Issue link: https://beckershealthcare.uberflip.com/i/1531804
11 THOUGHT LEADERSHIP for-profit insurance company's fiduciary responsibility is to maximize shareholder value. I have a different value system, and I am certain my colleagues and any healthcare system will oppose any efforts to devalue the professional, highly skilled services anesthesiologists and CRNAs provide. For those patients considering insurance options, caveat emptor. ese opinions are solely my opinion and not those of Yale School of Medicine or Yale New Haven Health. Udaya Padakandla, MD. President of the Texas Society of Anesthesiologists: I can't read the insurers' minds, but I do sincerely hope this decision to rescind such a capricious policy gets the insurers to really rethink their policies on making profits for their shareholders at any and every expense. ey have been systematically chopping down payments to physicians, and unjustly denying services to patients by implementing draconian pre-authorization requirements (another greedy attempt at maximizing profits). ey do need to take a step back and see for themselves how far they have taken the profit motive in healthcare markets. e healthcare market is NOT the goose that lays the golden egg. is also brings up a thought in my mind. I always wondered why only physicians are beholden to the Hippocratic oath. In fact such an oath, "to NOT harm the patient (and the physician that takes care of the patient)" should be instituted for every entity that steps into the arena of healthcare — be it a facility, ASC/hospital, nursing home, PBM, GPO or an insurance carrier. Aer all, health — and healthcare by extension — have been turned into commodities on Wall Street, to the detriment of our own population. Profit needs to take a back seat where health and lives are involved. at is a better way forward for civilized societies. Stan Plavin, MD. Anesthesiologist and owner of Oral Surgery Anesthesia Associates: I do think it is possible that Anthem and other carriers are always looking for ways to control the narrative and the payment models. Aer all, physician care and services are what patients appreciate most — Anthem and other carriers should spend more time and energy making sure physician-directed care is compensated more than reckless spending on dietary medications or unproven chemotherapeutic agents. For the carriers and most people, it is always a balance between time and money. Focus on preserving the physician-patient relationship and the rest will hopefully take care of itself. Looking at various payment models may work, but have a robust discussion and engage the physician groups accordingly; don't randomly try to pull a fast one. Rick Richter, MD. Anesthesiologist at Anesthesia Associates of Rock Hill (S.C.): I believe this approach to alter the methodology of paying for anesthesia services is only one of several facets that will attempt to force anesthesiology to become a wholly integrated service for surgical reimbursement in a misguided effort to ratchet down costs in order to improve profits for insurance companies. James Stockman, MSN, CRNA. Past President of the Texas Association of Nurse Anesthetists and CEO of Grasshopper Anesthesia Services: Sadly, I feel this is an isolated incident due to significant negative feedback from stakeholders such as the American Association of Nurse Anesthesiology (who I know voiced significant opposition behind the scenes on the decision) and the American Society of Anesthesiologists, who was more public. is, combined with significant opposition from the public, seems to be what caused the reversal. What gets lost in these discussions on anesthesia cuts (Medicare has decreased reimbursement over 8% in the last four years) is that the costs are passed on to hospitals and patients. is is particularly hard on rural hospitals, which are already significantly financially stressed. Our country desperately needs to have a wider conversation on the decreasing anesthesia reimbursement versus the increasing demand for CRNAs and anesthesiologists. Gerald Szelagowski, MD. Anesthesiologist at Buckeye Anesthesia Services and Consultants (Lima, Ohio): Insurance companies make money by not paying out claims. is is an example of the extreme limits that these multibillion -dollar companies will push their paying customers and contracted providers. is is not the end.… Jeff Tieder, MSN, CRNA. Clinical Associate Professor at the University of Tennessee at Chattanooga: I do hope that reimbursement for anesthesia services will continue to be valued. As an anesthesia provider and CRNA faculty, I believe that an efficiency- driven model of provider is the only real way to navigate the current and future provider shortage. Insurance companies that devalue the role of CRNAs in the community do a disservice to their clients and the providers who serve them. Incentivizing surgeons that stay within the "normal time" and quality for routine procedures would have a better impact than decreasing anesthesia fees. Jay Weller, MD. Anesthesiologist at Seven Hills Anesthesia (Cincinnati, Ohio): Anthem BCBS is not unique, but this is not the first time they have attempted unilaterally to completely rewrite the rules for how anesthesia services are reimbursed. ey did it successfully in 2012, when they became the only insurer to abandon the standard base plus time model and convert to paying a flat fee for anesthesia for endoscopy services. ey failed in an effort to deny reimbursement for anesthesia for cataract surgery in 2018 and have failed again in their effort this time. Based on this history, it appears that Anthem has a strategy of trying to rewrite the rules unilaterally every five years. Recently, other insurers have also begun to implement unilateral efforts to rewrite the norms that have defined reimbursement for anesthesia services for more than 30 years. Unfortunately, the insurance industry is highly concentrated, which will undoubtedly encourage carriers with dominant market positions to continue to look for creative ways to maximize profits at the expense of patient care. n "Insurers seem more driven by profits than helping patients. ey will probably look for new ways to reduce payments and increase their profits. Physicians are more wary now, but whether they can keep their payments seems uncertain." - Bob Johnstone, MD.