Becker’s ASC Review
Two weeks ago, I assumed the position of president of the American Society of Anesthesiologists, an organization and specialty of which I am immensely proud. More than 60,000 ASA members work every day to provide the safest, highest-quality care for the patients we serve, while working with the leadership of our healthcare institutions to improve hospital efficiency, cut costs and ensure operating rooms run smoothly. But that’s not to say we aren’t facing challenges. The top three pressing issues confronting the specialty of anesthesiology are as follows:
1. Protecting our patients’ safety by advocating for anesthesiologist-led care and the Anesthesia Care Team model. The laws in most states and the policies of the nation’s top hospitals require physician-led anesthesia care. However, that doesn’t stop the national nurse anesthetist organization from pushing legislation for the nurse-only model, which is costly and associated with worse patient outcomes. The nurse-only model is permitted only if state law allows, and if the state has formally opted out of the federal Medicare rule that requires physician supervision of nurse anesthetists. This is far from the norm — 45 states in the U.S. require physician-led care. A real-life example of the danger of the nurse-only model occurred in 2024 in two hospitals in Modesto, Calif. The California Department of Public Health surveyed the hospitals after complaints. Both were cited with an immediate jeopardy declaration (the most critical condemnation a hospital can receive) after CDPH found issues including the inappropriate use of the nurse-only model, which was a violation of California law. It is also important to note that patients and surgeons prefer anesthesiologist-led care. Ninety-percent of patients want an anesthesiologist leading their care, and 91% of surgeons believe anesthesiologists are best to handle complications. Over the past year, ASA has defeated over a dozen nurse anesthetists-backed practice expansions proposals. We will continue to fight for our patients’ safety as it is the physician-led model that has made anesthesiology one of the safest specialties in medicine.
2. Workforce challenges are troubling all members of the ACT — anesthesiologists, nurse anesthetists and certified anesthesiologist assistants. However, anesthesiology residency positions increased 40% in the last 10 years and have more than doubled since 2002. Anesthesiology’s match rate of 99.74% reflects the impressive interest in our highly sought medical specialty. To alleviate workforce pressures, ASA supports federal initiatives to grow anesthesiology resident positions, and that allow for appropriate utilization of international medical graduates. Additionally, ASA has worked closely with our ACT members, the CAAs, to expand their practice opportunities. Over the past two years, ASA has joined with our state component societies to expand CAA practice in South Carolina, Tennessee, Virginia and Washington.
3. Third, but as important as the first two, is ensuring the economic integrity of the specialty. Anesthesia care in the U.S. is at a tipping point. Payment cuts and rogue insurer policies are destabilizing the anesthesia care system — threatening patient safety, hospital operations and access to surgery, particularly in rural communities.
The anesthesia payment structure has been underfunded for decades, and new cuts affect everyone on the ACT. Across the country, public payments have not even kept up with inflation, and private insurers are prioritizing profits over patients, undermining physicians’ ability to provide timely, high-quality care. ASA has initiated campaigns to address policies that hurt our specialty and the patients we serve. We are fighting: Medicare Advantage upcoding that inappropriately diverts billions to insurers; health insurance companies that underpay care for sicker patients; prior authorizations that delay necessary treatment; facility payment penalties of 10% for services provided by out-of-network professionals; and insurer gaming of the No Surprises Act system with extremely low and delayed payments.
These insurer practices exacerbate financial and workforce pressures on hospitals. This is especially problematic in rural areas, where demand for anesthesia services is rising as payments fall and the gap between revenue and expenses increases. Congress and regulators must act now to stop insurer abuses.