Becker's ASC Review

6 ASC MANAGEMENT Aetna cuts some physical status modifiers on anesthesia claims By Patsy Newitt A etna will no longer provide additional payment for physical status modifier 3-5 on anesthesia claims, according to an April 19 post by medical revenue cycle management group Coronis Health. Effective July 15, Aetna's commercial plans will stop reimbursing additional unit values for anesthesia physical status modifiers. In January, Aetna announced it would no longer reimburse additional unit values for anesthesia physical status modifiers for all its Medicare Advantage Plans to align with CMS guidelines. is update went into effect April 8. Some anesthesia leaders are unhappy with the move and how it could affect patients and providers. "Physical status modifiers have been part of commercial insurance payments for decades and reflect the challenges associated with providing anesthesia services to patients with the greatest severity of medical conditions," American Society of Anesthesiologists President Ronald Harter, MD, told Becker's in a statement. "is could adversely affect the care provided to these insurers' most medically complex patients." "Medicare acknowledges the importance of assessing patients' complex medical conditions," Dr. Harter added — referencing how Medicare approved an HCPCS add-on code that pays primary care physicians more for providing care to complex patients. According to the Coronis post, Blue Cross Blue Shield of Illinois, New Mexico, Oklahoma, Texas and Montana have made recent revisions to their anesthesia policies that contain a note that physical status modifiers are not utilized to determine payment for anesthesia services. e report cites a recent BCBS of New Mexico policy that states the payer "will no longer offer additional reimbursement for services based on the use of physical status modifiers when appended to anesthesia services." "By ceasing to recognize the medical complexity of patients requiring anesthesia care, BCBS and Aetna are moving away from patient- centered care, placing profits over patients." Dr. Harter said. "Aetna will no longer reimburse additional unit value for Anesthesia Physical Status Modifiers for Aetna commercial plans," an Aetna spokesperson confirmed to Becker's. "is change became effective for Aetna Medicare Advantage on April 1, 2024, which is in accordance with the Centers for Medicare & Medicaid Services (CMS) guidelines." n 116 new ASCs open in 2023 By Claire Wallace B y the end of 2022, there were roughly 6,087 Medicare-Certified ASCs in operation in the U.S., with California holding the most facilities at 848. In 2023, the presence of ASCs continued to grow nationwide, expanding by roughly 116 new facilities in 2023, according to an April 16 article published in Outpatient Surgery Magazine. Many of 2023's new ASCs were orthopedic- specific in nature, as the musculoskeletal industry continues to expand into the outpatient setting, according to the report. According to research from Philadelphia- based Rothman Orthopaedic Institute, the majority of orthopedic procedures cost 40% less in the ASC setting than the hospital outpatient department setting, driving a surge of investment. n What's new with physician pay cuts? By Patsy Newitt As practice costs rise, many physician leaders are concerned about cuts in CMS reimbursements. Here are five major updates on physician pay cuts: 1. Congress halved 2024's 3.4% Medicare pay cut for physicians to roughly 1.7% in a $460 billion spending package released in March. The cut comes on top of last year's 2% Medicare physician pay reduction. 2. Many physicians were disappointed by Congress' move. The American Medical Association said in a blog post that the cut was not enough as the cost of running a practice is becoming unsustainable for many physicians. 3. The original pay cut, released in CMS' 2024 Physician Fee Schedule Final Rule Nov. 2, cut overall physician pay by 1.25% and updated the Medicare conversion factor to $32.74. 4. Additionally, many physicians are facing more pay cuts from the cost-performance category of the merit-based incentive payment system, which could reduce Medicare payments by up to 9%. 5. The Medicare Payment Advisory Commission released a report to Congress in March recommending a roughly 3% year-over-year pay increase for physicians. n

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