13 Reimbursement and Business Concepts You Should Know About GI in ASCs

GI and endoscopy continue to be profitable specialties for ASCs in spite of some declines in reimbursement. Here are 13 important reimbursement, business and physician concepts you should know for your ASC.

Reimbursement
1. Reimbursement for GI centers will continue to decrease. As has been the case for the last few years, reimbursements for GI procedures have decreased across the board. This has hit ASCs especially hard as surgery centers often receive reimbursement at a percentage of hospital outpatient departments.

“We anticipate that CMS will continue to pressure facility fees in a downward fashion,” says Barry Tanner, president and CEO of Physicians Endoscopy. “It is at least conceivable that freestanding ASCs could get rates at 50 percent of HOPD rates in the next four to five years.” 

With CMS setting lower rates, a problematic trend could be seen across private insurers and third-party payors as their rates are often set relative to what CMS pays for Medicare-covered procedures. As a result, gastroenterologists and GI-driven ASCs must continue to run their centers efficiently and economically.

“Unfortunately, reimbursements are likely to steadily decline over the next few years,” says Stephen Sears, MD, a gastroenterologist in Loveland, Colo. “This effect will cause ASCs to become more efficient or to stop operating. This may also drive more cases into the hospital setting. By doing so the procedural cost will double and in the end healthcare costs will increase. To remain profitable, the GI physician must focus on delivering quality care in the most efficient manner. That can be done with better bowel preps, training, state of the art technology and assessing quality measures.”

One consequence of decreasing GI reimbursements may be a reduction in the number of Medicare patients a GI ASC sees in a year, according to Fernando Bermudez, MD, medical director, and Beth Miller, administrator, of Eastside Endoscopy Center in Saint Clair Shores, Mich.

“Unless Congress changes the existing rules, Medicare will reduce the professional fees for procedures by 20 percent in 2010,” Dr. Bermudez says. “This won’t directly affect ASCs, but it may affect the willingness of gastroenterologists to perform endoscopies on Medicare patients and to do procedures on Medicare patients in the ASC setting.” 

Irving Pike, MD, president of Gastroenterology Consultants in Virginia Beach, Va., has seen some ways in which physicians at ASCs have tried to combat declines in reimbursement. “Several ambulatory endoscopy centers have reported to me that they have recently negotiated an increased fee schedule from non-government insurance companies. In the past when Medicare payments to facilities were decreased, insurance companies did not follow with similar cuts, but ASC fee schedules remain substantially below HOPD fee schedules. In my opinion, insurance companies do not want to discourage physicians performing endoscopy in ASCs. I think at some point it may be plausible for ASCs to move more CMS cases to the hospital and fill the slots opened at the ASC with patients covered by non-government insured patients,” he says.

2. Gaining access to HOPD rates alone is not reason enough to partner with a hospital. Although partnering with a hospital in order to gain access to outpatient department reimbursement rates can be a potentially attractive strategy, GI-driven ASCs should be aware that they may not receive access to full HOPD rates, although they may be better than current reimbursements. Since many hospitals want to own 100 percent of the GI center, physicians may be asked to give up your ownership and access to future distributions.

“HOPD rates can increase GI center facility revenue 35-40 percent for non-Medicare patients,” says Jon Vick, president of ASCs Inc.. 

“If the GI physicians are going to be owners, then the expectation of getting HOPD rates is misplaced,” Mr. Tanner says. “Better rates may be possible, but HOPD rates are highly unlikely.”

In some cases the hospital and an ASC management development company may form a joint venture that then purchases a 51 percent interest in the center, according to Mr. Vick. “I suggest partnering with a management company first and letting the company negotiate with the hospital as the hospital partner will want to control the deal,” he says. “The management company would then work on the side of the physicians and ensure that the hospital doesn’t ’steamroll’ the physicians into accepting less than the center is worth. Additionally, with the ASC management company managing the center it will retain it efficiencies and economies.” 

It is important to remember when considering this arrangement that even if a physician-owned ASC partners with a hospital, it is still a freestanding ASC and it does not become an HOPD nor does it share in the HOPD reimbursement rates, according to Rick Jacques, president and CEO of Covenant Surgical Partners. “Sometimes, however, a hospital may have such good contracts with third-party payors that a partnership with the hospital would increase the reimbursement rates with payors other than Medicare,” he says.

