Anesthesiologist reimbursements are sinking as a provider shortage plagues ASCs and hospitals nationwide.
Udaya Padakandla, MD, president of the Texas Society of Anesthesiologists, joined Becker's to discuss the changes he'd like to see to anesthesiology reimbursements.
Editor's note: This interview was edited lightly for clarity and length.
Question: What changes would you like to see regarding anesthesiologist pay specifically?
Dr. Udaya Padakandla: 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.
There have also been cases where payers have said they are not going to pay for patients undergoing preventive colonoscopies. Why do patients undergoing colonoscopy for preventative care deserve less anesthesia care than the ones with disease is beyond my comprehension.