Becker's ASC Review

9 THOUGHT LEADERSHIP Jordan Taradash. CEO of PeopleOne Health (Pittsburgh): Two main opportunities are set to evolve further in 2025. First, there will be ongoing consolidation of independent ASCs into larger health systems, insurance companies and payviders, mirroring the integration of primary care and specialty practices over the past 20 years. Second, independent ASCs will increasingly align with value-based health plans, aggregated by independent third-party administrators and through direct contracts with self-funded employers. In 2025, we will continue to see the dynamic tension between established industry players and value-based disruptors unfold at the front lines. n 'There's going to be a breaking point': Long-term implications of anesthesia pay cuts By Patsy Newitt A s anesthesia reimbursements continue to sink, many leaders are concerned about the potential ripple effects on patients, physicians and ASCs. Brian Cross, CRNA, owner of Youngstown, Ohio-based CS Anesthesia, joined Becker's to discuss the long-term implications of anesthesia reimbursement cuts and the biggest misconception about anesthesia billing. Question: Could you characterize the long-term implications of anesthesia cuts trends on patients? Brian Cross: Long-term, I can see anesthesia groups going out of network and charging patients directly. In the next five to 10 years, large groups may exit insurance networks altogether. They'd bill patients, who would then have to fight to get reimbursed by their insurers. It's not unlikely. There's going to be a breaking point for smaller companies like mine. I hire [certified registered nurse anesthetists] to work for me, but the costs are almost too high to justify keeping contracts with surgery centers. These centers are going to have to increase their volume to stay viable. Right now, CRNAs and anesthesiologists expect to be paid for an eight-hour day, but if the surgery center finishes in six hours, that's lost revenue. Unless things change, this entire system will likely hit a breaking point within five years. Q: What would you say is the biggest misconception about anesthesia billing? BC: The biggest misconception is that we get paid lots and lots of money, especially because, in most realms, from Medicare, you're getting about 30 to 35% of what we would typically get from private insurance companies. It's kind of bizarre how, in our world, every year we could be doing the same amount of cases, everything, same number of centers that we're billing, and we keep getting less and less and less. And I don't think the payers are taking pay cuts, to be honest. n 'Companies will continue to scheme': 22 leaders on what Anthem BCBS' reversal could mean moving forward By Patsy Newitt A nthem Blue Cross Blue Shield has reversed its decision on a controversial anesthesia reimbursement policy update — leaving many leaders wondering if this could signal a broader shi. Amid outrage from anesthesia leaders, the payer said the reversal was spurred from "widespread misinformation" surrounding the update, which would have introduced a new reimbursement structure based on CMS physician work time values. Twenty-one anesthesiologists and certified registered nurse anesthetists connected with Becker's to discuss what the move could say about the future of insurance behavior. Question : Do you think Anthem BCBS's reversal could signal a broader shift in how payers approach anesthesia reimbursement policies, or do you see this as an isolated incident? Editor's note: Responses were edited lightly for clarity and length. George Anastasian, MD. Chief of Anesthesiology at White Plains (N.Y.) Hospital: is proposed move plainly exposes insurance companies' drive to increase profits. I expect more tricks down the line to deny or curtail anesthesia claims. Alan Bielsky, MD. Anesthesiologist at Children's Hospital Colorado (Aurora): I think this does not signal any shi. ey just got caught and shamed publicly. Brian Cross, CRNA. Owner of CS Anesthesia (Youngstown, Ohio): What I expect is for Anthem and other insurance companies to continue to look for ways to reduce payment to medical providers in order to maintain their individual million-floor bonuses every year. Katy Dean, CRNA. Certified registered nurse anesthetist in Yorktown, Va.: CMS has decreased anesthesia reimbursement a total of 8.2% from 2019-2024, with another 2.2% slated for 2025. is discrepancy between government and private pay has insurance companies looking for ways to decrease reimbursement. Cuts that can affect patient care so drastically need to be stopped. We are in the

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