A recent anesthesia reimbursement policy change penalizes facilities that use more efficient, flexible anesthesia staffing models. The vast majority of hospitals in the United States, an estimated 80% or more, pay anesthesia subsidies.
Declining anesthesia revenues have furthered the inadequacies of anesthesia reimbursement covering anesthesia expenses. Several factors are driving this decline, including a reduction in Medicare reimbursement, poorly executed implementation of the No Surprises Act and its’ unintended consequences, an increase in outpatient surgeries, higher demand for anesthesia services, and clinician supply issues.
Taken together, the current situation is compelling hospitals to financially support their anesthesia departments even further to maintain coverage. Some outpatient centers are also now beginning to pay anesthesia subsidies. These are signs of how quickly the anesthesia market is changing. And healthcare systems are under growing pressure to find cost-effective solutions to cope with these disruptions.
This past March, Cigna Healthcare lowered its reimbursements to 85% of the Physician Fee Schedule for non-medically directed procedures, designated by the QZ modifier, and performed by certified registered nurse anesthetists. This policy change only applies to procedures with the QZ modifier. For QX procedures, where CRNAs are medically directed, the allowable reimbursement is still 100%, with CRNAs receiving 50% and the directing anesthesiologist receiving the other half.
Cigna’s reimbursement change puts an additional financial burden on facilities that are using anesthesia staffing models outside of the rigid, cost-prohibitive medical direction model, which limits the physician-to-CRNA ratio to 1:4.
The American Association of Nurse Anesthesiology (AANA) issued a statement strongly opposing Cigna’s policy change, arguing that it will create obstacles for anesthesia access without demonstrating improvements to the quality of care:
In some states, CRNAs are the sole anesthesia providers in nearly 100 percent of rural hospitals… Without CRNAs to administer anesthesia and pain management services in rural and underserved areas, where many of Cigna’s members reside, patients would lose access to vital treatment, which could result in poor healthcare outcomes, lower quality of life, and unnecessary costs to patients. This also penalizes facilities such as acute care hospitals, rural hospitals, and ASCs, who pay for the difference through higher anesthesia subsidies and stipends.
Reimbursement reductions like Cigna’s penalize healthcare facilities with efficient anesthesia staffing models designed to improve care quality and access while mitigating expenses. Hospitals and ASCs don’t need to be constrained by outdated anesthesia staffing models. They need new, flexible models that align and grow with their clinical, operational, and financial needs.
Facilities can benefit from working with anesthesia management partners that are able to customize staffing services for each center, opening up opportunities to improve efficiency and raise the bar on patient care and satisfaction.
Learn more about the benefits of working with an anesthesia staffing partner.