Anesthesia reimbursement remains one of the most misunderstood aspects of healthcare finance, not just by policymakers and insurance companies, but often even within hospitals and health systems themselves.
From payment model complexities to widespread myths about provider compensation, these are the biggest misconceptions regarding reimbursement six anesthesia leaders identified to Becker’s.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What are some of the biggest misconceptions you hear about anesthesia reimbursements (whether from policymakers, administrators, or even within the broader healthcare community)?
Andy Briggs, CRNA (Colorado Springs, Colo.): I have heard several misconceptions about anesthesia reimbursements during my years of practice. Something that I feel is shared amongst our colleagues, administrators and policymakers, is the misunderstanding that anesthesia can independently change the cost of care without compromising the quality of patient outcomes.
The wonderful but also challenging piece about anesthesia is that our specialty is extremely artistic when compared to other disciplines of medicine. In my training and employment career, I’ve witnessed our profession needing to change practice based on factors that are entirely one-dimensional. Some examples being – “use this drug instead of this one,” “do more or less regional anesthesia,” or even the shuffling of different providers such as CRNAs, physicians and anesthesia assistants all for the goal of optimizing the bottom dollar. I feel our utility is most valuable in providing education to our community of providers and policymakers, in helping our colleagues understand that such implementations may save money at face value, yet the outcome of patient care may be altered so much from a quality perspective, that our net savings are insignificant (at best).
Katy Dean, CRNA. TKMAnesthesia (Newport News, Va.):
1. One of the biggest misconceptions is that anesthesia is reimbursed like every other medical specialty — it’s not. Anesthesia uses a completely different payment model that’s based on a combination of base units, time units, and patient risk factors. This system is complex, and frankly, misunderstood even within the healthcare industry.
2. Another common myth is that all anesthesia providers get paid the same. That’s just not the case. Medicare does reimburse CRNAs and anesthesiologists equally when billing independently, but commercial insurers vary widely. Some pay less for CRNAs, even when we’re the sole anesthesia provider, while others apply obscure contract terms never agreed to.
3. People also assume we get paid for every case we work — but many don’t realize how often anesthesia providers go unpaid. Reimbursement can be denied due to documentation technicalities, incorrect time capture, or insurance games. We can provide safe, high-quality care and still have the claim denied.
4. Finally, there’s this idea that anesthesia is somehow “overpaid.” That’s because most don’t see what happens behind the scenes, like when we’re managing high-risk airways, emergencies, or staying late without additional compensation. We don’t bill separately for consults, pre-ops, or emergencies like other specialties often do. The work is real, even when the billing model doesn’t fully capture it.
Andrew Dickman, CRNA. CEO of Twin Anesthesia (Minneapolis): I get the impression that there isn’t a true understanding by those outside the anesthesia space of how little reimbursement anesthesia providers receive for taking care of Medicare patients. The amount of money anesthesia providers lose when they care for a patient on Medicare is astounding.
Antonio Hernandez Conte, MD. Former President of the California Society of Anesthesiologists: Hospital administrators continue to believe that third-party payer reimbursement and Medicare physician fee schedules are adequate to cover the actual cost of anesthesia services provided by anesthesiologists and/or nurse anesthetists. Hospitals frequently hire outside consultants to refute the need for anesthesia service contract revenue enhancements/subsidies only to find out that the anesthesia groups are indeed underfunded. This disconnect is persistent and often due to the frequent turnover in hospital C-suite executives who believe they will be able to easily solve the anesthesia workforce shortage and cease hospital subsidies by hiring another group or moving to a different anesthesia care team model. Additionally, state funding agencies continue to misunderstand that Medicare and Medicaid payments for anesthesiologists are simply not sufficient to sustain an anesthesia practice. Flawed payment models based on a % of Medicare for anesthesia services will likely continue to be an issue in a large number of states across the country.
Kelly Petz, DNAP, CRNA. KellCo Anesthesia (Port St. Lucie, Fla.):
1. CRNAs require supervision as a condition of payment and that surgeons assume liability if a physician anesthesiologist is not in the room.
2. Medicare supervision requires a physician anesthesiologist.
3. One of the biggest misconceptions I know of is that care provided by a nurse anesthesiologist is somehow of lesser quality and outcomes than that provided by a physician anesthesiologist.
4. Another misconception that I hear frequently is that anesthesiologist assistants are equivalent to CRNAs in terms of education and training. CRNA preparation requires 8–8.5 years of education and experience, including enrollment in a doctoral program. Graduates accumulate an average of 9,369 clinical hours.
5. AAs are not required to have any prior healthcare education or experience (e.g., nursing, medical, anesthesia or healthcare education, licensure, or certification) before they begin their AA educational programs. CRNAs, in contrast, must have a bachelor’s degree, be a registered nurse, and have at least one year of acute care nursing experience prior to entering nurse anesthesia educational programs.
Jay Weller, MD. Seven Hills Anesthesia (Evendale, Ohio): The biggest misconception I encounter about anesthesia reimbursement is the complete disconnect that has developed between reimbursement for care provided and the actual cost of providing those services. For decades, both federal and state governmental payers have consciously and successfully shifted the cost of anesthesia care to the commercial market. In recent years, commercial payers have become more aggressive in clamping down on payments for anesthesia services (e.g., unilaterally introducing decreased payments for use of the QZ modifier and applying arbitrary caps on time units). Unfortunately, a national shortage has allowed anesthesia providers to demand increased compensation in the face of decreasing clinical reimbursement. Because anesthesia is necessary to fuel the economic engine of most hospitals (i.e., its procedural suites), the gap between clinical revenue and provider compensation has increasingly fallen upon hospitals and surgery centers. The size of these gaps has grown so substantial that it is now cutting meaningfully into the operating margin even for very successful healthcare systems. This is a non-sustainable situation that is unfair to both providers and facilities. It is shocking to me that the government payers continue to get away with shirking their responsibility to this vulnerable patient population.
