Becker's ASC Review

19 GASTROENTEROLOGY What happened when Anthem cut GI anesthesia reimbursements? By Patsy Newitt A nthem Blue Cross Blue Shield recently reversed its decision on a controversial anesthesia reimbursement policy that could have deeply impacted gastroenterology services following intense pushback from providers and the general public. e proposed policy aimed to introduce a new reimbursement structure based on CMS physician work time values, a move that drew considerable criticism. Similarly, Kaiser Foundation Health Plan walked back on its proposed changes to anesthesia reimbursement in Washington state. Gastrointestinal procedures, particularly endoscopy, have been a focal point for payer reimbursement adjustments. In Ohio, Anthem adopted a flat fee structure for endoscopy procedures in 2012, providing a case study of the broader consequences such policies can have. Jay Weller, MD, anesthesiologist at Cincinnati, Ohio-based Seven Hills Anesthesia, highlighted the significant disparities caused by such flat fee models. For GI providers, the model failed to account for the complexity and duration of procedures such as upper endoscopy versus more intensive cases like endoscopic retrograde cholangiopancreatography. "While that flat fee may have been adequate for a short case, it was not for a lengthy or complex one," Dr. Weller said. "Practices handling complex, high-acuity GI procedures were disproportionately impacted, undermining their ability to provide care for vulnerable patients." GI procedures oen involve varying degrees of anesthesia, and the reimbursement structure directly affects access to care. Providers have warned that reduced reimbursements for services such as ERCP and colonoscopy could result in financial strain for practices, particularly those managing complex, outpatient-focused care models. e downward trend in anesthesia reimbursements is exacerbating the already critical shortage of anesthesia providers nationwide, a problem that directly affects GI care. Brian Cross, CRNA, owner of Youngstown, Ohio-based CS Anesthesia, explained that reductions in reimbursement rates have made it increasingly difficult to recruit and retain anesthesia providers. "e biggest impact is in regions where Anthem Blue Cross Blue Shield has [cut anesthesia reimbursements] is that it's made it more difficult to recruit anesthesia providers," Brian Cross, CRNA, owner of Youngstown, Ohio-based CS Anesthesia, told Becker's. "e income from these procedures goes down, probably by 30 to 40%, compared to what we get from Cigna, United Healthcare or Medical Mutual for the same procedures. Anthem is really leading the charge in cutting reimbursement for anesthesia, whether it's anesthesiologists or CRNAs." As reimbursement pressures mount, some providers foresee groups opting out of insurance networks altogether, potentially increasing costs for patients "In the next five to ten years, large groups may exit insurance networks altogether," he said. "ey'd bill patients, who would then have to fight to get reimbursed by their insurers. It's not unlikely." e challenges in anesthesia reimbursement are part of a broader trend where insurers unilaterally rewrite payment norms every few years, according to Dr. Weller. ese shis clash with rising healthcare costs, including GI-specific inflation for high-acuity procedures. "Many of these payer maneuvers reduce reimbursement while inflation — particularly for anesthesia services — has skyrocketed," Dr. Weller noted. "is creates an unsustainable gap that directly impacts critical GI care, especially for patients undergoing complex procedures." e impact of anesthesia shortages is already being felt across healthcare. Hospitals have delayed or canceled surgeries, including GI procedures, due to provider shortages. is strain highlights the fragile balance between payers' cost-cutting measures and the need for sustainable compensation to retain anesthesia providers. While Anthem and Kaiser's reversals provide temporary relief, GI providers remain at the center of the ongoing tension between payers and anesthesia providers. For gastroenterologists, ensuring adequate anesthesia coverage is vital for patient safety, procedural efficiency, and access to care. e need for sustainable reimbursement models that reflect the complexity and value of GI procedures remains a pressing concern, particularly as providers contend with anesthesia shortages and rising costs. n Medtronic launches 1st- ever patient procedure ingestion using PillCam By Claire Wallace M edtronic has partnered with the University of Miami Health System to perform the first-ever patient procedure ingestion using the PillCam Genius SB capsule endoscopy kit. The PillCam lets patients complete the procedure at a hospital, a clinic or even during a telehealth appointment, according to a Dec. 12 press release. The kit is designed to visualize the small-bowel mucosa in adult patients, aid in the detection and monitoring of conditions such as Crohn's disease, obscure gastrointestinal bleeding and iron-deficiency anemia when these abnormalities are not identified through traditional upper or lower endoscopy. The technology features a link device that replaces traditional data recorders in the form of a wearable, single-use device that efficiently stores images transmitted by the capsule and alerts patients via haptic vibrations, audible signals and LED lights when their procedure is complete. n

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