3. Declining pay may force GI physicians to seek new revenue opportunities. The proposed 21.5 percent cut in the physician fee schedule for specialists, including gastroenterologists, coupled with decreasing reimbursements for GI procedures, may encourage GI physicians to consider additional revenue streams.

“We believe that professional fees will continue to be pressured downward, and GI physicians will be forced to resign themselves to reduced income or to capture a portion of the technical fees,” Mr. Tanner says. “Those GI physicians that have not yet captured a portion of the technical fees through ASC ownership are increasingly under pressure to do so by forming coalitions, mergers with larger groups, etc.” 

General business concerns
1. Good case volume depends on the market. While there is no definitive average number of cases GI centers should see to remain profitable, most GI ASCs have a good referral base from which they can pull patients. However, there are some figures to keep in mind to help you determine if your center is on target.

“The key is to maximize utilization of each available procedure room,” Mr. Tanner says. “There is an average of 251 operating days per year, and full utilization for a GI procedure room operating eight hours each day would be approximately 16 cases per day (30 minute time slots per case) or roughly 4,016 annual cases. Sixteen cases per day is rarely achieved due to cancellations, no shows, etc. However aiming for 80 percent utilization is certainly reasonable (around 3,200 cases annually). Achieving that sort of utilization per room, and assuming that the ASC is not overbuilt, should result in a successful GI ASC.” 

Dr. Sears notes that physicians at the ASC where he practices average 12 procedures per day, or one every 30 minutes.

Mr. Jacques agrees that around 3,000 annual cases can lead to a successful center. “Most physicians [who use GI ASCs] have well-established practices, and it is very unlikely that those cases will go away. The key is keeping your relationships within the community strong,” he says.

2. Some GI centers have benefited from providing anesthesia. In the past, most GI procedures were performed under conscious sedation, which the gastroenterologist administered prior to the procedure, according to Mr. Jacques. Since the patient was not fully sedated, monitoring by an anesthesiologist was not necessary. However, over the past decade, the trend with GI procedures has moved toward monitored anesthesia, using drugs such as propofol, which must be administered by an anesthesiologist or CRNA. 

“I believe that monitored anesthesia care is fast becoming the standard of care,” Mr. Jacques says. “Patients who are under monitored anesthesia often allow physicians to provide a more successful colonoscopy, because they are more comfortable. Under conscious sedation, although the patient may not remember the procedure, they are still awake and uncomfortable, which may cause them to react and compromise how well the colonoscopy is performed.”

Mr. Jacques notes that centers have three options to keep them in compliance with what states mandate regarding anesthesia administration: 1) the physicians who own the ASC arrange to ‘employ’ an anesthesiologist or anesthetist who provides anesthesia through their private practice, 2) the ASC employs its own anesthesiologist or 3) the ASC contracts with an independent anesthesiology practice. 

However, anesthesia is not covered for many GI procedures, so some gastroenterologists have benefited by directing the administration by propofol. Mr. Tanner cautions that if physicians choose to do this, they must be aware of the regulations in their area regarding anesthesia administration.

Dr. Pike also notes a trend towards anesthesia in GI procedures but cautions that colonoscopies performed while the patient is under propofol have not been indicated for use by many gastroenterology societies. 

“It is true some ASCs have turned to various models of anesthesia as an additional source of revenue,” he says. “I have seen information estimating that currently 40 percent of GI endoscopy is performed with deep sedation involving propofol. One concern I have about this practice is that as the total cost of GI endoscopy increases due to the additional cost of providing anesthesia [and] the payment for both the professional fee for the endoscopy and anesthesia will be cut to control overall cost to insurers. It should be noted that the three GI societies have jointly written a letter indicating the opinion deep sedation with propofol administered by anesthesiologists or CRNAs is not warranted for standard GI endoscopic procedures.”

3. Beware of potential kickback scenarios with contract anesthesia companies. As more GI centers consider providing anesthesia services, they may look to an outside company to assist them with the process. Mr. Jacques warns that some companies may enter into joint ventures with GI centers in ways that “push the envelope” with regard to the law.

