refinement of potential next steps toward payment equityasahq.orgPayment Progress Series – The 33% Problem: Why It Matters and What We Can Do About It
20. June 2021 Request for Proposal (RFP)Examine Medicare payments for professional anesthesia services.Guidance on potential changes to the billing/payment methodology.asahq.org
21. Requested AnalysesAnalysis 1Compare Medicare Part B Fee for Service (FFS) payment rates with per anesthesia unit compensation of anesthesia professionals for other government payers.Analysis 2Comparison between Medicare Part B FFS and the effected per unit payment for anesthesia in Rural Pass Through (RPT) hospitals.Analysis 3Evaluate risks and benefits of changing anesthesia billing/payment methodology to be more in line with rest of medicine.asahq.org
22. Time Frame (proposed)asahq.org
23. 33% Workgroup Continuing WorkContainment strategy developmentMedicare – current and developing payment methodsPrivate PayersHealth SystemsToolkit materials for ASA membersPodcastsWebinars asahq.org
24. Thank youasahq.org
25. Addressing the Impact of a Public Option on Anesthesiologists’ PracticesNeal Cohen, MD, MPH, MSChair, ASA Ad Hoc Committee on Medicare for All
26. ASA Ad Hoc Committee on Medicare for AllCommittee ChargeEvaluate the implications for anesthesia practices of all proposed government-managed health insurance plans Facilitate ASA preparedness to respond to any proposals, particularly those that tie anesthesia payment to Medicare ratesCommittee MembersRose Berkun, MD, FASA Mark Brady, MD, FASA Stephen Comess, BSN, MHSAJonathan Gal, MD, MBA, MS, FASA Robert Hsiung, MD, FASANeal Cohen, MD, MPH, MS, Chair asahq.org
27. Medicare FFS Ratesasahq.org
28. ASA Ad Hoc Committee on Medicare for All Initial committee discussions took place prior to the election, concentrating on implications of Medicare for AllRequest for Proposals (RFP) 2019Selected Milliman in early 2020 to model the economic impacts of expanded Medicare payment rates on anesthesiologists’ paymentBiden election and change in Congressional composition allowed Ad Hoc Committee to include analysis of the “Public Option”Final revisions to Milliman assessment are being completed to provide the ASA with an analysis to utilize for discussions with legislators and othersasahq.org
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30. Public Option vs. Medicare for Allasahq.orgOpt-inLow-incomePre-existing ConditionsFunding methodCoverage includedCostsavingsCompeting plansMedicare for Allnoyesyestax-fundedessential health benefitsoverall cost reductionnonePublic Optionyesyesyestax-funded or individual-fundedessential health benefitspossible cost reductionprivate plans
31. Congressional Proposals for a Public OptionMedicare X (S. 386, H.R. 1227)Choose Medicare Act (S. 1180)Health Care Improvement Act of 2021 (S. 352)CHOICE Act (S. 983, H.R. 2085)asahq.org
32. Salient Features of Existing Proposals Uninsured individuals, families, and small businesses Initial offering in areas with high-cost or fewer plans Medicare/Medicaid enrolled providersIncreased reimbursement for physicians and hospitals in rural areasAlternative Payment Models, value-based insurance designMedicare FFS ratesBronze, silver, and gold tiersImprove premium tax credits Federal funding to investigate anticompetitive practices in health care marketOnly S. 352 (Health Care Improvement Act of 2021) features competitive payment rates, taking into account commercial rates and provider costsasahq.org
33. Key Committee Chairs Issue Public OptionRequest for Information asahq.org
34. Potential Areas of DiscussionScope of coverage Premium subsidies & funding Federal vs. State market exchangesImpact on private and employer-sponsored insurance Impact on Medicaid and MedicareCompetition in the private market Physician participation Physician reimbursementStrategies to mitigate the impact on anesthesiology payments asahq.org
35. Public Options: Next Stepsasahq.orgFinalize Milliman Report and Its ImplicationsRespond to Congressional RFIContinue to Monitor Federal and State Proposals for Public Option(s)Educate Legislators about Impact of Public Options and Payment Modelson Anesthesia Practices and Patient CareEngage ASA Members in Advocacy Efforts
