1. Understanding the Value of CRNA Services HOW TO FIGURE OUT WHAT YOU ARE WORTH

2. Missouri Association of Nurse Anesthetists State Reimbursement Specialists Sallie M. Poepsel PhD,CRNA Jeanie Skibiski, MHA, DNAP (c) CRNA

3. OBJECTIVES Describe the relationship between CPT and the RVG Determine the monetary value of anesthesia services Using available app(s) compute the billable anesthesia charges and projected reimbursement given select case scenarios

4. DEFINITIONS CPT: Current Procedural Terminology RVG: Relative Value Guide TM: Time Modifiers; 15 min. = 1 unit

5. DEFINITIONS MODIFIERS: physical status; age, events CF: Conversion Factors or Cost/Unit

6. CPT CODES: Examples 00836 INGUINAL HERNIORRHAPHY 00790 LAP. CHOLECYSTECTOMY 00740 EGD 00560 CABG 01382 R KNEE ARTHROSCOPY 01402 L TOTAL KNEE REPLACEMENT 00600 C4-5,C5-6 MICRODISCECTOMY

7. RVG BASE UNITS for CPTs 00560 CABG 15 + TM 01382 R KNEE ARTHROSCOPY 7 + TM 00600 C4-5,C5-6 MICRODISCECTOMY 10 + TM

8. CASE SCENARIO A 45 year-old female ASA II underwent an elective lap. cholecystectomy. Anesthesia start time was 0715; after completion of the surgery, patient was transferred to PACU @ 0815. The CRNA after giving report ended anesthesia time @ 0820.

9. Compute Billable Units RVG code for Lap. Cholecystectomy: 00790 CPT Code: 38100 Base units using the RVG: _____ Time Units: _____ Modifiers: _____ Total Units: _____

10. ANESTHESIA BILLABLE UNITS 1) Determine the RVG code 2 Find corresponding Base Unit 2) Determine the TM 3) Identify other modifiers if any 4) Compute the total anesthesia units

11. Compute Billable Units RVG code for laparoscopic Cholecystectomy: Base units using the RVG: 7 Time Units: 4.3 Modifiers: 0 Total Units: 11.3

12. TOTAL ANESTHESIA CHARGES 5) Determine the Conversion Factor (CF) for the CPT: Insurance provider: BCBS, Aetna, Healthlink Medicare

13. Total Anesthesia Charges Total Anesthesia Billable Units: Conversion Factor: $50.00/unit x 11.3 total units TOTAL CHARGES: $ 565.00

14. GROUP WORK Group I Group II Group III

15. Case Scenario # 1 A 55 year-old female with stable HTN, smoker, has GERD and a BMI of 39. Had exploratory lap - total abdominal hysterectomy with anesthesia time lasting from 1005-1205. Payor Mix: Mercy CF: $ 60/unit

16. Case Scenario # 2 A 55 year-old female ASA II who underwent lap assisted vaginal hysterectomy BSO. Total anesthesia time 3 hours. Payor Mix: GHP; CF: $72/unit

17. Case Scenario # 3 A 70 year-old male, with COPD, DM, Hyperlipidemia and HTN. Had total knee arthroplasty with anesthesia time from 0807 hrs. to 1039 hrs. Payor Mix: Medicare; CF: $22.74/unit

18. End-of-year PAYOR MIX: Medicare = $22.74 (450 cases) 12 units GHP = $72.00 (100 cases) 8 units Mercy = $60.00 ( 98 cases) 14 units BC/BS = $75.00 (132 cases) 10 units TOTAL……780 cases)

19. Anesthesia Charges MEDICARE: 5400 units X $22.74 = $122,796.00 GHP : 800 units X $72.00 = $ 57,600.00 Mercy : 1372 units X $60.00 = $ 82,320.00 BC/BS : 1,320 units X $75.00 = $ 99,000.00 TOTAL….. $ 361,716.00

20. CRNA Compensation BASE SALARY $ 145,000.00 BENEFITS: 6 wks ETO (336 X 69.71) $23,422.56 Profit Sharing $14,000.00 Professional liability insurance: $ 7,200.00 AANA membership fee: $ 645.00 TOTAL PACKAGE: $190,267.56 BASE SALARY $ 145,000.00 BENEFITS: 6 wks ETO (336 X 69.71) $23,422.56 Profit Sharing $14,000.00 Professional liability insurance: $ 7,200.00 AANA membership fee: $ 645.00 TOTAL PACKAGE: $190,267.56

21. Comparative Analysis REVENUE GENERATED: $ 361,716.00 TOTAL COMPENSATION : $ 190,267.56

22. Case Scenario 68 yr old male with ventral hernia repair; smoker, HTN Procedure takes one hour Medicare coverage Conversion factor(CF) = $20.00/unit.

23. Case Con’t CPT: 00832 Ventral hernia Base Units: 6 units Time: 1 hr: 4 units Total units: 10 units x 20.00/unit = $200.00 (Medicare pays 80% = $160.00) (Patient pays 20% = $ 40.00)

24. Case Con’t Medicare case 1 hour Turn around time 30 minute; + 30 minute lunch 15 min breaks x 2 No of cases you can do: 5 cases/day 5 cases x $200.00 = $1000.00 (generated/day)

25. Case Con’t What if you only did Medicare cases? 365 days/year = 52 weeks - 5 weeks vacation = 25 days - 1 week misc. time - work 5 days/week + call x 46 weeks = 5 x 1000/day = 5000 x 46 = $230,000.00 JUST DOING MEDICARE CASES

26. Case Con’t Therefore: 230K 30% usually would cover benefits 161K + benefits Bare minimum if you only do Medicare cases!!!

27. THANK YOU