ASA Monitor 12 2015, Vol.79, 10-11.
Thomas R. Miller, Ph.D., M.B.A.,is ASA Director of Health Policy Research.
The 20-year period between 1994 and 2014 saw increases in both the number of Medicare fee-for-service beneficiaries and in the volume of the health services they received that required anesthesia. We estimate that the number of Medicare fee-for-service beneficiaries increased approximately 10 percent during this period*1 1 –3 while the anesthesia claims count increased 136 percent. In this abbreviated “Policy Matters,” we show that the mix of facility settings where these services were provided also changed substantially.
Our analysis was based on the Medicare Physician Supplier Procedure Summary Master File, which provides counts of the number of claims submitted on behalf of Medicare’s fee-for-service beneficiaries. Claim counts can be summarized by Current Procedural Terminology (CPT®) codes, type of professional submitting the claim and place of service (i.e., facility setting such as inpatient hospital, outpatient hospital, ambulatory surgery center, office and others). We obtained counts of the number of claims submitted with an anesthesia CPT® code (00100 to 01999, excluding 01996: “daily hospital management of epidural or subarachnoid continuous drug administration”). We excluded counts of claims recorded as being submitted by entities rather than persons and excluded claims attributed to health care professionals that typically would not submit an anesthesia claim (e.g., audiologists, chiropractors, social workers and physical therapists). These exclusions represented less than 0.3 percent of anesthesia-related service counts in 2014. We also adjusted counts to avoid double counting of anesthetics resulting from multiple billings for the same case that occurs in the anesthesia care team model (i.e., anesthesiologists providing and non-anesthesiologists receiving medical direction or supervision).
Between 1994 and 2014, the percentage of anesthesia claim counts in the hospital outpatient setting (including anesthesia services provided to non-admitted emergency department patients) and ambulatory surgery centers increased from 46.6 percent to 69.5 percent. The percentage of services performed in the hospital inpatient setting declined from 52.9 percent to 28.2 percent; however, the anesthesia claim counts in the inpatient hospital setting still increased during the 20-year period, from 2.6 million to 3.3 million.
Our analysis depicted marked changes in the distribution of anesthesia services provided to Medicare fee-for-service patients across health care facility settings over a 20-year timeframe. It is reasonable to assume that similar trends have occurred in the Medicare managed care, Medicaid and commercial insurance patient populations. The expansion of anesthesia’s reach beyond the inpatient operating room has important implications for the evolution of patient care quality initiatives such as the Perioperative Surgical Home. In addition, the increasingly broad perspective of anesthesiologists and the extension of the specialty’s expertise and influence across the array of procedural-based service locations may help support the anesthesiologist’s leadership role in health care systems.
In a future “Policy Matters,” we will more closely examine trends in non-operating room anesthesia services within hospitals. In addition, the Health Policy Research Department will compile data such as these into a comprehensive annual anesthesia and perioperative data almanac to help inform planning and policy efforts related to anesthesia services. We will continue to highlight portions of these data in future issues of the ASA Monitor.
Medicare Enrollment – national trends 1966-2013: Medicare aged and disabled enrollees by type of coverage, . CMS.gov: Centers for Medicare & Medicaid Services website. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareEnrpts/Downloads/SMI2013.pdf. Accessed October 6, 2015.
Gold M, Jacobson G, Damico A, Neuman T. Medicare Advantage 2014 spotlight: enrollment market update. Kaiser Family Foundation website.http://kff.org/report-section/medicare-advantage-2014-spotlight-enrollment-market-update-overall-trends/. Published May 1, 2014. Accessed October 6, 2015.
Asper F, Mann E. Medicare managed care enrollees and the Medicare utilization files. ResDAC: Research Data Assistance Center website.http://www.resdac.org/resconnect/articles/114. Accessed October 6, 2015.