Becker's ASC Review

15 THOUGHT LEADERSHIP Anesthesiologists to CMS: 'We want to be valued' By Francesca Mathewes A nesthesiology faces numerous pressure points, including provider shortages and decreasing reimbursements. And, as private payers typically look to Medicare to determine their reimbursement rates, some look to CMS to change the course of consistent rate declines. Here is what four anesthesiologists told Becker's they would like to see from CMS: Editor's note: Responses have been lightly edited for clarity and length. Mark Destache, MD. Anesthesiologist with Associated Anesthesiologists, P.A. (Plymouth, Minn.): What anesthesiologists want from CMS is a fair wage for taking care of this patient population. e conversion factor for anesthesia has been cut by a third since 1992 when not adjusted for inflation. It is currently $20.77 per 15 minutes, which is the same whether it is open heart surgery or cataracts. at is less than what CRNA wages are, so in effect, the anesthesiologist makes less than nothing once the case is going. Christian Welch, MD. Anesthesiologist at UT Health San Antonio: In short, we want to be valued. Despite an ever-increasing percentage of patients on Medicare, which typically represents an older and sicker patient population, our profession is taxed with annual cuts. e 2025 proposed anesthesia conversion factor is $20.33, down from $20.43 in 2024 and $20.67 in 2023. Commercial insurers typically follow CMS reductions. In addition, we are taking care of more ASA 3 and sometimes ASA 4 patients in ASCs. Anesthesia has become very safe, mostly due to the work of the Anesthesia Patient Safety Foundation. at does not mean, however, that our role as perioperative physicians and "guardians" of the OR should be taken for granted. Donald Keusch, MD. Anesthesiologist at Boca Raton (Fla.) Plastic Surgery Center: Anesthesiologists would like fair reimbursement for their services. Currently, Medicare pays 28% of the anesthesia rate that is received from commercial insurance. is is intolerable and is not sustainable. Rather than increasing reimbursement over the years to account for inflation, there has been a further absolute decline in payments to physicians. e situation for Medicaid is even worse. Javier Marull, MD. Associate Professor in the Department of Anesthesiology and Pain Management at UT Southwestern Medical Center (Dallas): As anesthesiologists, what we really want is to give our patients the best care possible without getting bogged down in unnecessary red tape. We are with our patients through every step of their journey, not just in the operating room, and we would love to see that dedication reflected in fair compensation. A big part of the challenge we face is the amount of time spent on paperwork and approvals, which takes us away from what really matters: our patients! If CMS could simplify these processes, it would make a huge difference, allowing us to focus more on patient care and less on administrative tasks. At the heart of it all, we just want to do what we are trained to do, care for people without the constant barriers that make that harder than it should be. n Hopeful, but skeptical: The double-edged sword of medical advancements By Laura Dyrda W hile medical advancements enable ASC staff to achieve more with fewer resources, they come with their own set of challenges. Emma Gimmel, RN, director of nursing at Manhattan Endoscopy in New York City, joined Becker's to discuss what's making her hopeful and what's making her skeptical about the future of medicine. Editor's note: Responses have been lightly edited for clarity and length. Question: What makes you hopeful for the future of medicine? Why? Emma Gimmel: It's easier to reach communities. There's more accessibility with care alternatives, such as virtual consultations and deliveries whereas before this was not possible. These alternatives are helpful to access those who are too busy to take time to attend medical appointments. Virtual consultations/follow-ups and deliveries, with the prospect of practitioners' shortages, is a hopeful and convenient option that may help and facilitate care delivery. Additionally, [I'm hopeful about] monumental medical science advances, the resourceful advance testing, finding more with less. The quick and accurate diagnosis offering options for treatments, care and life modifications were previously limited or less certain. Can AI improve by eliminating medical errors? In theory, it all appears hopeful and promising, with a degree of skepticism due to, but not limited to, huge financial restraints (those actual and those manmade), government rulings, institutions distributions, earnings expectations and the trust in the medical system and [its] intentions. Q: What scares you for the future of medicine? EG: Medical science is amazing, but when we're moving at the speed of light as in the last years, including those findings that are circumstantial, then the concepts become more complex and difficult to assimilate by the general population. Additionally, with the communication options we have, pesky misinformation trends easily distributed and made available, attractive to some, only create more confusion with serious and damaging consequences. n

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