Here are five issues anesthesia providers are watching as we begin 2025:
1. Reimbursement. Declining reimbursement rates continue to be a significant issue in the anesthesia industry. In November 2024, CMS finalized a 94-cent (2.83%) conversion factor decrease from 2024. The physician fee schedule conversion factor for 2025 is $32.35, down from $33.29 in 2024. Physicians and medical groups have expressed concern over the decrease in reimbursements, sharing that year-over-year decreases are proving unsustainable for many.
Repeated cuts to reimbursement have intensified impacts on anesthesia groups trying to balance soaring operational costs alongside increased demand for their services.
"There’s going to be a breaking point for smaller companies like mine. I hire [certified registered nurse anesthetists] to work for me, but the costs are almost too high to justify keeping contracts with surgery centers," Brian Cross, CRNA, owner of Youngstown, Ohio-based, told Becker's. These centers are going to have to increase their volume to stay viable. Right now, CRNAs and anesthesiologists expect to be paid for an eight-hour day, but if the surgery center finishes in six hours, that’s lost revenue. Unless things change, this entire system will likely hit a breaking point within five years," said Mr. Cross.
2. CRNA policy. Several states changed their CRNA policies in the past year, impacting both CRNA reimbursements and supervision requirements.
- Cleveland-based insurer Medical Mutual announced plans to reduce CRNA reimbursements to 85% beginning Jan. 24, impacting communities and practitioners across the state.
- Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options also decreased CRNA reimbursements to 85% on Nov. 1.
- Anthem Blue Cross Blue Shield's health plans in Ohio, Missouri, Connecticut, New York, Nevada and Maine also reduced CRNA reimbursements to 85% on Nov. 1.
- Massachusetts opted out of federal regulations that require physician supervision of CRNAs.
- Washington, D.C., Mayor Muriel Bowser removed collaboration requirements for all advanced practice registered nurses, including CRNAs.
- U.S. Reps. Jan Schakowsky of Illinois and Dave Joyce of Ohio introduced a bipartisan resolution that would recognize CRNAs for the role they play in providing quality healthcare.
3. New "gold standards" of care. As demand for anesthesia services increases with more non-operating room needs for anesthetics and an aging U.S. population, anesthesia groups must expand their offerings to hospitals and health centers to add value to their services.
"As anesthesiologists, we do not bring patients to the hospital," Vijay Sudheendra, MD, president of Narragansett Bay Anesthesia in Providence, R.I., told Becker's. "That means you really have to be adding value in places beyond the operating room," he said. "We are looking at patients hitting the emergency room. How do we make sure that these patients are pain-free beyond three to four post-operative days?"
4. Staffing shortages. The Association of American Medical Colleges predicts a shortage of 12,500 anesthesiologists by 2033. The shortage could be even more acute in rural areas. Additionally, as of 2021, over half of practicing anesthesiologists were older than 55. This means several providers are nearing retirement age, just as shortages are just expected to escalate.
Some also point to bottlenecks in residency programs, noting that residency slots have not grown to match the need for anesthesiologists. In 2024, there were 1,695 anesthesiology residency positions available, and around 44 percent of medical students seeking an anesthesiology residency did not match.
5. Legislation. Following Anthem Blue Cross Blue Shield's reversal of its controversial anesthesia pay policy, Rep. Ritchie Torres (D-N.Y.) introduced a bill in the House that would ban time caps on reimbursement for anesthesia services.
Mr. Torres, a potential New York gubernatorial candidate, has introduced a four-page bill called the "Anesthesia For All Act." The legislation would prohibit time caps and direct the HHS inspector general to conduct audits to ensure payers are complying.
"We cannot trust insurers to do right by doctors and patients out of the kindness of their hearts," Mr. Torres said in a statement. "There is a need for legislation that prevents any insurer anywhere in America from micromanaging the length of anesthesia care in a medically necessary surgery."