“Some companies have been extremely aggressive when approaching gastroenterologists about these joint ventures,” he says. “We’ve seen gastroenterologists approached at a much higher rate over the past 1.5 years. Some scenarios have the company essentially providing kickbacks to the gastroenterologists for the contract to provide anesthesiology services to the center. The government is now looking very hard at these ‘pay for play’ arrangements.” 

Procedures and gastroenterologist issues
1. The number of procedures performed per endoscopy case can lead to lower reimbursements for secondary procedures. According to Mr. Tanner, the typical number of procedures per endoscopy case is 1.10-1.20. Many payors, including Medicare, often reimburse any secondary procedures at a much lower rate, which can affect revenue and efficiency in the ASC.

“The number of procedures per case impacts upon revenue per case because for many payors, the second and third procedures are reimbursed at half and then 25 percent of the first procedure,” Mr. Tanner says. “Therefore, valuable procedure room time is being utilized at an ever decreasing rate. If the facility is essentially fully utilized, the impact is not as strong; however, if an ASC is struggling with utilization, then it may not be profitable to perform these secondary procedures at one time.” 

2. Payment data for some of the most common procedures in GI ASCs. Here are 2008 CMS payment data for some of the most commonly performed GI procedures in ASCs.

Upper stomach-intestine scope for biopsy (CPT 43239)

• average submitted charge: $1,451
• average allowed charge $408
• average payment: $321

Scope of colon for diagnosis (CPT 45378)

• average submitted charge: $1,502
• average allowed charge: $422
• average payment: $330

Scope of colon with biopsy (CPT 45380)

• average submitted charge: $1,549
• average allowed charge: $406
• average payment: $318

3. With the number of certified gastroenterologists decreasing, it is important to focus on recruiting. As with many medical professionals, the number of practicing gastroenterologists is decreasing as physicians retire or leave practice, and the number of GI physicians coming out of medical school is not enough to sustain the rate of departing physicians. A recent New York Times report indicated an additional 1,050 GI physicians is needed by 2020 to meet the demand, with current employment around 10,390 as reported in the Times. According to Mr. Tanner, around 20 percent (2,000-2,500) of practicing GI physicians are at or close to retirement, and only 300 GI fellows graduate each year. Thus, competition for new, talented GI physicians is high.

“Recruiting new physicians is difficult especially because there is such a demand for their services,” Mr. Tanner says. “They can literally pick a place on the map where they want to work and go there with near certainty of getting a good job. This makes it more difficult for smaller, more out of the mainstream communities to find and recruit GI physicians. Many physicians graduating today are seeking a better quality of life, and, for them, the employment model is a better option.”

Although the outlook for recruiting new physicians may seem grim, Mr. Tanner notes some new physicians may be looking for options outside of the employment model. “There are still many entrepreneurial physicians not seeking employment, but they are looking for ownership in an ASC knowing that the ASC will be responsible for a significant portion of their total medical practice income,” he says.

4. Single-specialty GI ASCs have a lot to offer gastroenterologists. Although some concern has been raised by the trend of many specialists and practices seeking employment with local hospitals, single-specialty GI ASCs offer gastroenterologists an additional source of income and autonomy that may not be available through the hospital. As a result, ASCs should demonstrate the potential benefits of ASC ownership to physicians looking to partner with the center.

“Many GI physicians who have ownership in a single-specialty ASC earn a substantial amount of ancillary income from their ASC ownership, sometimes as much as they earn from their professional fees,” Mr. Jacques says. “A single-specialty ASC is an excellent recruiting tool for practices, because it gives the practice the ability to offer new physicians ownership in the center. A hospital trying to recruit physicians to their [facility] might not be able to offer the new physician the same ancillary income potential an independently-owned, single-specialty ASC can. Typically, once a hospital buys a physician practice and ASC, the physician income decreases substantially.” 

