Anesthesia Alert: A Tumultuous End of 2024 for Anesthesia Payments

The ASA is calling for commercial payors to halt payment reductions in 2025.

Anthem Blue Cross and Blue Shield announced in mid-November that its policy update regarding how it evaluates time billed by anesthesiologists would result in changes in how it reimburses for anesthesia care payments. The update included potentially not paying for anesthesia care for the entirety of cases that went beyond a pre-set time limit — and the backlash was swift.

‘A cynical money grab’

On. Nov. 14, the American Society of Anesthesiologists (ASA), a group that works to raise and maintain the standards of the medical practice of anesthesiology and to improve patient care, called the move “appalling,” “unprecedented” and “a cynical money grab.”

The ensuing media coverage on the concept of paying for anesthesia for only a set time period — even if the procedures went longer than that — included patients’ fears that they would be strapped with huge anesthesia bills if they underwent lengthy procedures. Some online discussions invoked beyond-worst-case scenarios of anesthetic gas being turned off mid-procedure.

Reading the room?

Then, on Dec. 5 — perhaps notably, one day after United Healthcare CEO Brian Thompson was shot and killed in midtown Manhattan by a man whose writings mentioned United and referenced what he called corporate America’s corruption and greed — Anthem announced it was not moving forward with its plan to revamp how it pays anesthesiologists. The company made no reference to Mr. Thompson’s murder in its announcement to halt its plan to revise anesthesia payments. The changes were scheduled to go into effect Feb. 1 in New York, Connecticut and Missouri.

“There has been significant widespread misinformation about an update to our anesthesia policy,” says the Anthem Dec. 5 statement. “Based on feedback received and misinterpretation of our policy change, it is evident that our communication regarding this policy was not clear, and as a result, we have decided to not proceed with this policy change.”

Anthem, one of the largest commercial health insurance companies in the U.S., said the proposal was essentially a move to prevent overbilling by anesthesiologists. Doing so, the company says, would prevent patients from being overcharged and would allow the company to provide more affordable care across its system.

“The proposed update to the policy was only designed to clarify the appropriateness of anesthesia consistent with well-established clinical guidelines. Any medically necessary anesthesia would have been paid under the update,” says the Anthem statement. “In circumstances when anesthesia providers went outside of well-established clinical guidelines, they would have been able to submit medical documentation to support accurate payment.”

Critics such as the ASA, however, say the proposal would have shouldered patients with large out-of-pocket costs for the portion of the cases for which anesthesia care would have been denied. ASA said the proposal was deeply flawed, that the proposed time limits were “arbitrary” and “Anthem-set,” and that it hopes the company’s reversal will be permanent.

Similar story

A move by Kaiser Permanente (KP) followed a similar timeline. On Dec. 10, ASA responded to a KP statement about anesthesia reimbursements that went into effect Nov. 1, 2024. The changes at Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options included reducing payments for work done by certified registered nurse anesthetists (CRNAs) to 85% of the Physician Fee Schedule. The American Association of Nurse Anesthesiology (AANA) opposed the move, saying it was discriminatory against CRNAs.

On Dec. 12, two days after the AANA opposition, Kaiser announced it was discontinuing the change and reinstated the old reimbursement schedule retroactive to Nov. 1.

“Like other recent policy reversals, the news that Kaiser will walk back their new anesthesia reimbursement policy is appropriate albeit late,” says AANA President Jan Setnor, MSN, CRNA, Col. (Ret.) USAFR, NC. “This policy — and those similar — never should have been implemented in the first place. Expanding and ensuring access to timely, quality care should always be the priority, and these dangerous policies stand in direct opposition to patient needs.”

AANA also objected to Medical Mutual’s announcement that it would reduce CRNA’s reimbursements by 15% starting Jan. 24, calling on the Ohio insurance company to change its mind.

“It is the AANA’s position that Medical Mutual follows Anthem and Kaiser’s lead by reversing course on this discriminatory and dangerous policy that is in violation of the nondiscrimination provision within the Affordable Care Act,” says Ms. Setnor.

Calling Anthem’s recent policy proposal part of a larger trend among commercial health insurers to unilaterally undercut established anesthesia billing and payment norms that recognize anesthesia services and care, ASA issued an open letter to commercial payors on Jan. 1, calling on them to change their ways. ASA says the recent payor proposals weren’t cost-cutting solutions. Rather, they would merely shift costs from insurers to hospitals, physicians and patients, says ASA.

Patient over profits

Here are the New Year’s resolutions ASA recommended to the commercial carriers: Prioritize patient care over corporate profits; promise to halt all efforts to limit necessary care for patients, including limiting the duration of anesthesia care; acknowledge the unique needs of patients with health conditions and risk factors — such as high blood pressure, significant heart disease or uncontrolled diabetes — and support the physicians who care for them; commit to respecting the physician-patient relationship and reforming prior authorization systems that undermine physician expertise and directly limit patient care; and work with anesthesiologists and other physicians, not against them, to improve access to care.

“It is not a secret that America’s health insurance companies have recorded record profits in recent years,” says the letter. “It’s time for the insurance companies to turn over a new leaf and begin putting patients over profits.” OSM