Recently, the ImagineSoftware team had the privilege of joining many of the nation’s leading experts in the field of anesthesia billing and practice management at the Institute of Anesthesia Billing and Practice Management (AIABPM) annual conference. As proud corporate supporters of AIABPM, it was a pleasure to share insight and collaboration around the future of anesthesia practices, as well as discuss what is currently taxing physician leaders, practice managers, billers and coders within anesthesia billing and revenue cycle management.
As with many hospital-based specialties and healthcare overall, the challenges faced by independent anesthesia practices today are numerous and all-encompassing. From staffing issues to mergers, acquisitions, and consolidations across hospitals and health systems, the landscape of healthcare is constantly shifting. Added to that is the ever-increasing regulatory environment created by the Centers for Medicare and Medicaid Services’ (CMS) No Surprises Act and other regulations. This can create significant challenges for anesthesia practices, such as payer negotiation breakdowns, reimbursement cuts, and poor patient collections.
To truly evaluate the anesthesia landscape, we first need to outline what it looks like. There are various service models that were highlighted throughout the conference that help to better breakdown what category of employment an anesthesia provider may fall under today. These can include:
- Large national groups
- Independent single-specialty group practice
- Independent multi-specialty group practice
- Locums
- Hospital-owned
Although each model can be inherently different in how they operate, the top challenges all are facing remain very much the same.
Challenge #1 = Staffing
As mentioned regularly throughout numerous sessions, an overarching problem for all these groups, and the anesthesiologists who support them, is staffing. Emphasis was placed on strategies to attract and retain top talent, including a new generation of physicians, along with why staffing issues are seemingly such a struggle. Aside from the current workforce shift coming out of the COVID-19 pandemic, employees remaining loyal to the industry may not be remaining loyal to their practice. A more readily transparent “jump ship” mentality is proving prevalent across the industry, with work/life balance now a major sticking point for employees who refuse to settle. Generational disparities are also becoming more apparent, as younger generations shift from the “work harder” mentality of the baby boomers and instead focus on ways to “work smarter” that help provide better career satisfaction. Anesthesia groups are having to up the ante with compensation and benefits plans, in turn causing a veritable “arms race” for talent. All this uncertainty surrounding the upkeep of a well-staffed office is directly contributing to growth challenges. Many independent groups are struggling to even accept new hospital contracts as they ask themselves, “Will we still have the needed number of physicians or CRNAs employed by the time the contract is negotiated, agreed upon, and signed?”
Challenge #2 = Consolidation
Centering around the topic of hospital contracts, several sessions offered a look at the continued consolidation trend that doesn’t seem to be slowing down. If anything, hospitals and health systems continue to acquire, acquire, and acquire at a steady pace, leading to mergers of “mega systems” that are now changing how they approach anesthesia services. These larger hospital groups are often searching for a single anesthesia practice that is large enough to support their entire business, which can narrow down the playing field considerably. For the hospital, it cuts down on multiple contracts and negotiations. Unfortunately, for the anesthesia providers who can’t support this type of mammoth volume following a merger, they could get passed over. Many hospitals are also looking to purchase and incorporate groups into their systems directly, threatening the independence of anesthesia practices who may struggle to provide services on their own without a guaranteed hospital contract.
Challenge #3 = Regulations & Reimbursement
The healthcare industry is no stranger to government regulations and reimbursement cuts, regardless of specialty. Current regulations, namely relating to the No Surprises Act (NSA), are providing more confusion than ever before for today’s anesthesia practices and leading to “a significant imbalance that benefits insurance companies while harming physicians, especially small- and medium-sized community-based practices” according to an article published by the American Society of Anesthesiologists (ASA). Another topic of interest regarding government proposed regulation included the January 2023 introduction of a Federal Trade Commission (FTC) ban on non-compete agreements in employment. Anesthesiologists are in debate over the pros and cons of such a ruling – some feel non-competes hinder career progression and push providers to look for employment elsewhere, while others feel they protect groups from annual hospital contract renegotiations and acquisition. In addition to these regulatory challenges on the table, practices continue to face payment challenges by being asked to cover more services that are not self-supporting due to poor payer mix or insufficient funding. Many groups feel as though insurers are “strong-arming” them by refusing to enter into meaningful payer negotiations or terminating contracts to try and lower base unit reimbursements. Simply put – increased reimbursement cuts and lower levels of reimbursement on services provided continue to grow, stretching groups too thin as they recover post-pandemic and struggle to do more with less.
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With these challenges also come the added layer that the specialty of anesthesia, as a whole, has been slow to adopt newer technologies, which could truly help alleviate pain points like those outlined above.
Highlighted in a recent Anesthesiology News article, “anesthesiology…relies on unreliable handwritten notes and documents uploaded via a scanner as well as anecdotal data to publish scientific papers.”
To ensure anesthesia practices can stay competitive in the healthcare industry and survive the challenges outlined above, it is essential that they have access to reliable anesthesia billing software solutions and anesthesia practice management software. An in-house anesthesia billing platform, for example, can provide anesthesia practices with the tools they need to manage and process claims efficiently while offering total data control for complete reporting visibility. By streamlining the anesthesia billing process, anesthesia practices can reduce administrative costs while improving accuracy and reimbursement rates.
Furthermore, an anesthesia practice management billing software solution tailored to a practice's unique needs can help simplify workflow processes by automating tasks, providing better visibility into cash flow and collections, and allowing anesthesia practices to stay compliant with the ever-changing regulatory landscape.
In short, anesthesia practices need reliable anesthesia billing software solutions that are tailored to their individual needs to meet the challenges they face today and remain competitive in the healthcare industry. With the right tools and anesthesia practice management software, anesthesia practices can streamline their operations and reduce costs while simultaneously improving patient collections and reimbursement rates.
By investing in anesthesia billing software solutions that are designed to be customizable, anesthesia practices can ensure they have the tools needed for success in the ever-changing healthcare landscape.
Sources:
Anesthesiology News, “What Ails Anesthesiology Today”
American Society of Anesthesiologists, “American Society of Anesthesiologists Proposes Nine Recommendations to Address Flawed Implementation of No Surprises Act”