Dr. Sears notes that some GI specialists may turn to the hospital to avoid feeling the financial hit of reduced reimbursements, but that reason alone is not enough for all GI physicians to turn away from private practice and ASCs. “I feel that remaining as a private practitioner, I have more to offer than as a salaried hospital employee,” he says. “In order to keep the edge on the hospitals, we will need to focus on an equivalent or better product for the same cost. Patients will be able to see what procedures cost at different facilities and in the future may refuse to be treated in the hospital setting due to the additional charges.”

5. Although GI physicians aren’t running to the hospitals, primary care physicians are. Primary care physicians, who refer cases to gastroenterologists, are increasingly employed by hospitals. As a result, GI centers and their physicians should develop a positive relationship with hospitals.

“We have seen a significant number of PCPs employed by the hospitals,” says Dr. Bermudez. “This gives the hospitals significant leverage in the referral pattern to specialists, and it is very important that specialists, including gastroenterologists, maintain a good relationship with the hospital and work more like a partner than a competitor.”

6. Surgery centers should look to grow their referral base. When it comes to recruiting new physicians to your surgery center, looking within the local community still remains one of the best tactics. According to Mr. Jacques, there are probably unaffiliated physicians nearby who would jump at the opportunity to invest and perform cases at a single-specialty center, if approached properly and given a fair proposal.

“In order to grow, you also need to expand your referral base,” Mr. Jacques says. “Look into the areas of the community that are not getting screened for colon cancer. The same tried and true techniques that have worked in building a physician’s practice are still successful. Make sure you are consistently making call backs and follow-ups to local referring physicians.”

7. Salary information for gastroenterologists. In respect to other surgical and medical specialties, salaries for gastroenterologists have increased at an average rate. For example, the median salary in 2008 was $389,385, up 3.93 percent from 2007, compared with a 6.58 percent increase for ophthalmologists and a 5.80 percent for orthopedic surgeons over the same period, according to data from the American Medical Group Association’s 2009 Medical Group Compensation and Financial Survey. The average starting salary for GI physicians was $275,000, according to the same report.

Here are regional median salaries for gastroenterologists, according to the AMGA:

• East — $401,615
• West — $385,611
• South — $385,542
• North — $394,417

Arkansas Physician Assistant Sentenced in Healthcare Fraud Scheme

Geffrey Alan Yielding of Jacksonville, Ark., was sentenced to 78 months imprisonment for his role in a healthcare fraud scheme, which in he was convicted of violating the healthcare anti-kickback statute and for falsifying document to conceal the fraud, according to a release from the Department of Justice.

Mr. Yielding was convicted in April 2009. According to the charges, Mr. Yielding and his now-deceased wife, Kelley Yielding, received commissions from the sales of Orthofix bone growth stimulators and Osteotech allograph bone to Baptist Health Medical Center – North Little Rock during the years 2003 and 2004. Those commissions, earned by Ms. Yielding through her company, Advanced Neurophysiology, which was a distributor for both companies, totaled in excess of $380,000. During this time period, Mr. Yielding was employed as a physician assistant for Richard Jordan, MD, a North Little Rock neurosurgeon, which enabled Mr. Yielding to dictate what products were ordered for use in surgeries performed by Dr. Jordan at Baptist NLR.

As part of the scheme, Mr. Yielding bribed Baptist NLR charge nurse Jordan Wall to order excessive amounts of the products for which Ms. Yielding would receive commissions, according to the release. When the nurse was terminated, Mr. Yielding created a fraudulent promissory note in an effort to disguise the bribes as a loan. Mr. Wall pleaded guilty to making a false statement to a federal agent and was sentenced to a term of probation and a fine, according to the release.

In imposing the sentence, the Court further considered the amount of monies paid by Baptist NLR for the products Mr. Wall ordered in exchange for the bribes as well as the loss to Baptist NLR’s insurer, Travelers Insurance, of $131,300 based on a claim it paid to Baptist NLR for fraud loss, according to the release. Finally, the Court held Mr. Yielding accountable for causing false claims to be filed with federal healthcare programs in an aggregate amount exceeding $740,000.

Mr. Yielding received sentence enhancements for both obstructing justice and for his aggravating role as a leader or organizer of the criminal activity. According to the release, Mr. Yielding’s obstruction of justice occurred in Dec. 2004 when he aided and abetted Mr. Wall in falsifying the promissory note.

