Four anesthesia practices are suing CMS and HHS, among other parties, alleging CMS’ methodology for calculating reimbursements is illegal in its inclusion of costs associated with nonphysician practitioners.
The suit, filed Dec. 18 by U.S. Anesthesia Partners of Texas, U.S. Anesthesia Partners of Florida, U.S. Anesthesia Partners of Colorado and Physicians Anesthesia Service, alleges that CMS’ reimbursement calculations account for nonphysician practitioner performance.
“CMS’ refusal to exclude certain nonphysician practitioners at plaintiffs’ specialty medical practices from its calculation of the ‘total per capita cost’ measure under the [merit-based incentive] program is contrary to law, arbitrary and capricious and results in a grossly disproportionate financial penalty,” the complaint reads.
The complaint alleges CMS includes nonphysician practitioners, such as nurse practitioners and physician assistants, “even if they solely furnish services in a medical group comprised only of excluded physician types.”
Specialty practice groups are then held responsible for every cost because they employ nonphysician practitioners to perform routine tasks, the complaint reads.
When CMS changed the way it calculated total per capita cost in 2019, it excluded specialties such as anesthesiologists. According to the suit, the new measurement amounts result in a fine, which violates the excessive fines clause of the Eighth Amendment.
The move will cut a combined $3.7 million from the four practices’ Medicare reimbursement rate in 2024, the suit alleges.