AANA Mid-Year Assembly
Crystal Gateway Marriott
April 14-17, 2013
Doubletree Seattle Airport
April 26-28, 2013
The Mirage, Las Vegas
August 10-13, 2013
Click here for more.
2013 NW States Anesthesia Conference
Davenport Hotel, Spokane
September 13-15, 2013
2013 AANA Fall Leadership Academy
Eden Roc Renaissance Miami Beach
Miami Beach, FL
November 8-10, 2013
Photo galleries from 2012 events are available online:
Greetings from WANA
Challenges and Opportunities: The last year has been very challenging for the nurse anesthesia profession on both the practice and business aspects of anesthesia. With massive changes in the system and pressure to reduce costs, the sea change has started.
The challenges in Washington State have been in reimbursement for services denied after the fact for endoscopy and other procedural anesthetics. Some states have experienced complete denial for CRNA anesthetics. Out of state "Anesthesia Management Organizations" from eastern states have aggressively pushed the takeover of "all CRNA practices" in Washington and most western states. Competition for the shrinking healthcare dollar for anesthesia services will be fierce. A review and understanding of the healthcare reform trends and recent laws is essential.
In 2015, the expenditure on healthcare will be 18-20% of the GDP ($4 trillion plus). In 2005, it was 16% of the GDP ($2 trillion). Forty-seven million Americans are uninsured and this number is rising, and out-of-pocket costs have increased 140%. Insurance costs for employers have doubled compared to the inflation rate and more than four times the increase in salaries. Medicare, Medicaid, and social security will account for more than 50% of federal spending in one year, 2014! The operating margins of the top five insurance companies are trending up since 2006 to 2012. Forty-two states have budget deficits. Washington State is in the second highest tier at 10-20% budget deficit in 2012 (Center on Budget and Policy Priorities). Outpatient and Inpatient surgeries declined by 0.2% and 0.4% respectively while uncompensated care volumes in 2011 went up by 1.7% (Center on Budget and Policy Priorities). From March 2001 to March 2010 a comparison of the percentage change in employment cost index for all private industry versus hospitals was 27% and 38% respectively (Bureau of Labor Statistics). The effect of improved life expectancy is so crucial to costs in the future when you realize that the life expectancy was 62.9 years in 1940 and now is 79.4-80 years in 2011 we are paying for progress (National Center for Health Care Statistics/CDC). The patients that we are caring for are much sicker using the CMI (inpatient case-mix index) went from 0.97 in 2000 to 1.18 in 2008 (AHA). The statistics regarding self-restraint of consumption of healthcare has steadily declined, though (one payer) European healthcare use statistics historically have increased when someone else is paying. Knee replacements decreased 18.6% from 2007-2010 and doctors office visits decreased 1.8% since 2010. Regulatory, compliance, and administrative costs for hospitals are mounting by the day. In Washington State, by last count there are 23 state agencies and 24 federal agencies to deal with (WDOH, AHA). The cost of care nationally is growing faster than and has a greater effect than GDP, an effect of the aging population (CBO, "The Long Term Outlook for Healthcare Spending"). So, the fixed costs for hospitals are increasing while reimbursements are rapidly decreasing. Hospitals are delaying capital improvements and reducing administrative and medical/nursing staff.
Reimbursement changes will evolve due to these market and governmental forces mentioned. Some of the government driven changes we already know. CMS comparison data will be the basis for Value Based Care reimbursement (SKIP data, quality care core measurements on certain DRGs) or 70%. The remainder 30% will be based on HCAHPS Patient Satisfaction. State healthcare insurance exchanges will be established by January 2014 (well on their way in Washington State). Expect decreased reimbursement for readmission within 30 days for certain DRGs (heart attack, stroke, pneumonia, embolism, infection, etc.).
NQF (preventable errors) are errors that are "identifiable, preventable, and serious in consequence"; a partial list includes retained object, air embolism, blood incompatibility, UTI, pressure ulcer, central line infection, surgical infections, and hospital acquired injuries will result in decreased reimbursement.
Payment models will continue to use financial incentives to encourage evidence based practice. P4P value based purchasing basically offers financial bonuses, penalties, and withholds based on outcomes or process performance. If total expense of care is less than the target cost, Accountable Care Organizations (ACO) get the difference and the ACO is responsible for disbursement to the stakeholders.
One of the possibilities in 2013 is that the Sustainable Growth Rate (SGR) formula will rear its head again 31 December 2012, due to when the SGR extension was passed last year. The GAO study in 2010 showed the Medicare and private pay differences. Anesthesia was paid 40% of private payments compared to 87% of other specialists. CRNAs predominate in high Medicare population areas and where the pay is less.
The AANA has developed a new position, State Reimbursement Director, to help members deal with all the different changes that have developed and will certainly continue to develop over the next few years. WANA is pleased to announce that Dan Simonson, CRNA has accepted this role for Washington State.
It is evident that this is the time to get active, to get a place at the table, and a voice at the Federal and Washington State level. The WANA web site will change over the next few months to assist members to be better advocates at this crucial time in our history.
Patrick Corbett, CRNA, ARNP
7710 E. Woodland Lane
Spokane, WA 99212
Tel/Fax (509) 466-7197
WANA IS LOOKING
WANA maintains a list of CRNA/MDA speakers available from Washington State. If any of you are interested in speaking or know of available speakers in the field of anesthesia, health care, or wellness, please respond by e-mail to WANA Executive Secretary JoAnn Kaiser at firstname.lastname@example.org. The speaker list is very helpful when planning Fall and Spring WANA educational meetings.
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