A big year for anesthesia: 14 controversies to know

There have been numerous legal, political and clinical developments in the anesthesia field in the last year that have significant implications for both patients, providers and healthcare organizations.

Here are 14 notable anesthesia controversies that took place in 2025, as reported by Becker’s:

1. Anesthesiologists urge Anthem to drop policy penalizing out-of-network providers: An Elevance Health policy that was finalized Oct.  1 and will take effect Jan. 1, 2026, will penalize hospitals and contracted facilities for using care providers who are not in-network with its Anthem Blue Cross Blue Shield commercial plans in 11 states. Under the policy, facilities could face an administrative penalty equal to 10% of the allowed amount of any facility claim involving a nonparticipating provider. Facilities are prohibited from passing this penalty on to patients, and they risk termination from Anthem’s network if they repeatedly use out-of-networks providers.

A joint letter from the American Society of Anesthesiologists and several other physician associations argued that the new policy will effectively force hospitals to pressure independent physician groups into joining Anthem’s network.

2. Anesthesiologists slam proposed Medicare cuts to pain procedures: A recently proposed Medicare Administrative Contractors policy aims to restrict coverage for peripheral nerve blocks and related procedures used to treat chronic pain, but anesthesiologists and pain medicine physicians are concerned about potential consequences of the policy.

“For decades, chronic pain patients have received treatment from PNBs and ablation techniques that provide rapid and durable pain relief, enhance function and quality of life, and decrease reliance on systemic pain medications, including opioids,” said ASA President Patrick Giam, MD. “We urge Medicare to consider the compelling clinical and functional evidence that supports coverage of PNBs and related procedures.”

3. North American Partners in Anesthesia settles noncompete lawsuits: North American Partners in Anesthesia reached an undisclosed settlement with two hospitals in Florida and New York that filed lawsuits against the anesthesia provider earlier this year, claiming it unlawfully restricted its physicians from choosing their place of work.

4. UnitedHealthcare’s cut to CRNA services went into effect Oct. 1: 

• In July, UnitedHealthcare issued a policy update that cut reimbursements to certified registered nurse anesthetists by 15%. For claims billed under the QZ modifier — those rendered by CRNAs — the provider will now receive 85% of the allowable.
• CRNAs in Arkansas, California, Ohio, Colorado, Hawaii, Massachusetts, New Hampshire and Wyoming are exempt from the new reduction.
• The updated policy no longer includes certain physical status considerations in its anesthesia reimbursement calculations. The policy update specifies that the reimbursement calculations for anesthesia services will no longer include physical status modifiers P3, P4 and P5. These modifiers indicate a patient’s level of disease, with P3 denoting patients with severe systemic disease and P5 denoting a “moribund patient who is not expected to survive without the operation,” according to the American Society of Anesthesiologists.
• In a statement shared with Becker’s, ASA urged UHC to reverse this policy update, saying that the payer “is breaking a meaningful standard in healthcare — that patient care be individualized and care processes and payment appropriately account for the additional risk level of the patient.”
• The update also cut reimbursements for independently practicing CRNAs by 15%, effective Oct. 1. The update has drawn criticism from the American Association of Nurse Anesthesiology, who told Becker’s that the policy will have damaging effects to healthcare cost and access at a time when anesthesia providers are already under pressure from staffing shortages and increasing demand. “It benefits the insurance companies and their bottom line — who it doesn’t benefit are the patients,” Janet Setnor, MSN, CRNA, former president of the AANA, told Becker’s.

5. AANA appeals court ruling in reimbursement bias case. The AANA filed an appeal of a ruling that dismissed claims of payers unlawfully paying CRNAs less than physician anesthesiologists for providing the same services.

