ASCs and other healthcare providers have been facing major obstacles to secure anesthesia coverage as reimbursements continue to sink.
Here are 10 notes on the decline of anesthesia reimbursements:
1. CMS anesthesia reimbursements declined 8.2% from 2019 to 2024 — from $22.27 per unit to $20.44, VMG Health said in a May 22 blog post.
2. If an anesthesia provider generates 10,000 billable units from Medicare, the total revenue potential is only $218,000, according to a Jan. 16 blog post from Coronis Health, assuming that all revenue could be collected.
3. The No Surprises Act and its independent dispute resolution process have created obstacles to secure reimbursements. The act has "led to unintended consequences for anesthesia providers," and the IDR process has been used by payers to "reduce reimbursement by refusing to go in network with anesthesia providers," according to VMG Health's 2023 "Physician Alignment: Tips & Trends" report.
4. Nearly 30% of anesthesiologists are predicted to leave the practice by 2033, according to a 2023 white paper from Medicus Healthcare Solutions, leading to a shortage of 12,500 anesthesiologists. Additionally, more than 17% of anesthesiologists are nearing retirement, and 56% are older than 55.
5. From 2021 to 2022, more than 2,872 anesthesiologists left the workforce, according to a report from Definitive Healthcare.
6. Around 13% of anesthesiologists said the hardest part of their job was dealing with Medicare and/or other insurers and getting fair reimbursement, according to Medscape's "Anesthesia Compensation Report 2024"
7. Cigna announced in March 2023 it was lowering the reimbursements for non-medically directed procedures performed by certified registered nurse anesthetists by 15%. Cigna lowered its reimbursement for claims submitted with the QZ modifier, which indicated a non-medically directed CRNA service.
8. The inflation-adjusted Medicare reimbursement for the selected pain management procedures decreased annually by 2.81% over the last 23 years, according to a February report from American Association of Physician Leadership.
9. Many anesthesiologists are frustrated with the decline.
"Anesthesia reimbursements continue to be misunderstood by CMS, insurers and even our own colleagues," Thomas Durick, MD, anesthesiologist at Columbus-based Ohio State University Wexner Medical Center, told Becker's. "We allow the government and insurance companies to dictate what our services are worth (such as the recent bundling of ultrasound services into the most commonly performed regional anesthesia procedures for a reduced total reimbursement). We do the same (or more) work each year for less reimbursement and more challenges to get paid. Until we fight to be seen as more than nameless, faceless plunger pushers with opposable thumbs, we will remain in the shadows."
10. The declines in anesthesiologist reimbursement and pay have pushed ASC leaders into rethinking their anesthesia models.
"Anesthesia has been a hot topic of discussion the last two to three years and I don't see that getting better any time soon," Andrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, told Becker's. "We have moved to a fully integrated model in our practice where the anesthesia staff are employed through our group practice. This created stability with insurance benefits, better contracts and a more marketable pay range."