Becker’s ASC Review recently published some thoughts expressed by various anesthesia providers who exhibit a general dismay at what’s happening in the context of reimbursement and, consequently, overall practice stability. Here are a few examples:
Alan Bielsky, MD, an anesthesiologist at Children’s Hospital Colorado (Aurora) writes:
Ultimately, there just doesn’t seem to be an acknowledgement of our continued hard work. I think that payers’ continued downward pressure on my earnings has really just dejected me and my colleagues. The payers seem to have capitalized on our good will and sense of calling, yet everyone is shocked when we all show signs of burnout.
Antonio Hernandez Conte, MD, immediate past president of the California Society of Anesthesiologists, digs in a bit deeper:
There are multiple ways in which insurance companies have recently exhibited dangerous policy-making that directly harms patients, creates barriers to access to care, and explicitly denies fair compensation for physicians who have provided services. As physicians, we want to work with commercial payers as partners in the healthcare system, and we want patients to be able to access care effectively and efficiently without needless insurance obstacles, such as pre-authorization for well-established medical and surgical procedures.
Dr. Conte went on to suggest that insurance companies should negotiate with anesthesiologists and all physicians in good faith to secure fair market contracts and provide coverage for appropriate patient care. He asserted that payers place patients at risk by second-guessing the need for their services and perioperative expertise. Additionally, Conte stressed that insurance companies must avoid targeting anesthesia care with disruptive payment policies, such as the recent Anthem BCBS “time limit” policy that was initiated in Connecticut and New York (later rescinded). Other poorly advised policies related to anesthesia, he said, include failing to recognize ASA patient physical status modifiers and special patient circumstances.
Anesthesia practices noticed early on that certain insurance companies took unfair advantage of certain provisions of the federal No Surprises Act (NSA). Many feel that certain health plans have utilized the NSA to force anesthesia providers to become “in-network providers”—only to then force them to accept unreasonably low reimbursement rates that have the effect of destabilizing the future of the specialty. This, in turn, places additional fiscal burdens on hospitals to support anesthesia services. Dr. Conte noted that some insurance companies will delay payments to providers even when the payer loses a payment dispute under the NSA’s arbitration process. The payments are deliberately withheld for weeks or months, even when they are required under the law to pay within 30 days.
Similar sentiments were expressed by Corey Koenig, MD, an anesthesiologist at Providence Anesthesiology Associates (Charlotte, N.C.):
Payers continue to leverage the NSA and arbitration process in a continued effort to push down rates. Unfortunately, the rules are tipped in the favor of the payers, and they have deep enough pockets to continue the process despite losing the vast majority of disputes. They are simply squeezing out those who don’t have the cash flow to participate in the costly and lengthy process.
The downward spiral in payer behavior is not lost on the specialty’s CRNA community. John Kezele, MSN, a CRNA at Franklin County Medical Center (Preston, Idaho), said the following:
I have personally seen reimbursement go down, especially in the last five years. In the case of CMS reimbursement, current payments are on par with 2011 actual payments. 2011 CMS anesthesia conversion factors for my State of Idaho were $20.17 and for 2025 $19.30.
He went on to lament that “the time I spend chasing the revenue cycle issues with payers is discouraging.”
And then, of course, there are the increasing denial trends and delaying tactics that make it even more difficult to get paid on first pass. This means extra work on the part of your billing staff to recover those hard-earned dollars.
So, what to do about all this bad behavior on the part of payers that we are increasingly encountering? The specialty must continue to push back. With the help of the American Society of Anesthesiologists (ASA), other specialty organizations and individual providers, we have seen victories in recent months, such as the rescinding of the aforementioned Anthem time limit policy. But more needs to be done. It is an ongoing battle, and anesthesia providers must continue to make their case to payers, insurance commissioners and members of Congress. As you know all too well, the availability and quality of patient care is ultimately at stake. So, we encourage you to let your voice be heard, like those featured in today’s alert. Together, we can make a difference.