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SCA Salary Survey Data

Compensation, Coding, and Billing and Reimbursement

On April 24, the members of the Economics and Governmental Affairs Subcommittee gathered in Orlando, FL, to construct the agenda for the year ahead. During the course of that meeting several issues were identified that will hold growing importance for the SCA membership in the coming months and years. The matters of greatest priority included benchmarking of compensation levels for cardiothoracic anesthesiologists, representation of members’ interests with regard to coding and billing controversies, and facilitating the adaptation of our subspecialty to the rapidly evolving reimbursement models.

The subcommittee will be distributing the next SCA Salary Survey in early 2018. This survey has been conducted biannually since 2010 and collects data pertaining to both compensation levels and practice characteristics for active SCA members. The survey is the exclusive source for such information specific to the practice of cardiothoracic anesthesiology in the United States. In past years, the complete survey results have been distributed to all survey participants, and this practice will continue for the 2018 survey. However, sufficient data has now accumulated to allow meaningful trends to be identified. Over the coming months, the aggregate data from past Salary Surveys will be published in the SCA Bulletin. The members of the subcommittee hope that this will provide both a broader perspective on practice patterns across the United States as well as an understanding of the importance of continuing to gather this information.

Data represent the percent of survey respondents in any given year providing the answer specified. For TEE training, the 2010 and 2012 surveys asked respondents to indicate whether they were certified in echocardiography. The 2014 and 2016 surveys additionally allowed respondents to indicate if they held testamur status.

The only ongoing billing controversy at the national level involves CPT code 93355—Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (e.g.,TAVR, transcathether pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure) (peri- and intra-procedural). This code was introduced in 2014 and was assigned significantly more relative value units than 93312 in recognition of the increased time requirement and cognitive workload associated with echocardiographic guidance of percutaneous treatments for structural heart lesions. At present, the National Correct Coding Initiative policy manual bundles 93355 with all concurrent codes for anesthetic care. The leadership of the SCA, American Society of Anesthesiologists (ASA), and American Society of Echocardiography (ASE) are coordinating efforts to correct this edit. The initial appeal to the medical director for the National Correct Coding Initiative did not produce a positive response, but the arguments in favor of removing this bundling are being reformulated and will be resubmitted.

Two changes to Medicare are imminent regarding the reimbursement of physicians in general and cardiac anesthesiologists in particular: the Merit-Based Incentive Payment System (MIPS) and the Episodic Payment Models (EPM) initiative.

MIPS is a key component of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA). MACRA repealed the sustainable growth rate adjustment that had been threatening to slash physician Medicare reimbursements since 1997. Virtually all U.S. physicians will be affected by MIPS (those participating in accountable care organizations or other advanced alternative payment models are exempted). The program has been accumulating performance data since January 2017 and will issue the first physician report cards in July of this year. The MIPS score is a composite measure comprising quality, performance improvement, cost, and information technology use domains. Beginning in 2019, bonuses and penalties will be applied to all Medicare physician reimbursements depending on relative performance as assessed through the composite MIPS score. The maximum adjustment for 2019 will be +/- 4% of all Medicare payments, and this amount will increase to +/- 9% of all Medicare payments by 2022.

The EPM initiative is a form of retrospective bundling that will be trialed at more than 1100 hospitals across the United States beginning this fall. Further details regarding this program will be included in the next issue of the SCA Bulletin.

Within SCA, the Economics and Government Affairs Subcommittee, the Safety and Quality Leadership Committee, and the Clinical Practice Improvement Subcommittee have recognized the intersection of our mandates in these two Medicare programs. As a result, these three groups have initiated steps to coordinate efforts. Planning has begun for jointly sponsored educational sessions at the 2018 Annual Meeting focused on the knowledge and practice modifications necessary to succeed under these value-based purchasing programs.

ommittee members have been successfully placed on the ASA and CMS committees charged with overseeing the perioperative surgical home model and the MIPS program, respectively. Together, these three committees will attempt to serve as a clearinghouse for critical information and real-world experience as the practice model for hospital-based procedures evolves.

As the year progresses, we hope that you find the efforts outlined above to provide value to your daily practice. If you have any concerns that are not addressed by the agenda described, or would like to share your personal experiences with any of these issues, please do not hesitate to contact any of the committee members listed on the SCA website.

Gordon Morewood, MD MBA FASE
Chair, Economics and Governmental Affairs Committee
gordon.morewood@tuhs.temple.edu

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