There has been a lot of debate as to whether practices should implement anesthesia quality reporting. One of the primary financial drivers of this type of reporting is Medicare.

You may feel like you need to implement anesthesia quality reporting but before you decide – be realistic about how much you are actually billing to Medicare.

Quick Terminology Review

• MIPS: The Merit-based Incentive Payment System combined three legacy CMS programs into one for reporting on quality, cost, improvement activities, and promoting interoperability.
• APM: The Alternative Payment Model is a payment system that provides added incentives for physicians providing high-quality and cost-efficient care. Anesthesiologists must participate in the advanced program to avoid penalties if they substitute APMs over MIPS.

Explore the different payment programs

Let’s Look at the Numbers

The Magic Number is $90,000

That’s how much you should be billing to Medicare per doctor to make implementing anesthesia quality reporting worth it. For doctors billing at least $90K every year, it makes financial sense to participate in MIPS or APM, if for no other reason than to avoid a 7% penalty for not participating.

It’s a Wash for Anywhere Between $50,000 and $90,000

If you’re billing between $50K and $90K annually, then you will likely break even with MIPS when it comes to direct costs versus bonuses. Anesthesiologists who bill less than $90,000 aren’t subject to penalties and the bonuses you might receive are likely to be offset by the costs associated with participating.

If You Bill Under $50,000 – It’s Probably Not Worth It

If you’re billing less than $50K then you almost certainly won’t break even on the investment needed to set up and report for MIPS. You may still choose to implement anesthesia quality reporting, but you shouldn’t expect a direct financial paycheck.

Need More Proof? Here’s the Math Breakdown for Billing to Medicare:

• If you bill less than $90K in Medicare for reporting as an individual (or participate in an advanced APM) you are exempt from penalties for not reporting.

• The maximum theoretical bonus for 2019 is +7% of your Medicare billing. That’s $6,300 for a physician at the $90K “magic number” but only $3,500 for a more common $50K in Medicare billing.

• Realistically, no one will get 7%, and most anesthesiologists will see more like 0.5% on average. That’s $450 if you’re billing $90K and a whopping $250 if you’re at $50K.

• Even if you have a billing provider like Fusion Anesthesia that will help you set up your reporting frameworks for no additional charge, direct costs like software, submitting via qualified registry or a QCDR, paperwork, etc. will likely cost you at least $1,000 a year per provider.

• Keep in mind that all the above scenarios consider direct costs only. They effectively value your time at zero.

• Don’t forget, providers who choose to participate but score poorly on MIPS (below 30 points) will be subject to a 7% penalty. So, there is some financial risk to participating!

Should You Implement Anesthesia Quality Reporting For Billing to Medicare?

Ultimately, the answer lies in how much you annually bill to Medicare. To put it simply:

• If you bill over $90K annually, implement anesthesia billing to avoid the penalty

• If you bill between $50K and $90K then it’s truly up to you, since costs versus bonuses will likely break-even

• If you bill under $50K then we wouldn’t recommend implementing for the financial benefits since you will spend more money implementing than you will get back

Of course, Medicare isn’t your only payer and there is a range of other reasons why you may (or may not) want to implement anesthesia quality reporting. For a more comprehensive overview of all the components to consider, download our free eBook What’s the Rush? Anesthesia Quality Reporting.