Each October, the American Society of Anesthesiologists (ASA) releases their ASA Commercial Conversion Factor survey results. In 2016, about the time the results were released, the Centers for Medicare and Medicaid Services (CMS) also unveiled their MACRA final rule, which took us down another path for the past few months.
Before the 2017 ASA commercial surveys are distributed this summer, we thought we’d take a look at the 2016 results and the state of commercial payments.
Overall, the 2016 national average conversion factor was $71.02, ranging between $68.33 and $74.36 across each practice’s top five commercial plans. Compare that to 2015, when the average commercial conversion factor was $71.92 nationwide, ranging between $69.64 and $74.29. Based on these findings, the ASA has determined that reimbursement has “remained essentially unchanged.”
By way of comparison, the 2016 national Medicare conversion factor for anesthesia services was $21.9935, or about 30.9 person of the average commercial factor. In 2015, the Medicare conversation rate was $22.6093 (after July 1, 2015), which is about 31 percent of the 2015 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 2016, 204 practices responded, which employ or contract with the following: 5,886.6 full-time equivalents physician anesthesiologists, 5,135.8 FTE nurse anesthetists, and 496.2 FTE anesthesiologist assistants. As well, those practices work with the following additional staff not directly employed by them: 817.9 FTE nurse anesthetists and 15 FTE AAs. Respondents reported data on a total of 809 managed care contracts or 2.5 percent more in 2015.
A few other interesting findings from the survey:
- One hundred seventeen of the 204 groups (57.4 percent) negotiated at least one flat fee contract, down from 61.7 percent in 2015.
- More than 51 percent of the respondents have flat fee contracts for labor and delivery.
- When dividing the US into four regions, the conversion factors are (in order from highest to lowest): East – $76.24; South – $72.14; Midwest – $68.18; West – $66.91.
- Using the Minor Geographic Regions as identified by the Medical Group Management Association (MGMA), Indiana falls within the “Eastern Midwest,” whose average commercial factor was $65.00 in 2016.
- Every region and nearly every contract category had a conversion factor high of at least $97.00.
- The highest conversion factor reported was $182.00.
This data about commercial fees is more than just interesting. It becomes most meaningful when you use it to help manage your anesthesia practice. Here are three ways to start:
Benchmark
Compare your own reimbursement to these numbers, particularly your top five payers. The full report (download here) breaks down the numbers by region and state. How do you compare to other practices in your region?
Renegotiate
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.
Update
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? Don’t leave money on the table by undercharging for your services.
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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