The way in which payers set their rates for anesthesiology services is causing many physicians to go around them, looking for ways to provide care without dealing with insurance companies.
Payers negotiate rates based on leverage, often giving better rates to bigger groups, not those who necessarily provide the best care, according to this anesthesiologist.
Nick Schiavoni, MD, is also the co-founder and CEO of Calder Health, a direct anesthesia placement platform that connects facilities directly with physicians. He recently connected with Becker’s to discuss how payers’ tactics are leading to many anesthesiologists simply going around them.
Editor’s note: Dr. Schiavoni’s response was lightly edited for clarity and length.
Question: What specific payer tactic is causing the most disruption to anesthesia services at your facility right now, and how are you pushing back?
Dr. Nick Schiavoni: The most disruptive payer tactic isn’t a denial code. It’s how the rates get set in the first place. Payers negotiate on leverage, and that rewards scale. The bigger the group, the better the rate, so it comes down to your size, not your quality. And that’s slowly pushing traditional insurance-based private practice out of the picture.
And here’s the really interesting part. The pushback isn’t coming from leaders, groups or facilities. It’s coming from the clinicians themselves. More and more anesthesiologists are pursuing opportunities that avoid the insurance model entirely. They’re choosing locums, cash-pay and concierge work over consolidated employment.
When the best clinicians are building careers that go around you, it’s time to start paying attention. If payers want quality and continuity of care, they have to break the link between leverage and rates, and give private and independent practice a viable path again. One that rewards outcomes, not just size.