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Anesthesia: Pain Relief for Your COVID-19, OR Revenue Headaches

October 29, 2021

Each COVID-19 wave of cases, and each COVID-19 variant, has wrought tragic consequences, both clinical and financial. Healthcare organizations continue to reel from the first two waves as personnel shortages, emotional fatigue, and revenue scarcities linger. More recent Delta and Lambda variants appear poised to unleash another potent wave, despite the efforts of vaccine research and deployment.

On its website, the American Hospital Association (“AHA”) shares that the estimated revenue loss from the first wave exceeds $161 billion from March to June 2020. In other words, in 120 days the first wave erased $175,000 for each of the 919,000 U.S. staffed, medical beds (AHA, 2021). As hospitals search for financial viability against this staggering loss and razor-thin margins, every dollar matters.

COVID-19 revenue loss stems primarily from cessation of non-emergency surgeries While the return of voluntary cases has provided a revenue jump-start, two questions loom: Is the pent-up demand sufficient to bridge the gaps in lost revenue? What if another wave not only halts the current recovery; but exacerbates prior revenue loss?

“Anesthesia can help boost my revenue!” is probably not the first thought that comes to mind when pondering the remedy to financial loss due to COVID-19. In fact, it is likely the opposite may have come to mind. Anesthesia, like many peri-operative services, is often perceived as an “overhead,” or business expense. This mindset, however, obscures a helpful reality behind a curtain of ingrained belief. Using a few key facts to pull back that curtain of belief a bit reveals that anesthesia can be a tool for financial recovery; not a revenue drain.

Beyond the obvious formula of surgeon + anesthesiologist/anesthetist = what’s necessary for most surgeries; consider the following incremental facility fees and subsidy/salary offsetting options. An experienced anesthesia management partner like Premier Anesthesia will ensure the move from suggestions to bottom-line buffering realities.

GI cases are increasingly being performed with 100% anesthesia. Patient recovery, case time, and surgeon satisfaction are helping drive this trend. It is worth noting that the increasing number of physicians completing medical school and residencies with an expectation that anesthesia will be a component in all cases, will quickly cement the trend into a norm. While many insurers will still balk at reimbursement when patients are healthy; remember anesthesia is billed by time. A nominal, pre-op, self-pay charge, and additional case volume can more than offset the 30–60-minute cost of an anesthesiologist or CRNA creating incremental revenue.

Premier Anesthesia’s onsite clinical and dedicated business management teams work with your anesthesia practitioners to ensure:

  • All the monitoring that is available and appropriate is being done and noted. Common OR monitoring is not often reported in documentation, letting $15.00 in facility fees slide away with each case

  • Positioning and instrumentation are documented. Each, when properly, noted carries a value of two billing units in the fee determination formula.

  • Blocks are properly referenced, when done. Sometimes overlooked in documentation, this is a $110 average save, when properly noted.

  • Pre-operative assessments for cancelled cases are being noted, documented, and billed. These assessments are still viable and carry a possible value of $35 per assessment.

The American Society of Anesthesiologists and have each explored the importance of billing coding specificity, timing, and modifiers (ASAHQ, 2021). Anesthesia billing is unique with its focus on timing and exceptionally weighty importance of modifiers. Nearly 14,000 billing codes in combination with modifier and add-on codes result in an overwhelming and confusing array of coding choices. It is more important than ever to maximize the capture of allowable charges. Some overlooked items that can bolster your billing:

  • Team care versus single care, during complicated surgical cases

  • Additional monitoring for complex procedures (monitored anesthesia care or MAC)

  • Add-on codes for hypothermia, extremely young or old age, and existing aggravating conditions like hypertension and diabetes

Premier Anesthesia’s billing and revenue cycle management means smooth sailing through this sea of options, ensuring no avoidable drop off of potential revenue.

These suggestions are not at all exhaustive in their consideration of how anesthesia can safeguard financial viability and revenue flow during these trying times. $35 here, $110 there, two additional billing units here, $15 monitoring dollars there. Those “here and there” amounts, when equally applied as occurring one per case, across an annualized volume of 6,000 cases recapture roughly $217,000. That’s great pain relief for any revenue headache!

Premier Anesthesia employs all these strategies and more as we partner with hospitals to create individualized suggestions to boost their revenue recoupment plan. As we emerge from the current wave and hopefully an eventual post-pandemic environment, hospitals should ask themselves this simple question: do I want a partner who will save money by decreasing the quality service or a partner who will save by increasing the use of effective strategies?