36. ASA Ad Hoc Committee on Medicare for AllThank YouNeal Cohen, MD, MPH, MScohenN@ucsf.eduasahq.org
37. Surprise Medical BillsMichael Champeau, MD, FASAASA First Vice President
38. Federal Surprise Medical Bill LawBackgroundCongressional interestMultiple Congressional and White House proposals 2017-2020“No Surprises Act” CompromiseEnacted December 27, 2020Effective January 1, 2022 asahq.org
39. “No Surprises Act” = Big DealHow will this new law work?Covers Federal ERISA plans (large employer, union plans)State regulated plans in states that do not have a state lawProhibits balance billing for out-of-network services – no balance bills!Creates mechanism to resolve out-of-network payment disputes between the physician and insurerInitial/interim payment30-day negotiation periodIndependent dispute resolution/arbitration process“Baseball-style” arbitration processasahq.org
40. “No Surprises Act” Rulemaking Exampleasahq.org- “No Surprises Act” Text
41. “No Surprises Act” RulemakingRulemaking entitiesDepartment of Health and Human ServicesCenters for Medicare and Medicaid ServicesCenter for Consumer Information and Insurance Oversight (CCIIO)Department of Labor (ERISA)Department of Treasuryasahq.org
42. Some Questions to be Resolved in RulemakingHow does the federal law interact with your state law?Example: What happens in a state that doesn’t have an IDR process like the ‘No Surprises Act?” How will the IDR process work?How will the benchmark median-in-network amount be defined?What are the mechanisms in place to prevent insurers from gaming the process?How will physicians be able to batch or bundle similar claims they wish to dispute?What special consideration do anesthesiologists require?asahq.org
43. ASA Communication with Biden AdministrationPrioritiesFair IDR processAccuracy of Qualified Payment Amount (median in-network amount) Audits on insurers to prevent gaming of the processFree anesthesiologists from administrative burdens of new lawEnsure that anesthesiologists have access to a strong IDR processSpecial considerations for anesthesiologists – Use anesthesia conversion factorUse anesthesia CPT coding families for bundlesBatching by individual or groupasahq.org
44. Other ASA Leadership ActivitiesRecent activitiesWorking with physician coalition on shared issuesASA leadership meeting with Center for Consumer Information and Insurance Oversight (CCIIO)ASA meeting with CCIIO contractor studying IDR processContractor interviewing anesthesiology practice experts on IDR processes asahq.org
45. Next stepsComing soonComment opportunities Continue to follow ASA communications including Dr. Philip’s “Monday Morning Outreach”asahq.org
46. Payment Progress Resources and Educational Assets
47. asahq.org/paymentOne-stop-source for exploring the economic issues facing anesthesiologists, and how ASA is responding Eight ASA Governance bodies contribute to the educational resources, programs, and initiativesVisit often and bookmark this site!
48. asahq.org/paymentInteractive payment literacy quiz is a fun way to test your knowledge Take the quiz today to see how you stack up!
49. asahq.org/paymentInformative one-sheeters explain the three key economic issues:33% ProblemSurprise Medical BillingThe Public Option Download them today and share with colleagues!
50. asahq.org/paymentInfographic visually, concisely explains the history of the 33% problem and next steps Download it today to see how we got here!
51. asahq.org/paymentASA Monitor® compendium offers a curated list of articles about economics and paymentIncludes 4-part series May-August Get versed in all things pertaining to economics & payment: Start reading today!
52. Keep in mind..."33% Problem" Request for proposalASA containment strategyPublic Option Formal response to Congressional inquirySurprise Medical Bills – No Surprises ActBe ready! Public comment period coming soon Stay Informedasahq.org/payment – Visit often and bookmark this site!asahq.org