How Will Medicare Sequestration Impact Anesthesiology? Q&A With ASA President Dr. Jerry Cohen

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When the Budget Control Act's Joint Committee on Deficit Reduction failed last year to reduce the national deficit by $1.2 trillion over 10 years, sequestration was triggered beginning in the 2013 fiscal year. The cuts include $11.065 billion, or 2 percent of Medicare spending.

Dr. Jerry Cohen, president of the American Society of AnesthesiologistsIn September, the American Society of Anesthesiologists joined 72 other medical organizations in opposition to the automatic cuts and urged Congress to repeal the Medicare Sustainable Growth Rate payment cuts.

Here is ASA President Jerry Cohen, MD, on how these cuts could affect the practice of anesthesiology.

Question: How will anesthesiology specifically be impacted?

Dr. Jerry Cohen: Really a lot of folks' first thought is that it's better than the 27 percent looming Medicare Sustainable Growth Rate cut. The reality is that anesthesiologists already suffer from what's known as the 33 percent problem, which is a description of the fact that a 2007 Government Accountability Office report found that Medicare payments for anesthesia services represent only 33 percent of the prevailing commercial insurance payment rates for the same service. In contrast, the Medicare Payment Advisory Commission has consistently reported Medicare payments for other physician services represent approximately 80 percent of commercial rates when averaged across all physician services and geographic areas.

There also other potential looming regulatory penalties that anesthesiologists may be subjected to in the not-too-distant future, such as those associated with physician quality reporting system or following the expiration of a hardship exemption for electronic health records. It's the totality of these cuts that really have a deep impact upon anesthesiology.

Q: How will the sequestration directly impact anesthesiologists' ability to do their job?

JC: It's important to remember hospitals will also be cut under sequestration. As largely hospital-based specialists, there may be significant implications for anesthesia groups and anesthesiologists' hospital contracts.

Q: What steps are being taken by anesthesiologists to fight against these cuts?

JC: ASA has reached out to Congressional leaders to state our opposition to these sequestration cuts as well as to the SGR cuts. ASA will continue to advocate against these harmful cuts.

Q: If the money is cut, how can anesthesiologists best work within the new parameters?

JC: As a specialty, we're always striving to improve quality and patient safety. One of the ways we can accomplish both outcomes and assist in cost containment is by leading coordinated care efforts in the surgical setting, such as [ASA's] Perioperative Surgical Home model of care.

Q: What does this mean for the future of anesthesiology and the U.S.'s healthcare system?

JC: Anesthesiologists serve a critical role in the practice of medicine and this will not change. But these reductions are also a reminder to anesthesiologists about the importance of continuing our new models of coordinated care and other quality and safety improvements.

Q: How will patients be impacted by these cuts?

JC: It's the totality of the cuts that will have the most impact upon patients. As we said in a joint letter to Congressional leadership, "adequate and stable investments are necessary so that physicians can modernize their practices  to support the coordinated care that will improve health and prevent costly complications, and enable the participation in new payment and delivery models."

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