Anesthesia reimbursement declines, along with demographic trends and case volume shifts, have drastically changed the ways that providers approach anesthesia coverage, according to a Jan. 16 blog post from Coronis Health.
Medicare payments for anesthesia "do not begin to cover the cost of providing care," according to the post. The average anesthesia rate for 2023 was $21.88, a 5.5% decline from 2019, according to a review of six Coronis clients' anesthesia data.
If an anesthesia provider generates 10,000 billable units and its only source of payment is Medicare, the total revenue potential is only $218,000, the report said, assuming that all revenue could be collected. This deficit has pushed anesthesia providers to non-Medicare plans and hospital support.
This challenge is compounded by the size of the Medicare population. Currently, around 18% of Americans are covered by Medicare, and this number is expected to increase as the population ages.
Coronis also found that outpatient cases have increased. In its analysis, the total billed units generated in outpatient venues increased from 52% in 2019 to 60% in 2023. There has also been an increase of patients who have opted for HMO plans, which could make it more difficult for anesthesia providers to secure reimbursements.
Additionally, an increase in anesthesia for endoscopy and colonoscopy has also created new challenges. Coding changes have reduced the base value for most cases, diminishing the revenue potential.
These changing factors have pushed practices to expand their scope, making coverage requirements difficult to meet. According to the report, anesthesia practices have three options — try to replace declining Medicare revenue with other revenue, attempt to increase their subsidies from the facilities they serve, or explore ways to reduce the cost of anesthesia care.