ASA Commercial Conversion Factor Survey Results – 2024

Based on the 2024 ASA commercial CF survey results, the national average commercial CF was $80.70, and the national median was $74.59 (Figure 1, Table 1). The mean and median figures for the past 10 surveys are presented in Table 2. The 2023 national Medicare CF for anesthesia services was $21.12, or about 26.2% of the contemporaneous mean commercial CF 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 1,351 individual contracts reported by 297 practices.

The survey was circulated to all ASA members from April through July 2024. To comply with antitrust “best practices,” the survey requested that participants only report data from contracts that were in effect prior to January 31, 2024. 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 geographic-related 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 26 states.

The survey was formatted as a spreadsheet that could be downloaded in combination with line-by-line instructions. A total of 48 data elements were requested – the first 10 dealt with practice demographics, the next eight with overall service volumes and billing practices, and the final 30 described the details of the group’s five largest commercial contracts by volume. After an individual practice’s clinical leadership completed the first 10 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 designated secure email address.

Often the revenue cycle management details were compiled and submitted by an outsourced billing services vendor contracted by the practice. Starting in 2023, efforts were made to work directly with these billing services vendors to increase practice participation.

ASA urged participation in the survey through various electronic mail offerings, including ASA committee listserves, ASAP (all-member weekly e-mail digest), ASA Monitor Today, 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 268 and 296 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 268 practices reported employing or contracting with 12,351 full-time equivalent (FTE) anesthesiologists, 12,220 FTE nurse anesthetists, and 1,221 FTE anesthesiologist assistants (AAs).

The 296 practices reporting practice volume data accounted for a total of 14,184,557 anesthetic cases and 171,355,928 ASA units. Less than half of the total case and unit volumes (43% of both) were attributed to commercial contracts.

Ninety-six percent of the contracts reported were based upon a 15-minute time unit. The remaining 4% employed 12-, 10-, or 1-minute time units. Conversion factor 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 was used to make these calculations (asamonitor.pub/462Wieg).

A total of 146 of respondents indicated that they had at least one flat fee contract. The most common clinical service involved was Labor and Delivery (134 respondents), with Endoscopy (34 respondents), Cataracts (5 respondents) and “Other” (31 respondents) reported somewhat less frequently. Among the 1043 commercial contracts for which data were available, 79% provided payment for Physical Status modifiers. Twenty-two percent of the 237 practices that answered the question reported that they participated in some form of bundled payment arrangement.

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 $63.44 in Hawaii to a high of $115.78 in New York. Both interstate and intrastate CF variability was significant, indicating that local market conditions play a substantial role in determining commercial CFs.

The 2024 ASA CF survey accrued data from 297 practices, compared to 211 in the 2023 survey (41% increase). The number of physician FTEs represented (12,351 vs. 9,989), cases reported (14,184,557 vs. 10,595,943) and total ASA units (171,355,928 vs. 120,917,435) also grew substantially, providing a robust national sample of active CFs. The average group size among respondents was smaller for the 2024 survey (41.7 physician FTEs/practice) than in 2023 (47.3 physicians/practice), but larger than in 2022 (32.8 physicians/practice).

The year-over-year reduction in the mean (from $85.41 in 2023 to $80.70 in 2024, –5.5%) and median (from $79.00 in 2023 to $74.59 in 2024, –5.6%) national CF reported here is the largest measured over the past decade. Previous annual decreases were minor and likely did not meet statistical significance. Although causation is impossible to determine from this survey, contemporaneous implementation of the No Surprises Act (NSA) is concerning (asamonitor.pub/3sQGZam). Commercial insurers, emboldened by the NSA, have adopted a practice of terminating anesthesia agreements with CFs above their median contracted rate (as reflected by the “qualified payment amount” or “QPA”, often determined by insurers using a flawed methodology) (asamonitor.pub/3AS5AQ7). This has effectively lowered the QPA over time. Although group practices have demonstrated significant positive outcomes arbitrating out-of-network payments through the NSA’s independent dispute resolution process, these results will not be reflected in this survey of in-network commercial rates (asamonitor.pub/4dPmNIv).

The Committee on Economics would like to sincerely thank all of the 2024 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.