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North American Partners in Anesthesia (NAPA): New value-driven MSO/RCM services offer hospitals innovative solutions

Health system economics are increasingly under pressure. Challenged by nationwide clinical staffing shortages, decreasing reimbursements from government and private payors, and the increased administrative burdens associated with a value-based care environment, hospitals are seeking new strategies and solutions to ensure their sustainability.

The dynamics of hospital profitability encompass a multitude of factors. On the frontline, patient experience and clinical expertise drive brand loyalty and case volume. Equally critical is back-end operational efficiency, from perioperative utilization to compliance reporting and revenue cycle management (RCM), where even the smallest missteps can cascade into significant financial impacts.

Just as medical innovation opens new opportunities for clinical care, new technologies can help hospitals optimize operational performance to achieve better outcomes. One obstacle is that healthcare providers often lack the change management expertise, sophisticated technologies, knowledge capital, and bandwidth to implement new systems that create process improvement. For example, as some hospitals bring their medical specialty workforces in-house, they may struggle to manage all the specific nuances inherent in the complex quality reporting metrics required for reimbursements by CMS (Centers for Medicare & Medicaid Services) and private insurers. Even with the right tools in place, without the right experience, the substantial learning curve will be costly.

Similar problems affect RCM. In the anesthesia specialty, for instance, highly specialized billing and coding requirements include procedure type, duration, and complexity; patient diagnosis, and provider type(s). For hospitals that employ their anesthesia providers and try to handle anesthesia RCM in-house, coding errors may correlate to decreased revenue, while improving net collections by even a few percentage points can translate to capturing millions of dollars.

A new MSO solution

North American Partners in Anesthesia (NAPA), the nation’s largest single-specialty anesthesia management services organization, has partnered with healthcare providers since 1986 to provide patients with excellent experiences. Over nearly 40 years, NAPA has earned a reputation for being innovative, nimble, and a proactive catalyst for change.

Now, the company is deploying nearly four decades of anesthesia and change management expertise to provide certain health systems with an alternative for managing the business of anesthesia. Leveraging its leadership, scale, and robust IT resources, NAPA has introduced a Management Services Organization (MSO) solution with turnkey services for hospital clients who choose to convert or employ an in-house staffing model and seek a better way to manage certain support services, such as anesthesia billing and coding, payments, quality reporting, leadership development, transitional management, and other non-clinical services like anesthesia clinician recruiting and retention. NAPA’s MSO services can be tailored to support an institution’s unique perioperative success goals.

Rafael Cartagena, MD, NAPA CEO, says, “As a clinician-led company, the decision to launch a non-clinical MSO service line reflects NAPA’s long and successful track record in driving change management.” He notes that NAPA pioneered technologies for collecting and reporting quality analytics decades ago, and now maintains the nation’s largest anesthesia outcomes database, advancing clinical care with metrics from the two million patients it serves annually.

He adds that over the past decade, NAPA built a national infrastructure to support its approximately 400 healthcare facility partners in 22 states with senior clinical and business leaders at the local level. It invested in a digital and corporate transformation that revolutionized IT systems and streamlined processes in Quality Improvement, RCM, and OR Staffing and Utilization across the enterprise. Further investments in its People and Organization functions, including Talent Acquisition and Onboarding; Diversity, Equity, and Inclusion; Human Resources Service Delivery; and Marketing and Communications, have focused on making NAPA the destination of choice for anesthesia clinicians, resulting in industry-leading retention rates.

NAPA has also earned some of the nation’s leading honors. In March 2022 and 2024, NAPA achieved HITRUST Certified status for its proactive approach to cybersecurity, data protection, and risk management. In 2022, the innovative Anesthesia Risk Alert (ARA) program, created under NAPA’s Patient Safety Organization, received the John M. Eisenberg Patient Safety and Quality Award from the National Quality Forum and The Joint Commission. In 2023, the American Society for Health Care Risk Management also recognized the ARA program with its Patient Safety Award. These coveted recognitions place NAPA in an elite group of organizations, assuring clients of exceptional IT security and clinical quality outcomes.

