Becker's ASC Review

10 THOUGHT LEADERSHIP business of taking care of people, not taking advantage of them. Bob Ebener, DO. Anesthesiologist in Middleburg, Fla.: I believe that payers are always looking for ways to cut reimbursement to cut costs. is is just an example of an overreach that even the public had realized. ey will certainly come up with other ways to keep the patient's money and pay as few of their bills as possible. Ladan Eshkevari, PhD, CRNA. Editor-in-Chief of the AANA Journal and Professor at Georgetown University (Washington, D.C.): I am hopeful that a misguided decision such as this will have a postmortem analysis by Anthem to figure out what went wrong, i.e. how the decision was made and who were the personnel responsible for making it. Obviously, I do not know what the future will hold, but I think if the insurance companies can't regulate themselves internally against these grave decisions, perhaps Congress needs to start putting some guardrails and regulation in place on how decisions are made by insurance companies. Of course, that would take an act of Congress, pun intended! Megan Friedman, DO. Anesthesiologist and Director of Pacific Coast Anesthesia Consultants (Los Angeles): While Anthem's reversal is a positive step, it is likely a response to strong advocacy rather than a broader trend. Insurers oen prioritize cost containment, and this incident highlights the need for continued vigilance from medical professionals and organizations. Policies that undermine care quality or place undue financial burdens on providers can create ripple effects, worsening staffing shortages and increasing costs for patients and facilities. at said, this case serves as a reminder that collaborative dialogue between payers and providers is essential. It is possible that other insurers will take note of the backlash and tread more carefully when proposing similar changes. However, sustained advocacy and evidence-based discussions will be needed to ensure reimbursement policies align with the realities of patient care. Dewey Galeas, CRNA. Certified registered nurse anesthetist in Grovetown, Ga.: Unfortunately, I see Anthem's policy as a current and continuing trend in anesthesia reimbursement. Administrators, surgeons and non-anesthesia personnel view anesthesia as a "cost." Furthermore, there is a view that money should be made on the backs of anesthesia. We're not getting rich. But I can promise that the lights go out in a room when anesthesia is absent. ese sentiments and experiences have shied anesthesia providers into temporary settings at greater cost to everyone involved. Robert Gordon, MD. Anesthesiologist in Ramsey, N.J.: is type of maneuver is nothing new. "Managed care" has existed for 25 years. Companies will continue to scheme. Matthew Gummerson, MD. Anesthesiologist in Dallas: I don't think this was a broader policy shi or statement as to anesthesia reimbursements across the board but an experiment to explore what the possible fervent reactions might be from the anesthesia community. It was significant. Calvin Johnson, MD. Professor of Anesthesiology at Cedars-Sinai Medical Center (Los Angeles): While it's tempting to view this reversal as a broader shi, it's more likely to be a response to specific pressure from stakeholders in this instance. at said, this could set a precedent for how payer policies are craed and revised in the future. If other payers observe that collaborative dialogue and adaptation improve outcomes for all parties, we may see a more balanced approach to anesthesia reimbursement policies industry-wide. e key takeaway is that provider advocacy and data-driven evidence remain essential tools in shaping fair reimbursement practices. Bob Johnstone, MD. Chair of the Department of Anesthesiology at West Virginia University (Morgantown): 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. John Kezele, CRNA. Certified registered nurse anesthetist at Franklin County Medical Center (Preston, Idaho): In the face of rising costs, including wages, I find payers are reducing payments, including an additional 15% because I am an independent functioning anesthesia provider. Anthem's policy was just another cost-saving tactic to help define a "failed market." ey aren't the only ones. CMS has been doing the same. Mike MacKinnon, DNP, CRNA. Owner of Mackinnon Anesthesia (Show Low, Ariz.): I think this is a one-off based on current events and anti-commercial insurance sentiment. I fully expect this to come back. ese types of policies place unnecessary burdens on both patients and providers, seemingly designed to frustrate the process of payment until someone gives up. Starting in January 2025, two major commercial insurers will reduce CRNA reimbursement rates by an additional 15%. Now, some insurers are introducing arbitrary caps on reimbursable anesthesia time, regardless of how long a case actually takes. is policy unfairly penalizes anesthesia providers for circumstances beyond their control. Surgeons are reimbursed the same regardless of case duration, while anesthesia is penalized for prolonged surgical times caused by inefficiency, unavoidable complications, or delays for essential steps such as sterilizing instruments or waiting on pathology. ese issues are intrinsic to the operating room environment, yet anesthesia providers are singled out financially. is devaluation of anesthesia services is a direct affront to the expertise and vigilance required to keep patients safe throughout the perioperative period. e ripple effects of such policies extend beyond the operating room. Groups employing anesthesia providers will inevitably turn to hospitals for increased subsidies, and hospitals employing anesthesia will face higher operating costs as the gap between collections and salaries widens. In a competitive market, salaries for anesthesia providers will not — and should not — fall simply because insurers have decided to prioritize profits over patient care. Meanwhile, the CEOs of these for-profit insurers continue to receive massive bonuses and salaries, further highlighting the disparity between their corporate interests and the realities of providing quality healthcare. It is crucial to remember that commercial insurance companies are not in the business of healthcare — they are in the business of profit. Matt Mazurek, MD. Assistant Professor of Anesthesiology at Yale School of Medicine (New Haven, Conn.): Anesthesiologists and CRNAs have enormous leverage. Anesthesia services are currently in great demand, and that demand is outstripping supply. Insurance companies are treating anesthesia services as a cost center to be exploited, and this is not an accident because CMS has been reimbursing our services far below our true market value for decades. Around 57% of anesthesiologists are over 55 years old, and 50% of CRNAs are over 50 years old. ese numbers are facts. A good percentage of these providers are over 60 and can retire at any time. Any attempt by insurance companies to propose this kind of reimbursement scheme will be met with the same response. e optics are exceptionally poor, and I am sure patients who are examining Medicare Advantage plans are considering what Anthem just proposed. In fact, the governors of New York and Connecticut contacted Anthem directly about the consequences of this proposal. Unfortunately, I am certain that there will be continued pressure to reimburse us less in order to maximize profits and shareholder value. A

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