As a subcontractor of CRNA service to companies that contract anesthesia services to GI practices, I am gaining first hand experience in anesthesia bundling . Recently one of the new GI practices terminated a contract after only four months of service. The primary motivation behind this questionably ethical move was a prominent payors negotiation, which enhanced the GI practice’s facility fee in exchange for the bundling of anesthesia services.
Some Back Story – This particular Payor has spent the past year refusing to pay for anesthesia services without pre-authorization, delaying or denying payments and in general discouraging the administration of propofol by qualified anesthesia professionals. Bundling is the next hoop to be added by this Payor.
Bundling occurs when a Payor negotiates an all inclusive fee to cover expenses related to a particular procedure, known as a facility fee. This negotiated bundle shifts the propofol decision directly to the GI practice. Now the GI practice determines which of their patients (or physicians) warrants the use of an anesthesia provider and propofol.
Some may argue this removes the “middle man” anesthesia services companies and improves efficiency. Or does it simply shift the “middle man” to the GI practice? This particular practice believes they will avoid any “company model” issues because they will not be charging separately for anesthesia services, and therefore not profiting from the anesthesia provider’s services.
Really ? – Lets drill down a bit at this argument. I don’t have access to any actual numbers so I will invent some to illustrate my point. Lets assign a facility fee of $350 before the bundling negotiation. After negotiations the bundling results in a $150 increase for a total of $500. in the practices facility fee. This particular practice often does 45 procedures a day. Under the old facility their fee was $350×45=$15,750. The bundled fee $500×45=$22,500 results in a gain of $6,750 per day in facility fees. $6750x 5days= $33,750 week, 33750x 52weeks = $1,755,000.00 annual increase in facility fees.
Obviously this does not take into account the additional cost of a CRNA. This practice was never an anesthesia provider in every room practice. Only one of the four rooms had a CRNA or MDA. The remainder were the conscious sedation model where the GI physician directed nurses to administer a concoction of drugs to get the patient through the procedure.
With bundling this practice intends to employ a CRNA(s) and offer one room with propofol. If we use a CRNA market rate of $1000 a day for a 10 hour day – $1000 x 5days x 52 weeks = $260,000.00 $1,755,000 – $260,000 = $1,495,00 difference to the GI practice. Now who is the “middle man” ?
Although anesthesia bundling will probably not go away in the near future, there are ways to prepare for a bundling proposal.
Dennis Gundersen, CRNA
Next time – Anesthesia, the Insidious Creep ?