There is no secret that anesthesia providers have seen a decrease in payer reimbursement in recent years. According to one source, the anesthesia specialty has witnessed a downward trend in reimbursement due to cuts in the anesthesia conversion factor as found in the Medicare Physician Fee Schedule (PFS). The conversion factor has steadily decreased from $22.27 in 2019 to $20.43 in 2024, and this is without adjustment for inflation. This amounts to an 8.2% decline in Medicare reimbursement for anesthesia services.
In the February 1, 2024 edition of Healthcare Administration Leadership & Management Journal, Volume 2, Issue 1, several authors, including anesthesiologists, published an article dealing with trends in pain management reimbursement for anesthesia providers. In their Abstract section, they wrote this:
Over the past few decades, the reimbursement rates for Medicare have been decreasing steadily. Although some studies have previously evaluated trends in reimbursements in other fields, a comprehensive evaluation of geographic monetary reimbursement trends in pain management anesthesia has not yet been conducted. Because these trends have not been evaluated previously, we aimed to evaluate national and geographic trends of Medicare reimbursement rates in pain management anesthesia from 2000 to 2022. We selected 155 frequently billed codes to determine trends of reimbursement rates specific to pain management anesthesia. Our study shows that over the last 23 years, the inflation-adjusted Medicare reimbursement for the selected pain management procedures decreased annually by 2.81%.
The piece goes on to indicate that this negative trend may have the eventual effect of limiting the availability of these procedures due to the fact that lower reimbursement rates may decrease the number of providers accepting Medicare.
We recently reported that Anthem Blue Cross Blue Shield’s plans in Ohio, Missouri, Connecticut, New York and Maine will reduce QZ services performed by CRNAs to the 85 percent rate, beginning Nov. 1. At least one other national payer has the same policy, and this may spread to other major health insurers in the future.
Staffing Woes
When it comes to the current staffing situation within the anesthesia specialty, the numbers are certainly concerning. There are currently 42,264 active anesthesiologists and 56,000 active CRNAs. By 2033, The Association of American Medical Colleges (AAMC) predicts that there will be a shortage of 12,500 anesthesiologists, nearly 30 percent of the current staff.
According to Medicus Healthcare Solutions, more than 56 percent of anesthesiologists are over 55 years of age. More than 17 percent of anesthesiologists are nearing retirement. In addition, more than 2,872 anesthesiologists left the workforce from 2021 to 2022, according to a report from Definitive Healthcare. A Medscape survey has revealed that more than 50 percent of anesthesiologists are feeling the effects of burnout and/or depression. This is a slight increase from last year's survey, when 47 percent of anesthesiologists reported being burned out.
It also doesn’t help that some 46 percent of the 1,353 medical students seeking an anesthesiology residency in 2023 were not able to obtain a position. So, this may not bode well for those hoping that a new crop of clinicians will soon be available to fill the gap.
While these numbers are discouraging, there is hope in our concerted efforts. The American Society of Anesthesiologists and other lobbying organizations will be continuing their efforts to bring these numbers before Congress and other decision-makers with an eye toward a change in policy and hopefully a change in fortunes.
Many of the above statistics were brought to our attention by a recent article in Becker’s ASC Review, so we wish to thank them.