Ron Evans, MPH, FACHE, FACMPE  | Senior Healthcare Consultant

All of us involved in this business are acutely aware of the paltry payment rates received from governmental payers, and generally, Medicaid payments are at the bottom of the list. Recently, three California anesthesia groups (at St. John’s Regional Medical Center in Oxnard, St. John’s Pleasant Valley Hospital in Camarillo and Los Robles Hospital & Medical Center in Thousand Oaks) and turned down contract offers from the new California public insurance system, Gold Coast, reportedly because the proposed reimbursement was far too low.

How many other groups have on more than one occasion contemplated similar actions? I would be there are quite a few. Possibly, the only pressures not to do so come from the hospital or health system with which a group is contracted (and possibly receive an important stipend) and from the surgeons they support. From an economical perspective however, few outside the anesthesia community – certainly not the general public-may realize the ridiculously low reimbursement anesthesiologists are expected to accept as payment in full from governmental payers. This fact is particularly clear in California where, as this Ventura County Star article illustrates, “according to rough state estimates, anesthesiologists were paid about $180 for a one-hour C-section before the recent budget cuts and $190 for a two-hour hysterectomy.” This ten percent reduction in payments translates to anesthesiologists who are now being asked to receive $162 for a one-hour C-section and $171 for a two-hour hysterectomy. Compare those rates to the billable hours of most attorneys, or better yet, even your local auto mechanic!

… food for thought, and time for action!

Read the full article: Medi-Cal contract rejections limit surgery in Oxnard, Thousand Oaks
Ventura County Star   |  by Tom Kisken  |  November 11, 2011 at 2:45 pm

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abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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