NAPA’s results in the change management, leadership development, RCM, recruiting, and quality arenas show that we do anesthesia better than anyone else. Rafael Cartagena, MD, CEO, NAPA


Dr. Cartagena says, “A big differentiator for our MSO clients is we use the same proven tools and change management processes that we use for NAPA’s own anesthesia RCM, recruitment, quality, and operations. As the leader in single-specialty anesthesia, we do anesthesia and change management better than anyone else. We prove our expertise through unmatched, transparent data and reporting.

NAPA’s powerful RCM engine delivers results for hundreds of healthcare clients. Many clients benefit from NAPA’s 95%-96% collection rate, often representing a 5%-20% improvement as compared to the rates produced by in-house RCM services. NAPA clients receive best-in-class metrics in measurable components, such as the regionally specific collection rate, charge lag, speed to collect, and denial rates.

NAPA recognized the need for this new MSO solution through observations of how health systems and academic medical centers struggled to adapt to evolving market pressures. Dr. Cartagena says that NAPA’s Client Services teams witnessed hospitals migrate to in-house staffing models without optimized payor contracts, maximized credentialing processes, the ability to collect and report anesthesia-specific quality data, or a robust administrative infrastructure required to convert to a sustainable in-house managed model.

Lacking experience in the business of anesthesia, healthcare facilities that excelled at anesthesia care delivery were challenged by change management in these specialized areas of anesthesia billing, value-based care metrics, and anesthesia-specific recruitment in a highly demanding labor market. In the anesthesia space, these functions are unique and complex for hospitals with in-house multi-specialty RCM and billing departments, recruitment teams, and quality improvement-focused resources

Dr. Cartagena explains that with a customized MSO contract—depending on the institution’s specific needs—NAPA can facilitate change management with quality metrics, or manage professional fee collections, for example, without the hospital losing revenue while its in-house RCM team gains proficiency the intricacies of anesthesia billing and coding.

What’s powering NAPA’s RCM?

NAPA achieves industry-leading RCM results through an innovative service platform, utilizing advanced technologies with proprietary rules engines developed and managed by highly experienced RCM and IT teams. Encompassing reconciliation, coding, data entry, eligibility and insurance verification, claims scrubbing, billings and collections, payment posting, balance management, patient balance billing, and payment acceptance, every service offering is designed for accuracy and acceptance across the revenue lifecycle. The company’s strategic investments in sophisticated tools and highly talented billing specialists deliver proven results through an integrated process that maximizes client reimbursements.

Additionally, NAPA’s MSO cutting-edge reporting package provides real-time key performance indicators (KPIs) monitoring, delivering insights into the health of an institution’s revenue cycle to help optimize workflows. This advanced reporting system allows for real-time analysis of leading and lagging indicators that can be easily reviewed through a user-friendly dashboard with the push of a button.

Prioritizing the patient experience

The clinicians who founded NAPA built the organization on a patient-first philosophy that still imbues its clinical and corporate operations from coast to coast. Thus, as the company developed its MSO services, it did so while recognizing that both hospitals and healthcare customers demand seamless change management and payment experiences. This becomes even more critical in the current competitive healthcare marketplace, because while patients who are highly satisfied will likely return to a hospital, dissatisfied customers often have many options to pursue care elsewhere—and are increasingly willing to share negative experiences online and in the media.

NAPA’s new MSO service provides clients with the same prioritization of patient-friendly experiences as the company uses for its own RCM. Features include a state-of-the-art patient billing experience that delivers diverse payment acceptance methods and allows for mobile and online omnichannel options, including the acceptance of most debit and credit cards, ACH/EFT, ApplePay, and GooglePay. NAPA’s understanding of how the total patient experience impacts satisfaction (and brand loyalty) is one of many reasons why the independent Black Book Survey has ranked NAPA #1 for “Anesthesia Management Services” for seven consecutive years.

Dr. Cartagena says the bottom line is this: “NAPA can provide white glove change management, leadership development, and other added value features for institutions who choose to keep their clinical autonomy. It is an elegant solution for health systems that don’t have the experience or resources to optimize anesthesia management. Through an MSO, we are consulting and managing the institution’s pain points—which could be recruitment and retention, revenue cycle, analytics and quality, HR capabilities, or building anesthesia leadership and perioperative culture. Our motto is Patients First, Partners Always. This new service is yet another way our healthcare partners can benefit from NAPA’s vast single-specialty anesthesia business experience.”

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