Three anesthesia leaders joined Becker’s to discuss challenges with securing anesthesia reimbursements in the industry today.
Editor’s note: This response was edited lightly for brevity and clarity.
Adam Spiegel. CEO of NorthStar Anesthesia (Irving, Texas): The biggest challenge to securing anesthesia reimbursement in 2023 is the impact of the No Surprises Act. The act has tilted the scales in contract negotiations in favor of payers, making it difficult to predict future payment amounts and driving a trend of lower reimbursements in a period of increased costs of doing anesthesia.
The lack of visibility into future rates is incredibly challenging in our relationships with our hospital and ASC partners. The disastrous independent dispute resolution process has resulted in endless delays and ludicrous qualifying payment amounts being offered by out-of-network payers with little-to-no justification, and in-network payers are threatening or canceling contracts unless providers agree to take substantially lower rates. The rising cost of anesthesia providers and lower reimbursement creates a situation where even surgery centers are now faced with revenue guarantees or stipends for anesthesia care.
Anthony Lawson, MD. CMO of Quantum Anesthesia Services (Chicago): Regional anesthesia techniques make it possible for more complex cases to be moved to the ASC area, yet reimbursements and recognition of the skills set that makes this possible isn’t being acknowledged or reimbursed.
David Beardsley, MD. Anesthesiologist at Maria Parham Medical Center (Henderson, N.C.): Decreasing Medicare rates, expansion of Medicaid and high out-of-pocket expenses for Obamacare rules and plans.