December has been a tumultuous month for anesthesia pay policy, as provider and public outrage has spurred two payers to reverse controversial reimbursement policies.
On Dec. 5, Anthem Blue Cross Blue Shield announced it would rescind a planned update to its anesthesia reimbursement policy. The update proposed a new payment structure tied to CMS physician work time values, under which claims exceeding predetermined time limits would be denied.
The policy faced sharp criticism from the American Society of Anesthesiologists, which issued a statement Nov. 14 decrying the plan’s lack of consideration for the individualized nature of anesthesia care. The ASA warned the policy would “arbitrarily pre-determine the time allowed for anesthesia care,” potentially resulting in denied payments for complex or prolonged cases and risking patient safety.
On Dec. 4, social media outrage erupted when posts about Anthem’s policy went viral on the platform X. The widespread backlash prompted policymakers to intervene, leading to Anthem’s reversal the following day.
“It’s very interesting that Anthem’s policy was so egregious in how it attempted to not pay for anesthesia services that even had friends and family members who are not in the medical field texting me regarding this ridiculous policy,” Gerald Szelagowski, MD, anesthesiologist at Lima, Ohio-based Buckeye Anesthesia Services and Consultants, told Becker’s. “When the general public, who have no knowledge of how anesthesia time is billed, is reaching out to members of the medical community concerned, that tells you how far Anthem is going to go in order to increase profits.”
The controversy surrounding reimbursement policies was further amplified by broader scrutiny of insurance practices following the tragic murder of UnitedHealthcare CEO Brian Thompson. This incident cast a spotlight on decision-making within the insurance industry, fueling public anger and calls for accountability.
“It is the right thing to do, but I’m concerned about the decision-making process that led to this policy. My assumption is the recent murder of the UnitedHealthcare CEO and the subsequent outrage regarding commercial insurance companies had more to do with the reversal than anything else,” Mike MacKinnon, DNP, CRNA, owner of Mackinnon Anesthesia, told Becker’s. “At least the timing suggests that’s the case, as they announced this policy in the second week of November and not until it hit the news again after the CEO murder was another light shed on this issue and they decided to reverse. My guess is this was to avoid more negative press ‘eyes’ on them.”
Then, on Dec. 16, Kaiser Foundation Health Plan announced it had reversed an anesthesia reimbursement policy introduced in Washington state in November.
The now-rescinded plan required anesthesia services to include specific modifiers identifying who performed the service for reimbursement. Additionally, the policy reduced payments for QZ services — those rendered by certified registered nurse anesthetists — to 85% of the physician fee schedule.
“As one of the largest not-for-profit healthcare providers in the country, Kaiser Permanente’s mission is to provide high-quality, affordable care to our members and the communities we serve,” a Kaiser spokesperson said in a statement shared with Becker’s. “While we will continue our focus on keeping care affordable for our members, we will not implement changes in reimbursement rates for anesthesia services provided by CRNAs. We have returned to previous reimbursement rate levels, retroactive to November 1, 2024.”
The reversal came after the American Association of Nurse Anesthesiology strongly opposed the policy, describing it in a Dec. 10 statement as discriminatory. The AANA argued that the policy unfairly targeted CRNAs based on their licensure while not affecting other anesthesia providers delivering the same services.
Now, another insurance company — Ohio-based health insurance provider Medical Mutual — plans to reduce CRNA reimbursements to 85% beginning Jan. 24.
The AANA issued a statement expressing disapproval for the policy, calling it “a blatant, dangerous, and self-serving attack on CRNAs and the patients they seek to care for,” according to a Dec. 19 news release.
“CRNAs are often the only anesthesia providers in the rural communities across the nation, including rural communities in Ohio where Medical Mutual is headquartered,” the AANA said in its statement. “The attempt by insurers to restrict their practice, underscores the critical need for the Department of Health and Human Services (HHS) to enforce the nondiscrimination provision, and is why AANA continues its litigation in the United States District Court for the Northern District of Ohio to compel HHS to enforce the law.”
The push to cut anesthesia reimbursements is not new. Medicare’s average anesthesia rate for 2023 was $21.88, a 5.5% decline from 2019, according to an analysis by Coronis Health. Another analysis, from VMG Health, found that Medicare reimbursements for anesthesia services decreased from $22.2730 per unit in 2019 to $21.1249 in 2023 under CMS’ final rule.
“Many facilities and ASCs already provide stipends to maintain anesthesia services due to insufficient reimbursement rates. Additional cuts could have increased these stipends, straining resources further for hospitals and ASCs,” Megan Friedman, DO, anesthesiologist and director of Los Angeles-based Pacific Coast Anesthesia Consultants, told Becker’s. “This financial burden would only compound the existing workforce shortage, with 78% of facilities reporting difficulties in anesthesia staffing and over half of anesthesia providers nearing retirement age.”
