Becker's ASC Review

26 ANESTHESIA 50-physician anesthesia group must end allegedly illegal noncompete contracts, pay $110K: Washington AG By Alan Condon T he state of Washington filed an antitrust consent decree Aug. 25 against Bellingham (Wa.) Anesthesia Associates, urging the group to end allegedly illegal noncompete contracts and pay $110,000 to the state. The consent decree claims that the 50-physician group used illegal noncompete clauses and exclusive contracts with local providers to take about 90 percent of the market share for physician-administered anesthesia services in Washington's Whatcom and Skagit coun- ties, allegedly in violation of the Washington Consumer Protection Act. Over the last two decades, Bellingham Anesthesia Associ- ates allegedly used exclusive contracts with hospitals and clinics to become the "de facto anesthesia provider" in the two counties, according to an Aug. 26 news release. e group also allegedly coerced its physicians — many of whom are shareholders — to sign noncompete clauses that prohibited them from practicing anesthesia in the area for three years. Physicians who did not own shares in the group had 18-month noncompetes. e consent decree claims that Bellingham Anesthesia Associates' alleged monopoly limited the choices medical facilities and surgeons could make, as well as the options for patients. By controlling the local market, the group did not have to compete to provide improved services, offer more services or reduce its prices, according to state At- torney General Bob Ferguson. e antitrust consent decree, if approved by the Whatcom County Superior Court, would require the group to stop illegally requiring physicians to sign three-year noncom- pete contracts. e consent decree also would limit Bellingham Anes- thesia Associates' employees' noncompete time to nine months and shareholders' noncompete time to one year. If a judge approves the agreement, the group would be able to keep exclusive contracts with hospitals that need anesthesiologists on constant standby, but it would be re- quired to cancel contracts with ASCs, medical clinics and other providers that do not need emergency coverage. n 'The government pays us less than they pay their plumber': Anesthesia leaders on reimbursement challenges By Patsy Newitt F rom labor shortages to surprise billing legislation, five leaders in anesthesiology spoke with Becker's ASC Review on the biggest reimbursement challenges they experience. Editor's note: These answers were edited lightly for clarity and brevity. Question: What's the most significant reimbursement challenge in anesthesiology? Andrew Leibowitz, MD. Professor and Chair of the Department of Anesthesiology, Perioperative & Pain Medicine at Mount Sinai Health System (New York City): Anesthesiology practices with a large governmental payer mix require a substantive subsidy from the sites they staff. Anesthesiologists may provide on average 10,000-15,000 [American Society of Anesthesiologists] relative value units of work per year. In most states, Medicaid pays approxi- mately half what Medicare does. So, the biggest reimburse- ment challenge is to not succumb with commercial payers to a "multiple of Medicare contract" when Medicare is so grossly underpaying anesthesiologists to begin with. Further, many anesthesiology groups have experienced commercial payer contracts unilaterally revoked and rates significantly decreased before the end of the written contract cycle. Mark Casner. CEO of Providence Anesthesiology As- sociates (Charlotte, N.C.): The surprise billing legislation portends a murky start to 2022 — although we are wait- ing to see the final rules. I'm also concerned about payer reimbursement, particularly with companies like United that have kicked us all out of network. It is creating real head- aches for us. Scott Harper, MD. Assistant Professor of the Depart- ment of Anesthesiology and Perioperative Medicine at University of Alabama at Birmingham: Government payers pay us ridiculously low rates because they know they can get away with it. Every group in the country has a hospital contract that requires them to accept Medicare. As a result, Medicare doesn't have to negotiate in good faith with us. Currently, Medicare pays us about $45 per hour. Think about that — the government pays us less than they pay their plumber! Robert Millwee, MD. Anesthesiologist in Plano, Texas: The biggest problem is low pay from government insur- ance, and private insurance companies controlling laws passed by Congress to always result in their favor. n

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