Anesthesia reimbursements are seeing a steep decline – CMS anesthesia reimbursements declined 8.2% from 2019 to 2024, according to VMG Health.
Here's what five anesthesiologists have had to say about anesthesia reimbursements in 2024:
Thomas Durick, MD. Anesthesiologist at Ohio State University Wexner Medical Center (Columbus): Anesthesia reimbursements continue to be misunderstood by CMS, insurers and even our own colleagues. 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.
Anesthesia providers as a whole need to come together as one to make it clear that we need to be paid fairly and that without us medicine grinds to a halt. We should stop the infighting between anesthesia provider factions and unify our voices, resources and intelligence to rally against the reimbursement gods that we have allowed to dictate policy and payment. Make anesthesia billing simpler: You perform a nerve block that benefits the patient intraoperatively and postoperatively? You should get paid for the nerve block independently of the course of the anesthetic. You helped reduce postoperative pain, which might result in fewer opioids administered and a faster recovery, better patient satisfaction, less postoperative nausea and vomiting ... but if I can't get paid for it, what is the likelihood I will be compelled to take that medicolegal risk for no financial benefit? We should never have to ask ourselves that question, yet we do based on declining reimbursement for seemingly everything we do.
Udaya Padakandla, MD. President of the Texas Society of Anesthesiologists: The latest in the payer's armamentarium is that they are wanting to deny the physical status modifier payment that has been in place for several decades. This is calculated by the complexity of the patient's disease state — what we call the degree of sickness and the likelihood of complications related to that sickness in the perioperative period. Traditionally, we have had an amount of additional compensation added to the sicker patients and more complex disease states – for instance, a patient with heart, kidney and liver disease. A patient with liver disease is provided a set of care that is not the same thing as one receives when one has no other health issues.
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. 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.
Stan Plavin, MD. Anesthesiologist and owner of Oral Surgery Anesthesia Associates: As a physician; it is disheartening to constantly battle every year to reduce cuts. The day will come when physicians will not be able to provide services to the patients that we hold near and dear in our hearts. This is unfair to all parties and monies need to be allocated more appropriately to physician services.
David Rosenfeld, MD. Anesthesiologist and Interventional Pain Specialist at Alliance Spine & Pain (Peachtree City, Ga.): Many physicians face the challenge of effectively managing their practice’s financial aspects. This includes dealing with insurance reimbursements, understanding complex billing codes, and controlling operational costs. Every year, many of us find ourselves working harder and longer hours just to maintain our incomes. The costs of practicing medicine (rent, equipment, employee costs) continue to rise, while reimbursement often declines year over year.
Steven Waronker, MD. Anesthesiologist affiliated with Emory Healthcare (Alpharetta, Ga.): Since the mid-'80s when I went into private practice, the pendulum has simply swung back and forth with no clear trajectory on how to best handle supply/demand, all in the face of a shrinking reimbursement dollar. Entities like MedPartners and PhyCor were the early equivalent to the current day private equity players. The true challenge is simple to understand and perilous to finally address — and no one wants to face the hard facts to fix. There will be a true physician shortage for years to come, and all physician parent employers must be middlemen. A slice of the pie to the partners or owners by definition must make delivery more cost-effective, or there is less for the physicians. The conundrum so far has been somewhat mitigated by the ability to increase payments from payers as size and scope via mergers and acquisitions affords this opportunity. Going forward, it will mandate the ability to do more with fewer practicing professionals or finally acquiesce to accept that the salaries for physicians will stay flat or even decrease.