Five Key Issues Anesthesia Groups Are Currently Facing
Co-authors:
Daniel J. Marino, Lumina Health Partners
Andrew Woodmancey, Anesthesia Operations Consultants
In today’s dynamic healthcare environment, along with a continued shortage of anesthesia providers, anesthesia groups face a myriad of challenges that are reshaping their financial landscape. From contracting woes to recruitment dilemmas, these groups are encountering obstacles that demand innovative solutions. Let’s dive into five critical issues confronting anesthesia groups impacting their financial performance.
1. Payor Contracting Issues
The process of contracting with payors has always been fraught with complexities for anesthesia groups. However, with the implementation of the No Surprise Billing Act, the equation has become even more complicated. Aimed at protecting patients from unforeseen medical bills, the act has inadvertently impacted the financial stability of many anesthesia providers.
Aligning anesthesia billing with contracted market rates ensures that anesthesia providers are compensated fairly and competitively for their services, reflecting the current market dynamics and regional variations. By billing with the QZ modifier, which relates to anesthesia services provided by a Certified Registered Nurse Anesthetist (CRNA) without the supervision of a physician, groups can optimize revenue streams and ensure appropriate reimbursement for CRNA-administered anesthesia care. Regularly reviewing anesthesia payor contracts adjusting billing practices in line with market trends is vital for financial sustainability.
2. RCM Performance
Revenue Cycle Management (RCM) is the lifeblood of any medical practice. However, anesthesia groups face unique challenges in their RCM processes due to their distinctive operational structures. Unlike other specialties, anesthesia billing involves intricate aligned preauthorization with surgical partners, calculations of correct reimbursement, including time units, surgical procedure codes, and modifiers. These complexities often result in high denials, delayed reimbursements, and revenue leakage. To bolster their RCM performance, anesthesia groups must invest in specialized billing solutions, sound RCM processes, continuous staff training and timely provider enrollment procedures to ensure accurate and timely claim submission practices.
3. Provider Compensation and Recruitment Issues
The medical community is witnessing a low anesthesia unemployment rate, making the recruitment landscape incredibly competitive. Additionally, a significant change has emerged in the CRNA realm. The shift from a two-year master’s program to a 3-year doctorate program for CRNAs is affecting the pool of available talent. While the change was instituted to enhance the quality of education, it has unintentionally reduced the influx of new CRNAs in the short term. Anesthesia groups are grappling with not just recruiting top talent, but also ensuring competitive compensation packages that retain them. It’s
a balancing act, one that requires foresight and adaptability. The group must have the proper balance between variance pay, bonus structure, and salary to retain staff and optime overall performance.
4. Cultural Integration
Culture isn’t just about the aesthetics of an organization; it’s the very fabric that holds groups together. Many anesthesia groups, especially those undergoing mergers or expansions, struggle with cultural integration. Disparate practices, differing values, and varied operational methods can lead to internal discord, hampering patient care and employee satisfaction. It’s vital for anesthesia groups to prioritize cultural assimilation to foster an environment of open communication, mutual respect, and shared values. Groups must equip their leaders and focus on leadership development to build a healthy, sustainable team.
5. Performance Analytics
In our data-driven age, harnessing the power of analytics is critical to both operational and financial success. Anesthesia groups, however, often struggle with look at the right metrics and leveraging performance analytics to their advantage. By neglecting this, they miss out on insights that can revolutionize their service delivery, operational efficiency, and patient satisfaction levels. Embracing analytics can aid anesthesia groups to pinpoint areas of improvement, predict trends, and make informed decisions. An example of this is evaluating prior authorization of surgical cases. By analyzing anesthesia revenue cycle performance analytics, RCM leaders can work with their surgical counterparts to ensure the surgical prior authorization number is obtain and included on the anesthesia service claim. Without staying on top of prior-authorization process through performance analytics, denied claims will increase collections will decrease affecting overall financial performance of the anesthesia group.
The road ahead for anesthesia groups is filled with challenges, but they don’t have to face them alone. Focusing on these 5 core practices will support Anesthesia providers as they continue to navigate through the many financial challenges.
This article, jointly published by Lumina Health Partners and Anesthesia Operations Consultants, underscores the importance of professional guidance in these tumultuous times. We offer a suite of services tailored to address these specific issues and empower anesthesia groups to navigate complexities with confidence.
Please visit our website:
Lumina Health Partners – https://www.luminahp.com/
Anesthesia Operations Consultants – https://anesthesiaoperationsconsultants.com/