A number of compounding factors are affecting anesthesia reimbursements, an industry also facing an ongoing provider shortage.
1. CMS reimbursements are declining. Medicare's average anesthesia rate for 2023 was $21.88, a 5.5% decline from 2019, according to an analysis by Coronis Health. Another analysis, from VMG Health, found that Medicare reimbursements for anesthesia services decreased from $22.2730 per unit in 2019 to $21.1249 in 2023 under CMS' final rule.
2. Cuts to reimbursements for certified nurse anesthetists could worsen the rural healthcare gap. Anthem Blue Cross Blue Shield recently reduced QZ services performed by CRNAs to 85% of the physician fee schedule starting Nov. 1. This was met with criticism by the American Association of Nurse Anesthesiology, citing the effect this could have on rural communities who rely more heavily on CRNAs for anesthesia support.
3. BCBS also altered the physical status modifier policy for reimbursements. Physical status modifiers were developed by the American Society of Anesthesiologists to assess and report a patient's preoperative comorbidities. The PSMs classify the level of complexity of the anesthesia care and can be added to the base values for additional payment for complex patients.
"For instance, a patient with liver disease is provided a set of care that is not the same as one receives when one has no other health issues," said Udaya Padakandla, MD, and president of the Texas Society of Anesthesiologists, told Becker's. "CMS in their initial wisdom, decided early on, that every patient in the older age group is essentially a complex disease entity, so they did not recognize additional payments for them. Now, the insurance companies want to do the same thing — they just don't want to pay for a patient with complex care needs and more systemic illnesses.
"Their reasoning has been that Medicare doesn't pay, so they don't want to pay either for physical status modifiers," he added. "Their arguments are hollow and without merit. This arbitrary decision needs to be reversed and the PS modifier payments restored. It is also about time CMS acknowledges this and starts paying anesthesiologists for PS modifiers."
4. The lasting legacy of the No Surprises Act. The law, passedin 2022, slashed reimbursements to anesthesiologists by nearly 40% in some cases. In response, the ASA recommended that CMS adjust the policy by auditing payer qualifying payment amounts, lifting resolution despite holds and improving batch rules.