• The initial complaint was filed against HHS in September 2024, and claimed the agency had failed to enforce a provision of the ACA that prohibits discrimination against providers based solely on their licensure.
• The AANA further alleges that, by paying CRNAs less for the same services as a physician anesthesiologist, rural and underserved patients are put at a disproportionate disadvantage, as CRNAs account for over 80% of anesthesia services in rural counties and administer more than 50 million anesthetics annually in the U.S., according to a white paper from Medicus Healthcare Solutions.
• The court granted HHS’ motion to dismiss AANA’s complaint Aug. 26. In a statement, AANA President Jeff Molter said that the organization would “continue to evaluate and pursue all available legal options on behalf of our membership and remain focused on advocacy efforts against provider discrimination to ensure patients’ access to care.”
• In a separate but related case,, the ASA submitted an amicus brief in support of HSS’ attempt to dismiss a complaint issued by the AANA alleging provider discrimination. In AANA’s non-discrimination lawsuit, the group asserted that there are no differences between anesthesiologists and CRNAs. The ASA issued a brief “correcting” AANA’s assertions, noting that 45 states require physician oversight of CRNAs, anesthesiologists have almost five times the hours of clinical training and nearly double the education of nurse anesthetists and anesthesiologists and nurse anesthetists are not interchangeable. AANA’s complaint requests that the government enforce the provider nondiscrimination provision of the ACA, claiming that nurse anesthetists are facing discrimination from insurers and health plans based solely upon their license, which is in violation of the ACA.

6. The No Surprises Act: There have been several updates and legal controversies related to the NSA in 2025.

• A study published in The BMJ in August found that the NSA has saved individual patients about $567 per year in out-of-pocket costs.
• Despite the decrease in out-of-pocket costs for patients, a study published Aug. 25 in Health Affairs found that the independent dispute resolution process created under the NSA generated at least $5 billion in costs since it took effect in 2022.
• The American College of Radiology, American College of Emergency Physicians, and American Society of Anesthesiologists expressed support for the No Surprises Enforcement Act in a July 24 news release. The legislation would impose a penalty three times the difference between the insurer’s initial payment and the IDR arbiter’s ruling per claim, which would also be subject to interest.
•  In June, the 5th Circuit Court of Appeals sided with insurers over air ambulance companies, ruling that the No Surprises Act does not grant a private right of action to enforce IDR awards in court unless there is clear evidence of fraud or misconduct. The court also ruled that third-party IDR entities are immune from lawsuits, providing insurers with legal protection against disputes over arbitration outcomes.
• In May, Elevance Health, parent company of Blue Cross Blue Shield of Georgia, filed a lawsuit against billing company HaloMD, Hospitalist Medicine Physicians of Georgia, and Sound Physicians Emergency Medicine of Georgia, alleging the three organizations exploited the IDR process for financial gain. The lawsuit claims the disputes were falsely certified as eligible and structured to secure payments above market rates. Nearly 70% of disputes resulting in provider payments were allegedly not qualified for arbitration.
• In April, a New York federal judge dismissed an antitrust lawsuit against UnitedHealthcare and MultiPlan (now Claritev) that alleged the companies conspired to slash reimbursement rates to Long Island Anesthesiologists by more than 80% after the No Surprises Act took effect in January 2022.

7. New opioid safety labeling requirements: The FDA announced new requirements for safety labeling on all opioid pain medications that place renewed emphasis on the risks associated with their long-term use in August. The changes follow a public advisory committee meeting in May that reviewed data surrounding misuse, addiction, and both fatal and nonfatal overdoses for patients who use opioids long term.

8. ASA asks court to deny Change Healthcare request to dismiss negligence claims:

• The American Society of Anesthesiologists has filed a motion requesting permission to file an amicus curiae brief in an ongoing lawsuit against Change Healthcare, according to an ASA statement shared with Becker’s July 2. The case surrounds Change Healthcare’s responsibility to safeguard medical claims, patient records and other sensitive medical information. Change Healthcare, a subsidiary of UnitedHealthcare, is the largest clearinghouse for medical claims in the U.S., processing nearly 15 billion transactions annually and interacting with 1 in 3 patient records.
• In February 2024, the Russian ransomware group ALPHV, also known as BlackCat, launched a crippling cyberattack on Change Healthcare, encrypting and disabling large portions of its operations. According to the statement, Change Healthcare argues that they have “no obligation” to safeguard this data against cyberattacks. ASA’s brief contends that Change Healthcare’s argument is inconsistent with basic tort law, claiming that if Change’s conduct created a risk to patients’ private data, then it is obligated to “exercise reasonable care” for that data.

