'The government pays us less than they pay their plumber': Anesthesia leaders on reimbursement challenges

From labor shortages to surprise billing legislation, five leaders in anesthesiology spoke with Becker's ASC Review on the biggest reimbursement challenges they experience. 

Editor's note: These answers were edited lightly for clarity and brevity. 

Question: What's the most significant reimbursement challenge in anesthesiology?

Andrew Leibowitz, MD. Professor and Chair of the Department of Anesthesiology, Perioperative & Pain Medicine at Mount Sinai Health System (New York City): Anesthesiology practices with a large governmental payer mix require a substantive subsidy from the sites they staff. Anesthesiologists may provide on average 10,000-15,000 [American Society of Anesthesiologists] relative value units of work per year. In most states, Medicaid pays approximately half what Medicare does. So, the biggest reimbursement challenge is to not succumb with commercial payers to a "multiple of Medicare contract" when Medicare is so grossly underpaying anesthesiologists to begin with. Further, many anesthesiology groups have experienced commercial payer contracts unilaterally revoked and rates significantly decreased before the end of the written contract cycle.    

Mark Casner. CEO of Providence Anesthesiology Associates (Charlotte, N.C.): The surprise billing legislation portends a murky start to 2022 — although we are waiting to see the final rules. I'm also concerned about payer reimbursement, particularly with companies like United that have kicked us all out of network. It is creating real headaches for us.

Scott Harper, MD. Assistant Professor of the Department of Anesthesiology and Perioperative Medicine at University of Alabama at Birmingham: Government payers pay us ridiculously low rates because they know they can get away with it. Every group in the country has a hospital contract that requires them to accept Medicare. As a result, Medicare doesn't have to negotiate in good faith with us. Currently, Medicare pays us about $45 per hour. Think about that — the government pays us less than they pay their plumber!

Robert Millwee, MD. Anesthesiologist in Plano, Texas: The biggest problem is low pay from government insurance, and private insurance companies controlling laws passed by Congress to always result in their favor.

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