Once again, the American Society of Anesthesiologists (ASA) has released their annual ASA Commercial Payer Survey results for 2018. Overall, the 2018 national average conversion factor was $76.32, ranging between $73.26 and $81.32 across participating practices’ top five commercial plans. This represents a decrease from 2017, when the average commercial conversion factor was $78.57 nationwide, ranging between $70.87 and $83.38.
By way of comparison, the 2018 national Medicare conversion factor for anesthesia services is $22.1887, or about 29.1 percent of the average commercial factor. In 2017, the Medicare conversion rate was $22.0454, which was about 28.1 percent of the 2017 overall mean commercial conversion factor.
The survey is disseminated each June, asking providers to report conversion factors of their top five commercial contracts, the percentage of total patient volume each contract represents, and basic demographic information. In 2018, 254 practices representing 45 states responded. Those practices reported on a total of 962 managed care contracts, a 4 percent increase over the 919 managed contracts reported on in 2017.
Of the responding practices, demographic information was provided by 220, which employ or contract with the following: 6,935 full-time equivalents physician anesthesiologists, 7,763 FTE nurse anesthetists, and 776 FTE anesthesiologist assistants. As well, those practices work with the following additional staff not directly employed by them: 685 FTE nurse anesthetists and 46 FTE AAs.
A few other interesting findings from the survey:
- 928 of the contracts are based on a 15-minute unit, eight on a 12-minute unit, 16 are based upon a 10-minute unit, and 10 are based upon an 8-minute unit.
- In 2018, 108 of 254 groups, or 42.5 percent, negotiated at least one flat fee contract, down from 51.6 percent in 2017.
- More than 37.4 percent of the respondents have flat fee contracts for labor and delivery, down from 44 percent in 2017.
- When dividing the US into four regions, the average conversion factors are (in order from highest to lowest): East – $82.22; Midwest – $76.21; South – $75.38; West – $70.35.
- The average commercial factor in Indiana is $68.60, lower than the average for all states in MGMA’s “Eastern Midwest” region, whose average commercial factor was $69.11 in 2018, down from $72.29 in 2017.
- Every region and nearly every contract category had a conversion factor high of at least $110.00, down from $112.07 in 2017.
- The highest conversion factor reported was $230.00, down from $280.00 in 2017.
This data about commercial fees is more than just interesting. It becomes most meaningful when you use it to help manage your anesthesia practice. As we’ve recommended in past years, here are three ways to use this data in your own practice:
Compare your own reimbursement to these numbers, particularly your top five payers. The full report breaks down the numbers by region and state. How do you compare to other practices in your region?
Armed with the data about how you compare with other practices in your region, approach your commercial payer representatives to begin renegotiating your contracts. For payers that are reimbursing at lower rates compared to your own payer mix, provide redacted reports showing how they compare with other major payers in your area.
Not only do these conversion factor averages help you negotiate for greater reimbursement from your contracted plans, they can also help you ensure your chargemaster is in line with industry averages. When is the last time you evaluated or updated your per unit charge amount? What about flat fee procedures?
Curious to learn more about how you can harness the power of payer information to improve your bottom line? Contact CIPROMS today to discuss more options.
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