9. Anesthesia time limits: Several states have passed or are reviewing legislation that would ban anesthesia time limits statewide, following a November 2024 controversy surrounding Blue Cross Blue Shield and a policy it floated that would place time limits on procedures using anesthesia in Missouri, New York and Connecticut.

• Illinois Gov. J.B. Pritzker signed legislation that immediately banned anesthesia time limits statewide Aug. 6. The bill passed unanimously through the state Senate in late May.
• In late May, amendments were added to both a New York State Assembly bill and a Senate bill that would allow insurers to impose time limits on anesthesia care. These amendments would permit insurers in New York to predetermine allowable anesthesia durations for surgeries and procedures. In December 2024, Gov. Kathy Hochul responded to the original BCBS policy on social media, stating, “Outrageous. I’m going to make sure New Yorkers are protected.”
• Washington state legislators introduced a bipartisan bill that would immediately ban coverage denials or reimbursement caps based on anesthesia duration.

10. Fallout from IV-bag tampering scandal: In November 2024, Raynaldo Ortiz, MD, a Dallas-based anesthesiologist, was sentenced to 190 years in prison after being convicted of injecting nerve-blocking agents and other drugs into IV bags at Baylor Scott & White Surgicare North Dallas. Now, the family of a patient who allegedly experienced a near-fatal cardiac event following a routine procedure at the surgery center is suing Baxter International, the manufacturer of the IV bags and the largest producer of IV bags in the U.S.

11. The Federal Trade Commission’s antitrust case against U.S. Anesthesia Partners: The FTC  resolved an antitrust case against Welsh Carson, which was tied up in a lawsuit alongside its portfolio company, U.S. Anesthesia Partners, May 20. In a lawsuit filed Sept. 21, 2023, against USAP and Welsh Carson, the FTC alleged that the two companies executed an anticompetitive scheme to consolidate anesthesiology practices in Texas, drive up the price of services and boost their profits. The FTC claimed that Welsh Carson executed a roll-up scheme, buying up almost every large anesthesia practice in Texas to create a single, dominant provider that could demand higher prices.

12. ASA warns of head injuries for anesthesiologists: The organization released a safety alert highlighting “boom strikes,” head injuries caused by collisions with ceiling-mounted equipment, as a growing concern for both physician and patient safety in operating rooms, according to an April 21 news release.

13. Controversy surrounding VA’s CRNA policies: In March, two U.S. representatives introduced legislation that would allow CRNAs and physician anesthesiologists to provide anesthesia autonomously at the Veterans Health Administration. While the American Association of Nurse Anesthesiology has expressed its support for the legislation, the American Society of Anesthesiologists issued a statement “strongly opposing” the legislation in a March 24 news release obtained by Becker’s. Currently, Defense Health Agency policy allows CRNAs to practice independently, and the Ensuring Veterans Timely Access to Anesthesia Care Act of 2025 would align the VHA with those regulations.

14. Court rejects U.S. Anesthesia Partners’ challenge to alleged MIPS ‘miscalculation’: The Fifth Circuit Court of Appeals upheld the dismissal of U.S. Anesthesia Partners’ (lawsuit against the Department of HHS and CMS, which contested aspects of the Merit-based Incentive Payment System. The lawsuit, filed by USAP’s Texas, Florida, and Colorado divisions, challenged the Total Per Capita Cost measure used in MIPS to evaluate clinicians’ performance and adjust Medicare reimbursement rates. The measure attributes patient costs to clinicians who have billed for qualifying primary care services.