As a part of Mr. Yielding’s sentence, he was ordered to make restitution in the amount of $944,995.84 to Baptist NLR, Travelers Insurance, Medicare, Medicaid and TriCare for their respective losses, according to the release. He will begin his sentence on March 8.

This investigation was conducted by the Little Rock Field Office of the Federal Bureau of Investigation and the Office of Inspector General for the Department of Health and Human Services. United States Attorney Jane Duke, Assistant United States Attorneys Laura Hoey and Karen Whatley represented the United States in this matter, with the assistance of legal intern, Josh Robles.

Read the DOJ’s release on Geffrey Alan Yielding (pdf).

First Surgery Performed Using Integra Spine’s Pedicle Screw System

Plainsboro, N.J.-based Integra LifeSciences, a leader in regenerative medicine, has announced that the first surgery using Integra Spine’s Paramount Pedicle Screw System for minimally invasive spine surgery was performed by Andrew Parkinson, MD, of Orthopedic Associates of Oklahoma City (Okla.), according to an Integra news release.

The surgery was performed on a patient with degenerative disc disease in the L5-S1 disc space, according to the release.

Paramount Pedicle Screw System features a unique rod delivery method, where the rod is already attached to the polyaxial head, helping to streamline the fusion procedure and reduce the number of operative steps for the surgeon, according to the release. The system also features a novel compression/distraction system and a robust rod reduction system and uses a proprietary non-cannulated screw design with a K-wire guided tip for accurate screw placement and enhanced screw strength.

The Paramount system allows surgeons to use minimally-invasive techniques in order to place the pedicle screws through a percutaneous tube, according to the release. Patient benefits may include faster procedures, reduced blood loss, less tissue trauma, reduced postoperative pain and a shorter hospital stay, due to the minimally-invasive procedure.

Read the release on the first Paramount Pedicle Screw System procedure.

National Surgical Hospitals Opens New Surgical Hospital in Corpus Christi, Texas

Chicago-based National Surgical Hospitals, an owner, operator and developer of surgical hospitals and surgery centers in partnership with local physicians, has opened its newest surgical hospital, South Texas Surgical Hospital, in Corpus Christi, Texas, according to an NSH news release.

The 63,000-square-foot surgical hospital, adjacent to the Company’s Coastal Bend Surgery Center, is equipped with five operating rooms and 33 inpatient beds, according to the release. Surgeons will provide a range multi-specialty surgical care, including orthopedics, general surgery, gynecology, otolaryngology and other surgical specialties.

NSH will operate the new hospital in partnership with a group of 55 area physicians. This is the company’s fifteenth surgical hospital and its fifth surgical hospital in Texas.

“Like all of our surgical hospitals, South Texas offers a specialized approach to quality healthcare, playing an important role in the continuum of surgical care,” John G. Rex-Waller, chairman, president and CEO of NSH, said in the release. “We think our ability to offer expanded healthcare choices to consumers in South Texas will bring greater cost efficiency and convenience to the area while creating increased practice efficiencies for the surgeons who utilize our facility.”

Read the release on South Texas Surgical Hospital.

Learn more about National Surgical Hospitals.

Risk Calculators Increasingly Used to Determine Appropriateness for Surgery

A tool to calculate surgery risks for a particular patient is being used in heart surgery and will eventually be adopted to other surgical specialties, but access is still limited to mainly larger hospitals, according to a report by the Wall Street Journal.

The American College of Surgeons, which developed the heart surgery tool, recently introduced a similar tool for surgery of the colon and pancreas and plans to eventually cover 20 different types of surgery.

Surgeons enter the patient’s risk variables and receive a customized report outlining the risk of death and specific complications. The colorectal risk calculator, for example, is based on 15 variables, including age, body mass index, the extent of disease and how much of the colon must be removed.

Calculations are based on data from more than one million patient records gathered by National Surgical Quality Improvement Program, which works with hospitals to reduce surgical errors and complications.

The college adapted the tool from a Veterans Administration program that reduced deaths from surgery at VA hospitals by 27 percent and complications by 45 percent.

