CMS plans to cut anesthesiology reimbursement rates by 8% for 2021

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The 2021 Medicare fee schedule is proposing significant rate cuts to hospital-based specialties including EM, anesthesia, radiology, pathology, and critical care. Because nothing says "thank you" to front-line COVID specialties like across the board rate cuts in the middle of a pandemic.

 
Seems absurd. But it's hard to interpret what this abstracted table means?
 
Thanks to @DOctorJay

Midlevels and primary are seeing the increases. Loss for anesthesia and surgeons.
 

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Look at the amounts cardiology and ophthalmology are raking in. They’re getting more than FP. Think about the number of FP’s in this country/number of visits, and explain that. They’re even WAY above GI.
 
Between surprise billing legislation on the private sector side and this ridiculousness on the Medicare side, we can’t catch a break
 
Looks like they’re gonna give big raises to the PA’s and Nurse Prac’s....
 
DirtDocMD said:
Look at the amounts cardiology and ophthalmology are raking in. They’re getting more than FP. Think about the number of FP’s in this country/number of visits, and explain that. They’re even WAY above GI.
Click to expand...
Let’s not go against one another. Ophtho continues to deal with cuts like many other specialties, with expanded non-reimbursed post-surgical global periods that lasts for months (imagine getting paid only for a glaucoma operation, then seeing the patient numerous times post-surgery without reimbursement, for several months, etc)
 
Wow... I'm sure the CMS is a very lean, tight run ship not overhiring admins and running up bloated overhead costs and all the while continue scheming to screw over the evil doctors... Unbelievable
 
Lecithin5 said:
Let’s not go against one another. Ophtho continues to deal with cuts like many other specialties, with expanded non-reimbursed post-surgical global periods that lasts for months (imagine getting paid only for a glaucoma operation, then seeing the patient numerous times post-surgery without reimbursement, for several months, etc)
Click to expand...

How many of those do they do vs. 30 min cataracts? Cardiology doing 30 min-1 hr heart caths??

I don’t begrudge them making good money on their procedures, but compare the numbers of these specialties to FP, who number probably 10x more (FP Docs vs. Opthalmologists) , and likely (as a group) have 10-15x more pt visits, and it really seems crazy.
 
Ah, yes, instead of just paying the underpaid specialties more to entice people to go into primary care we must do this rob Peter to pay Paul zero-sum bull****. Makes perfect sense!
 
TheLoneWolf said:
Thanks to @DOctorJay

Midlevels and primary are seeing the increases. Loss for anesthesia and surgeons.
Click to expand...

The kicker is what exactly is "nurse practioner" they can and do jump around from ER, to inpt cards, to output derm, gi scopes, surgery, and now in california potentially radiology as they please while we practice in our specialty.

Maybe we should expand our scope and get rid of midlevels.
 
DirtDocMD said:
How many of those do they do vs. 30 min cataracts? Cardiology doing 30 min-1 hr heart caths??

I don’t begrudge them making good money on their procedures, but compare the numbers of these specialties to FP, who number probably 10x more (FP Docs vs. Opthalmologists) , and likely (as a group) have 10-15x more pt visits, and it really seems crazy.
Click to expand...
Not every ophtho does tons of cataracts. If you’re a glaucoma specialist, you primarily do glaucoma (ie elderly folks, probably on medicare/medicaid, and postop visits can be numerous, all unpaid for something like 90 days). And cataract reimbursement is usually first on the chopping block for reimbursement due to how many are done in the country (similar to epidural injections by pain docs). I agree that as a whole ophtho makes more than FP, but so do most specialties.
 
The future of medicine is a single payer system. I have always posted if your specialty can’t survive on Medicare rates then it is likely to fail at some point. Anesthesiology is an example of a specialty paid like an advanced practice nurse (Medicare). The reason the specialty is still doing Well is the 5 X rule. Private payers are reimbursing at 5 X Medicare rates for many practices. That gap in multiples will likely increases to 6-7 x before single payer sinks the specialty.

A Board Certified Anesthesiologist can do 6 Medicare cases over 10 hours and earn the same reimbursement as 1 private paying case at $115 per unit for 2 hours.
 
