Newly Published
Perioperative Medicine  |   July 2019
Trends in Direct Hospital Payments to Anesthesia Groups: A Retrospective Cohort Study of Nonacademic Hospitals in California
Author Notes
  • From the Department of Anesthesiology, Pain, and Perioperative Medicine and Department of Health Research and Policy (E.C.S.), Stanford University School of Medicine (C.O’C.), Stanford, California; the Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa (F.D.); and the Mayo Clinic School of Medicine, Rochester, Minnesota (D.J.M.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication October 23, 2018. Accepted for publication April 25, 2019.
    Submitted for publication October 23, 2018. Accepted for publication April 25, 2019.×
  • Correspondence: Address correspondence to Dr. Sun: Department of Anesthesiology, Pain, and Perioperative Medicine and Department of Health Research and Policy, Stanford University School of Medicine, H3580, 300 Pasteur Drive, Stanford, California 94305. esun1@stanford.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Practice Management
Perioperative Medicine   |   July 2019
Trends in Direct Hospital Payments to Anesthesia Groups: A Retrospective Cohort Study of Nonacademic Hospitals in California
Anesthesiology Newly Published on July 2, 2019. doi:10.1097/ALN.0000000000002819
Anesthesiology Newly Published on July 2, 2019. doi:10.1097/ALN.0000000000002819
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • In the United States, anesthesia groups derive revenue from insurers and “direct payments” or “institutional support” from hospitals

  • Direct payments can represent a significant portion of group revenue and may enable the provision of services to patients covered by public insurers, which disproportionately represent low-resource and underserved populations

  • The magnitude or characteristics of direct hospital payments to nonacademic private practice anesthesia groups is not well understood

What This Article Tells Us That Is New:

  • Among 240 nonacademic California hospitals analyzed between 2002 and 2014, more hospitals made direct payments to an anesthesia group in 2014 than in 2002 and the median payment increased

  • Hospitals where public insurers accounted for a larger fraction of anesthesia revenues were increasingly more likely to make direct payments to private anesthesia groups

  • Direct payments to private anesthesia groups are becoming increasingly important, particularly for hospitals providing care to underserved populations

Background: In addition to payments for services, anesthesia groups in the United States often receive revenue from direct hospital payments. Understanding the magnitude of these payments and their association with the hospitals’ payer mixes has important policy implications.

Methods: Using a dataset of financial reports from 240 nonacademic California hospitals between 2002 and 2014, the authors characterized the prevalence and magnitude of direct hospital payments to anesthesia groups, and analyzed the association between these payments and the fraction of anesthesia revenue derived from public payers (e.g., Medicaid).

Results: Of hospitals analyzed, 69% (124 of 180) made direct payments to an anesthesia group in 2014, compared to 52% (76 of 147) in 2002; the median payment increased from $242,351 (mean, $578,322; interquartile range, $72,753 to $523,861; all dollar values in 2018 U.S. dollars) to $765,128 (mean, $1,295,369; interquartile range, $267,006 to $1,503,163) during this time period. After adjusting for relevant covariates, hospitals where public insurers accounted for a larger fraction of anesthesia revenues were more likely to make direct payments to anesthesia groups (β = 0.45; 95% CI, 0.10 to 0.81; P = 0.013), so that a 10–percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 4.5–percentage point increase in the probability of receiving any payment. Among hospitals making payments, our results (β = 2.10; 95% CI, 0.74 to 3.45; P = 0.003) suggest that a 1–percentage point increase in the fraction of anesthesia revenue derived from public payers would be associated with a 2% relative increase in the amount paid.

Conclusions: Direct payments from hospitals are becoming a larger financial consideration for anesthesia groups in California serving nonacademic hospitals, and are larger for groups working at hospitals serving publicly insured patients.