ASA Commercial Conversion Factor Survey Results – 2023

Based on the 2023 ASA commercial CF survey results, the national average commercial CF was $85.41, and the national median was $79.00 (Figure 1, Table 1). The mean and median figures for the past 10 surveys are presented in Table 2. The 2022 national Medicare CF for anesthesia services was $21.56, or about 25.2% of the contemporaneous mean commercial CF factor reported here.

Figure 1 shows the frequency in percent and distribution of contracted CF values. The estimated normal distribution is the solid blue line. Table 1 provides the overall survey results nationally as well as by major and minor reporting region. The 2023 survey results comprise 999 individual contracts reported by 211 practices.

The survey was circulated to all ASA members from May through August 2023. To comply with antitrust “best practices,” the survey requested that participants only report data from contracts that were in effect prior to January 31, 2023. In addition, all survey responses were anonymized upon receipt and aggregated before analysis or dissemination of the results.

To prevent identification of the prices charged by, or compensation paid to, any particular group practice, no statistic was included in the results reported if it consisted of fewer than five respondents. The most obvious effect of this limitation was to restrict state-level reporting to only 21 states.

This year, the survey was formatted as a spreadsheet that could be downloaded in combination with line-by-line instructions. A total of 50 data elements were requested – the first 12 dealt with practice demographics, the next eight with overall service volumes and billing practices, and the final 30 decribed the details of the group’s five largest commercial contracts by volume. After an individual practice’s clinical leadership completed the first 12 demographic questions, they were encouraged to submit the spreadsheet to whomever was most knowledgable regarding their billing and contracting details. Once completed, the spreadsheet was returned directly to ASA staff via a secure email address.

ASA urged participation in the survey through various electronic mail offerings, including ASA committee listservs, ASA Monitor Today, ASAP (all-member weekly e-mail digest), Vital Signs, the Monday Morning Outreach, communications to state component societies and our Anesthesia Administators and Executives (AAE) members, and via the ASA website.

Tables 3 and 4 present demographic and clinical volume information for 180 and 208 practices, respectively (not all practices provided the supplementary data). Results are aggregated nationally as well as by Major and Minor Geographic Regions as identified by the Medical Group Management Association (MGMA) (asamonitor.pub/30PLj9B).

The MGMA Major Geographic Regions are as follows:

• Eastern: CT, DE, DC, ME, MD, MA, NH, NJ, NY, NC, PA, RI, VT, VA, WV
• Midwestern: IL, IN, IA, MI, MN, NE, ND, OH, SD, WI
• Southern: AL, AR, FL, GA, KS, KY, LA, MS, MO, OK, SC, TN, TX
• Western: AK, AZ, CA, CO, HI, ID, MT, NV, NM, OR, UT, WA, WY

The MGMA Minor Geographic Regions are defined as:

• CAAKHI: CA, AK, HI
• Eastern Midwest: IL, IN, KY, MI, OH
• Lower Midwest: AR, KS, LA, MO, OK, TX
• Mid Atlantic: DC, DE, MD, VA, WV
• North Atlantic: NJ, NY, PA
• Northeast: CT, MA, ME, NH, RI, VT
• Northwest: ID, OR, WA
• Rocky Mountain: AZ, CO, MT, NM, NV, UT, WY
• Southeast: AL, FL, GA, MS, NC, SC, TN
• Upper Midwest: IA, MN, ND, NE, SD, WI

These 180 practices reported employing or contracting with 9,989 full-time equivalent (FTE) anesthesiologists, 8,857 FTE nurse anesthetists, and 1,009 FTE anesthesiologist assistants (AAs).

The 208 practices reporting practice volume data accounted for a total of 10,595,943 anesthetic cases and 120,917,435 ASA units. Less than half of the total case and unit volumes (46% and 44%, respectively) were attributed to commercial contracts.

Ninety-seven percent of the contracts reported were based upon a 15-minute time unit. The remaining 4% employed 12-, 10-, 8-, 7-, or 1-minute time units. CF values from contracts with less than 15-minute time units were normalized to 15 minutes using the appropriate adjustment factor. Adjustment factors were calculated as ratios based on the mean time and mean base units per case. The CMS Physician/Supplier Procedure Summary (PSPS) data set, which represents over 21 million anesthesia claims, was used to make these calculations (asamonitor.pub/462Wieg).

A total of 108 of respondents indicated that they had at least one flat fee contract. The most common clinical service involved was Labor and Delivery (81 respondents), with Endoscopy (39 respondents), Cataracts (seven respondents), and “Other” (39 respondents) reported somewhat less frequently.

Regional CF data is presented in Figures 2 and 3, and state-specific data is reported in Table 5 and Figure 4. At the state level, the mean CF ranged from a low of $66.06 in Illinois to a high of $128.07 in New York. Both inter- and intra-state CF variability was significant, indicating that local market conditions play a substantial role in determining commercial CFs.

The 2022 ASA CF survey reported the data from 312 practices, compared to 211 in this 2023 survey. However, the number of physician FTEs represented (10,224 vs. 9,989), cases reported (12,172,442 vs. 10,595,943), and total ASA units (123,771,742 vs. 120,917,435) suggest similar and reasonably representative samples when comparing the two surveys. The smaller number of practices reporting in 2023 may relate to a substantive shift in the type of practices that are willing and able to submit data, or it may be indicative of ongoing practice consolidation.

The negligible (0.01%) reduction in the mean national CF and slight increase in the median compared to the 2022 results are of questionable significance in isolation. However, examination of recent trends reveals a distinct plateau in CF value beginning with the 2021 survey. Future survey data will be essential to detect any corrosive effect on commercial payment rates resulting from national policies such as the No Surprises Act (asamonitor.pub/3sQGZam).

The Committee on Economics would like to sincerely thank all of the 2023 survey participants. Many respondents emphasized the critical nature of the survey data for practice managers attempting to understand the market for anesthesia services. The committee will continue to refine the survey methodology in future years based on feedback received. The goal is to achieve participation by a majority of anesthesiology practices in order to continue to provide this important service to ASA members.