BLADEMDA said:
The future of medicine is a single payer system. I have always posted if your specialty can’t survive on Medicare rates then it is likely to fail at some point. Anesthesiology is an example of a specialty paid like an advanced practice nurse (Medicare). The reason the specialty is still doing Well is the 5 X rule. Private payers are reimbursing at 5 X Medicare rates for many practices. That gap in multiples will likely increases to 6-7 x before single payer sinks the specialty.

A Board Certified Anesthesiologist can do 6 Medicare cases over 10 hours and earn the same reimbursement as 1 private paying case at $115 per unit for 2 hours.
Click to expand...
The problem is that the 5 X "rule" doesn't apply to other specialties. I don't know about the other in-house folks, but surgeons aren't getting 20% reimbursement compared to their private insurance rates like anesthesiology is. Of course we've been harping on that for years and it's gone nowhere. And meanwhile the "nurses are cheaper" lies continue.
 
jwk said:
The problem is that the 5 X "rule" doesn't apply to other specialties. I don't know about the other in-house folks, but surgeons aren't getting 20% reimbursement compared to their private insurance rates like anesthesiology is. Of course we've been harping on that for years and it's gone nowhere. And meanwhile the "nurses are cheaper" lies continue.
Click to expand...

It does in Emergency Medicine, and in a field that doesn’t have defined supervision ratios, they have even more to lose here.
 
jwk said:
The problem is that the 5 X "rule" doesn't apply to other specialties. I don't know about the other in-house folks, but surgeons aren't getting 20% reimbursement compared to their private insurance rates like anesthesiology is. Of course we've been harping on that for years and it's gone nowhere. And meanwhile the "nurses are cheaper" lies continue.
Click to expand...
From the list it looks like Crna rates were cut as well and at a higher percentage. Am I reading this correctly?
 
BLADEMDA said:
The future of medicine is a single payer system. I have always posted if your specialty can’t survive on Medicare rates then it is likely to fail at some point. Anesthesiology is an example of a specialty paid like an advanced practice nurse (Medicare). The reason the specialty is still doing Well is the 5 X rule. Private payers are reimbursing at 5 X Medicare rates for many practices. That gap in multiples will likely increases to 6-7 x before single payer sinks the specialty.

A Board Certified Anesthesiologist can do 6 Medicare cases over 10 hours and earn the same reimbursement as 1 private paying case at $115 per unit for 2 hours.
Click to expand...
What if Medicare rates continue to drop through the floor? The whole country feels like it is going through a major belt-tightening. I suspect the purchasing power of physicians is going to decrease significantly. Less $1M homes, more Honda and less Tesla.

Will docs be willing to take 24 hour call for these rates?
 
Spikebd said:
What if Medicare rates continue to drop through the floor? The whole country feels like it is going through a major belt-tightening. I suspect the purchasing power of physicians is going to decrease significantly. Less $1M homes, more Honda and less Tesla.

Will docs be willing to take 24 hour call for these rates?
Click to expand...

it has already decreased significantly , especially in high cost of living areas like NYC. forget 1M homes, and teslas... after 50% tax im living in a rented 500 sq ft apartment
 
Within that Act is a provision that if changes in the Relative Value Units (RVUs) assigned to services within the fee schedule cause expenditures for the year to change by more than $20 million, then CMS must apply adjustments to the anesthesia and RBRVS conversion factors to bring expenditures for the year back into that range (per Section 1848 (c) (2) (B) (ii) (II) of the Act). We refer to this as budget neutrality.
Click to expand...

Are they saying total budget for anesthesia must remain the same every year even if more patients are having surgery and we're doing more cases? Do more for the same?
 
Spikebd said:
What if Medicare rates continue to drop through the floor? The whole country feels like it is going through a major belt-tightening. I suspect the purchasing power of physicians is going to decrease significantly. Less $1M homes, more Honda and less Tesla.

Will docs be willing to take 24 hour call for these rates?
Click to expand...
The future (which is pretty much here already) is in salaried positions likely employed by a hospital. COVID has shown us just how reliant hospitals are on surgical volume. What will determine our jobs, lifestyle and salary is the supply of anesthesia providers and the demand for our services. I worry more about independent CRNA practice increasing the supply of anesthesia providers than anything CMS is doing.....
 
dannyboy1 said:
The future (which is pretty much here already) is in salaried positions likely employed by a hospital. COVID has shown us just how reliant hospitals are on surgical volume. What will determine our jobs, lifestyle and salary is the supply of anesthesia providers and the demand for our services. I worry more about independent CRNA practice increasing the supply of anesthesia providers than anything CMS is doing.....
Click to expand...