However, access to the college’s risk calculator is limited to about 250 mostly large hospitals that are in its National Surgical Quality Improvement Program, which charges $35,000 a year to participating institutions.

Read Wall Street Journal’s report on the surgical risk calculator.

Moving Orthopedic Trauma Services Outside the Hospital Setting: Q & A With Dr. Alejandro Badia

Alejandro Badia, MD, FACS, a Miami-based orthopedic surgeon and founder of the Badia Hand to Shoulder Center, a fully integrated facility that offers clinical, imaging, surgery and rehabilitation services for the upper limb, who is also the chief of hand surgery at Baptist Hospital in Miami, and founder of OrthoNow, discusses the emerging trend of offering orthopedic trauma services to patients outside of the hospital emergency room.

5 Best Specialties for ASCs Now

1. Orthopedics. Rising ASC reimbursement for orthopedic surgery is transforming a sometimes break-even field into a money-making one, says William G. Southwick, president and CEO of HealthMark Partners in Nashville. For example, shoulder surgery used to be so underfunded it needed to be supplemented by income from other procedures, he says. Now, under Medicare’s ambulatory payment classification system, reimbursement for orthopedic ASCs is expected to increase 100 percent.

Orthopedics, along with otolaryngology and general surgery, is on Mr. Southwick’s list of specialties with enhanced value for ASCs. “These specialties are good for Medicare patients and are saving the healthcare system significant dollars,” he says.

Jerry Ippolito, director of perioperative services business development at Southeast Anesthesiology, Charlotte, N.C., also puts orthopedics at or near the top of his list. “Orthopedics is a big winner under APCs,” he says. “It has some lucrative cases, such as knee arthroscopies and it is not isolated to one payor population.” For example, while total joint procedures focus on Medicare patients, “some of the most severe joint injuries happen to younger people who are on private insurance,” Mr. Ippolito says.

2. Spine. Naya Kehayes, CEO of Eveia Health Consulting & Management in Issaquah, Wash., sees a great deal of promise for this specialty. “Spine is probably the newest, biggest most costly surgery done in the hospital that can be done outpatient,” she says, but she cautions that ASCs should contact payors before deciding to add any specialty. “The biggest mistake an ASC can make is to buy all the equipment and then talk to the insurer,” she says. Ms. Kehayes also sees great potential for ASCs that add cochlear implants, vaginal hysterectomies and some of the larger urology cases to their list of procedures..

Robert S. Bray Jr., MD, a neurosurgeon who runs a spine ASC in California, believes that “the future of spine surgery is in the ASC. “Spine will literally be a game-changer for ASCs in the next 10 years.” He warns that ORs have to be larger than at the average ASC to accommodate spine surgery equipment and ORs have to be “ultra clean,” so they cannot be shared with specialties like gastroenterology. And it takes a while to convince insurers that spine can be performed safely in an outpatient setting, he says.

3. Bariatrics. Along with spine and retina, bariatrics is on Mr. Southwick’s list of specialties with growing value for ASCs because they have been slowly moving out of the hospital setting. Laparoscopic gastric band procedures, or lap-bands, are the only bariatic procedures that are typically performed in an ASC, he says. In contrast, he says gastric bypass surgery requires two or three days of hospitalization and costs a great deal more.

Mr. Southwick notes that the recession has dampened demand for lap-bands, which cost $10,000-$15,000 and are often paid by the patient out of pocket. But popularity is expected to rebound, because an estimated 5-7 percent of the population is eligible for bariatric surgery.

However, “keep in mind that bariatrics needs the whole array of services [for the ASC] to be a bariatric center of excellence,” warns Ms. Kehayes. These include patient support services and features such as patient-lifting equipment, wide doorways, floor-supported toilets and sensitivity training for the staff.

4. Retina. Many ophthalmology ASCs limited to cataract surgery are adding retina surgery, which is usually handled by a separate subspecialty of some 1,300 ophthalmologists. These procedures are longer and more complicated and, until recently, were almost always done in the hospital.

While retina is now safe to do in ASCs, ophthalmology surgeons were discouraged from moving out of the hospital by low reimbursements that didn’t cover costs in the ASC. However, under the new Medicare APC system, retina payments will rise 100 percent, according to Leo T. Neu III, MD, a retina surgeon who runs an ASC in Springfield, Mo. He says the average payment for a standard pars plana vitrectomy, the most common retina procedure, will rise 145 percent by 2011, to $1,540.

