No Surprises Act is hurting anesthesia reimbursements, CEO says

Adam Spiegel, CEO of Irving, Texas-based NorthStar Anesthesia, joined Becker's to discuss the biggest controversies in anesthesia and the biggest challenges to securing anesthesia.

Editor's note: This interview was edited lightly for brevity and clarity. 

Question: What are the biggest challenges to securing anesthesia?

Adam Spiegel: 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.

Q: What are the biggest controversies in anesthesia?

AS: One of the more challenging trends we've seen in many markets is that hospitals are increasingly trying to win back volume lost to ASCs during COVID-19 by increasing their surgical capacity. They have done this at the expense of running efficiently. We've seen our hospital partners increase surgical capacity (number of rooms they are staffing with anesthesia care) by 15 percent nationally since 2019, yet volumes at those centers have decreased by more than 2 percent. This trend creates an unnecessary demand for anesthesia providers, making an already challenging workforce issue much worse.

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