While anesthesia groups can feel hopeful about some opioid-related legislation in the works, they face mounting barriers to getting paid fairly, according to Garry Brydges, PhD, DNP, CRNA, president of the American Association of Nurse Anesthetists.
Note: Responses were lightly edited for style and clarity.
Question: What are some insurer and/or government policy updates that are promising for anesthesia groups in 2019?
Dr. Garry Brydges: The Substance Abuse and Mental Health Services Administration is in the process of implementing a provision from the SUPPORT for Patients and Communities Act, which will allow [certified registered nurse anesthetists] to prescribe medication-assisted treatments to patients suffering from opioid addiction. CRNAs practicing in accordance with their professional scope of practice, federal and state law, and facility policy may prescribe MAT in states where they have prescriptive authority, consistent with state law. CRNAs are part of the solution to ending the opioid crisis, and increasing the number of provider types who may prescribe MATs is a step in the right direction.
Q: What are some policies AANA is lobbying to change this year?
GB: The AANA is lobbying to change the process of challenging harmful local coverage determinations issued by Medicare Administrative Contractors. MACs are exceeding their authority by refusing to cover medically necessary services — such as chronic pain treatment — provided by certain health professions. Without protections in place, neither patients nor providers have any recourse for filing a claim until after finalization of an LCD, at which time patients and providers are at the mercy of a MAC's reconsideration and appeals processes. These processes can last from three months to several years.
Q: How might surprise billing bans across the country affect anesthesia groups? How should anesthesia groups handle the changes?
GB: The AANA is opposed to proposals that strengthen the ability of insurers to potentially manipulate rates for reimbursement in their own favor, which will ultimately reduce competition and choice at the expense of the patient. Some proposals would require hospitals to eliminate providers who are not in network, which may have occurred due to the health plan's refusal to negotiate with a particular provider. Other proposals could create a median contracted rate that is below the typical in-network rate, which could give insurers no reason to negotiate in good faith with in-network providers. Without such protections in place, already-powerful insurers gain even more leverage in the negotiation process with providers.
The AANA is working with Congress to address the underlying causes of surprise billing, such as inadequate networks offered by insurers engaging in discrimination against providers based on their licensure or certification. While this is not an issue under Medicare Part B, as Medicare recognizes CRNAs as qualified providers and CRNAs must accept assignment as a condition for payment, this is an issue with private insurers, thus potentially affecting the private-payer market and Medicare Advantage plans. The AANA would like to see Congress direct CMS to use its authority to further implement the federal provider nondiscrimination law by issuing a proposed rule and ensure that qualified licensed healthcare professionals are paid the same rate for the same service.
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