On the professional fee side, Dr. Neu adds that declining reimbursement for some retinal procedures will lure retinal surgeons out of the hospital and into the ASC. For example, Dr. Neu reports that the Medicare professional fee for a vitrectomy with epiretinal membrane peeling fell by 24 percent in 2008.

5. Pain management. Along with gastroenterology and ophthalmology, pain management is on Mr. Southwick’s list of specialties with continued value for ASCs. “These specialties continue to be successful in ASCs, if expenses are managed carefully, even as reimbursements for them are cut,” he says. While most of the cutting has been due to Medicare APCs, “private payors are beginning to reflect those cuts,” he says.

Even though reimbursement to ASCs for pain management will fall 2 percent under APCs, volume is rising. A study conducted last year by KNG Health Consulting found that pain management was one of the few ASC-based specialties where most of the new procedures in centers were not simply moving out of the hospital. While 77-95 percent of new volume in orthopedics, ophthalmology and other specialties came from hospitals, the figure for pain cases was 15 percent. The new volume represents “significant changes in insurance coverage and advancement in the pain management clinical treatments [that] have evolved in the past seven years,” the study said.

8 Statistics About Orthopedic Surgeon Compensation-

Here is the median compensation for orthopedic surgeons for 2005-2008, according to the AMGA 2009 Medical Group Compensation and Financial Survey.

• 2008 — $476,083
• 2007 — $450,000
• Percent change 2007-2008 — 5.08 percent
• 2006 — $436,481
• Percent change 2006-2008 — 9.07 percent
• 2005 — $409,518
• Percent change 2005-2008 — 16.25 percent
• Dollar change 2005-2008 — $66,565

To order a copy of the complete 2009 Medical Group Compensation and Financial Survey, click here.

Reprinted with permission from the AMGA 2009 Medical Group Compensation and Financial Survey. ©2009,American Medical Group Association.

Federal Report Shows Physician Supply Won’t Keep Pace With Demand

In the next decade, physician supply won’t keep up with rising demand for physician services, according to a 2008 report by the U.S. Health Resources and Services Administration. The HRSA report projected trends in physician supply and demand from 2005-2020.

Number of physicians will rise by 16 percent. Physician supply will rise from 817,000 active physicians under age 75 in 2005 to a projected 952,000 active physicians by 2020, an increase of 135,000 physicians.

Hours of physician services will rise by 13 percent. Total hours of physician services will increase at a lower rate than numbers of physicians because more physicians are women or older, and these groups typically work fewer hours.

Demand for physician services will rise by at least 22 percent. Growth in demand will be highest among physicians who predominantly serve the elderly, such as cardiologists, internists and most surgeons. 

Demand for physician services may rise more rapidly. Demand could increase above baseline projections due to growing public expectations for healthcare and enhanced ability to pay for higher levels of care.

Several factors may narrow the supply-demand gap. These factors include:

• improvements in physician productivity, such as EHRs;
• scientific advances that can contribute to improved health, such as prescription drugs; and
• increased use of non-physician clinicians, such as nurse practitioners, physician assistants and certified registered nurse anesthetists.

See the HRSA report

Case Study: Creating an Anesthesia Staffing Model to Handle Increased ASC Case Volume

A multi-specialty surgery center had outgrown its currently location was relocating to a new facility capable of handling double the ASC’s current case load. In order to prepare for an increase in procedures, the ASC had to ensure that they could competently meet the demands this growth would have on anesthesia services.

Somnia Anesthesia Services was brought in to oversee this transition. Immediately, an anesthesia team was placed in the old facility to become familiar with the ASC’s surgeons and their practices. Creating an efficient staffing model to facilitate the center’s expansion from five rooms to 11 was also necessary to ensure patient and surgeon.

By creating this model, the center was able to double its procedures to 11,400 annually.

Read the complete case study on providing effective anesthesia staffing to increase case volume (pdf).

Learn more about Somnia Anesthesia Services.

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