Anesthesia providers face a number of insurance-related challenges from both CMS and commercial payers.
Reimbursement declines from both CMS and private payers remain a pressing issue for anesthesia providers as they manage high demand for their services amid an ongoing staffing shortage.
Udaya Padakandla, MD, an anesthesiologist at Baylor Scott & White Health in Dallas and immediate past president of the Texas Society of Anesthesiologists recently joined Becker’s to discuss the payer-related issues most concerning for anesthesiologists.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What are the most pressing payer-related issues facing anesthesiologists at the moment?
Udaya Padakandla: Our most pressing issues with regard to payers are:
1. Inappropriate linkage of underpaying Medicare payments as benchmark private
payers.
2. Non-compliance by payers in [No Surprises Act]-related independent dispute resolution-related awards.
3. Recent decision by [three] different payers to stop payments for [American Society of Anesthesiologists] physical status modifiers as well as other modifiers like controlled hypotension and field-avoidance techniques.
4. The recent decision by at least one payer to cap anesthesia payments on specific time units (physician work time values from the CMS to determine anesthesia time limits), which was later rescinded. This will likely resurface soon with payers in their attempt at reducing
costs (i.e., physician payments).
Q: Any thoughts on/response to UnitedHealthcare’s recent policy update?
UP: UHC was not the first payer to implement a reduction in anesthesiologists’ payments on ASA [physical status] modifiers and other modifiers. HealthCare Services Corp. and Aetna/CVS were the first. The stated reason is cost containment. The real reason, of course, is the appeasement of their investor/shareholder base in the face of significant recent downturn in UHC’s Wall Street earnings amid rumors of [a Department of Justice] investigation of their Medicare Advantage plans among many other things. This is deeply detrimental to all physicians in general and anesthesiologists in particular. Anesthesiologists are being squeezed financially from all directions, including payers, CMS and Affordable Care Act-imposed moratoria on physician ownership of healthcare facilities.
