From declining reimbursement rates to insurance companies leveraging the No Surprises Act to strong-arm anesthesiologists into unfavorable contracts, five anesthesia leaders recently joined Becker’s to discuss the payer behavior making them nervous.
Alan Bielsky, MD. Anesthesiologist at Children’s Hospital Colorado (Aurora): Ultimately, there just doesn’t seem to be an acknowledgement of our continued hard work. The cost of eggs goes up, my house payments go up and I work harder. I think that payers’ continued downward pressure on my earnings has really just dejected me and my colleagues. The payers seem to have capitalized on our good will and sense of calling, yet everyone is shocked when we all show signs of burnout.
Corey Collins, DO. Medical Director at Anesthesia Consults of Massachusetts (Boston):. Salaries for anesthesiologists and CRNA are increasing at a pace that is unsustainable based on decreasing reimbursement. This will create a need for the dramatic shift in service delivery. Insurers have tried already to change the landscape (e.g. endoscopy, fixed fees based on procedure codes) but it will likely be the healthcare systems that implement these changes.
Antonio Hernandez Conte, MD. Immediate Past-President of the California Society of Anesthesiologists: There are multiple ways in which insurance companies have recently exhibited dangerous policy-making that directly harms patients, creates barriers to access to care, and explicitly denies fair compensation for physicians who have provided services. As physicians, we want to work with commercial payers as partners in the healthcare system, and we want patients to be able to access care effectively and efficiently without needless insurance obstacles, such as pre-authorization for well-established medical and surgical procedures. Anesthesiologists provide care in many different practice settings (i.e., hospitals, ambulatory surgery centers, free-standing surgery offices), as well as for surgical emergencies. Therefore, we care for ALL surgical patients 24 hours a day/seven days a week, regardless of their insurance coverage (or lack of coverage).
A reasonable request of insurance companies is that they negotiate with anesthesiologists and all physicians in good faith to secure fair market contracts and provide coverage for appropriate patient care. Insurance companies place patients at risk by second-guessing the need for our services and perioperative expertise. Additionally, insurance companies must avoid targeting anesthesia care with disruptive payment policies such as the recent Anthem BCBS “time limit” policy that was initiated in Connecticut and New York. Poorly advised policies related to anesthesia include No. 1, artificial time limits on payments for the full duration of anesthesia for a surgical service, No. 2, failing to recognize ASA patient physical status modifiers and No. 3, failing to recognize special patient circumstances.
Finally, physicians feel strongly that insurance companies should stop playing games with the federal No Surprises Act. Insurance companies began weaponizing “out-of-network” billing laws as early as 2017 when California passed AB 72 — the state’s own version of the No Surprises Act. Insurance companies have utilized the NSA laws by forcing physicians to become “in-network providers” and subsequently strong-arming anesthesiologists to accept unreasonably low reimbursement rates that are destabilizing the future of the specialty. These tactics place additional fiscal burdens on hospitals to support anesthesia services. Additionally, insurance companies continue to delay payments to physicians even when they lose a payment dispute under the NSA arbitration process, and the payments are deliberately withheld by weeks or months even when they are required under the law to pay within 30 days.
John Kezele, MSN. CRNA at Franklin County Medical Center (Preston, Idaho): Vulnerable. A recent example of the games insurance companies are playing to cut costs is Anthem Blue Cross Blue Shield reversed its plan to limit anesthesia payments in certain states, had it not been for the tremendous pushback by many in opposition. The explanation by the company for why was lame and pathetic to say the least.
This kind of disconnect between payers, patients and providers appears to be increasing and is one reason I see the future of anesthesia services as we now know it to be vulnerable to similar misguided policy or attacks. The time I spend chasing the revenue cycle issues with payers is discouraging.
I have personally seen reimbursement go down, especially in the last 5 years. Not a single company has offered a payment increase. If I go asking, I get ignored. In the case of CMS reimbursement, current payments are on par with 2011 actual payments. 2011 CMS anesthesia conversion factors for my State of Idaho was $20.17 and for 2025 $19.30. Yet anesthesia provider wages are up 45% since 2011. The cost to process anesthesia billing and credentialing has gone up in a similar fashion.
There is a principle called “cost shifting” where big insurance companies pay 3-5 times CMS rates. These rates are needed to help anesthesia practices stay afloat. Some cost shifting has been placed upon the surgical facilities to make up the difference. CMS’ own studies claim it isn’t happening because of their low reimbursement. I question their data.
Corey Koenig, MD. Anesthesiologist at Providence Anesthesiology Associates (Charlotte, N.C.): Payers continue to leverage the NSA and arbitration process in a continued effort to push down rates. Unfortunately, the rules are tipped in the favor of the payers and they have deep enough pockets to continue the process despite losing the vast majority of disputes. They are simply squeezing out those who don’t have the cash flow to participate in the costly and lengthy process. Until payers are forced to actually negotiate in good faith efforts to be in network, this entire process will only make the arbitration companies money and cost physicians money just to collect the money they are owed.