+1. Also would add the number of docs pumped out each year.
 
BLADEMDA said:
The future of medicine is a single payer system. I have always posted if your specialty can’t survive on Medicare rates then it is likely to fail at some point. Anesthesiology is an example of a specialty paid like an advanced practice nurse (Medicare). The reason the specialty is still doing Well is the 5 X rule. Private payers are reimbursing at 5 X Medicare rates for many practices. That gap in multiples will likely increases to 6-7 x before single payer sinks the specialty.

A Board Certified Anesthesiologist can do 6 Medicare cases over 10 hours and earn the same reimbursement as 1 private paying case at $115 per unit for 2 hours.
Click to expand...
I thought private insurance always follows suit when CMS cuts a service.
 
Modanq said:
The kicker is what exactly is "nurse practioner" they can and do jump around from ER, to inpt cards, to output derm, gi scopes, surgery, and now in california potentially radiology as they please while we practice in our specialty.

Maybe we should expand our scope and get rid of midlevels.
Click to expand...
Too many people on this board love mid levels. Too many in medicine who use them to fill their coffers. They will tout how they are just as safe as MD only care ETC and continue hiring them, teaching them skills and making money off them.
The greed is real. And in medicine just like many other fields, it’s seeped everywhere. It’s making its way West where it was Physician only but now greedy partners are selling out and saying, screw y'all, I got mine.
 
jwk said:
The problem is that the 5 X "rule" doesn't apply to other specialties. I don't know about the other in-house folks, but surgeons aren't getting 20% reimbursement compared to their private insurance rates like anesthesiology is. Of course we've been harping on that for years and it's gone nowhere. And meanwhile the "nurses are cheaper" lies continue.
Click to expand...
What are the private payers paying per unit to the surgeons? Just curious.
 
Spikebd said:
What if Medicare rates continue to drop through the floor? The whole country feels like it is going through a major belt-tightening. I suspect the purchasing power of physicians is going to decrease significantly. Less $1M homes, more Honda and less Tesla.

Will docs be willing to take 24 hour call for these rates?
Click to expand...
Not me. I hate 24 hour call no matter the rate. Unless you promise me that I am going to sleep a good six hours, then I may give you 18.
But screw busting your ass for 24 hours straight. That sh.. is for the damn birds.
 
The whole thing is ludicrous. CMS wanted to “solve” the issue of misvalued E&M codes. In order to pay for that they decided to cut everyone else and probably end up misvaluing other codes.

It’s a joke. Anyone with half a brain in medicine right now should be thinking how do I minimize my exposure to Medicare. Honestly, you take their money and they own you.
 
RadsWFA1900 said:
The whole thing is ludicrous. CMS wanted to “solve” the issue of misvalued E&M codes. In order to pay for that they decided to cut everyone else and probably end up misvaluing other codes.

It’s a joke. Anyone with half a brain in medicine right now should be thinking how do I minimize my exposure to Medicare. Honestly, you take their money and they own you.
Click to expand...

This simply isn’t realistic for anyone that doesn’t care solely for kids (where Medicaid is the problem) or have a cosmetics practice. America > 65 is Medicare. That’s 44 million Americans. 15% of the US population. We will have Medicare for all in our lifetimes. The systemic and nationwide spread of greed/financial abuse by the suits (hospitals and insurance companies) has ruined any opportunity of affordable healthcare.

You can call me a socialist, which I’m not, but you can’t argue 100k bills to girls getting knee scopes. This nonsense happens everyday all across America.

Medicare for all will happen. We fight with our vote. Put physicians in the US congress and senate. People who see what we see and understand our lives and value to society. Physicians can understand that Americans need affordable healthcare AND physicians shouldn’t work in fear of yearly paycuts.
 
AdmiralChz said:
Um, are we hangin’ out in the same place?

Especially NPs/PAs which somehow (??) get a pay raise with this. Which makes me wonder if this isn’t bogus?
Click to expand...
CRNAs. Yes too many people love them.
In general and on this board. So many statements on people hating to “stool sit” and we “don’t have enough providers to provide anesthesia and research shows no difference in Physcian only and ACT models. As they fill their damn pockets with extra cash from mid levels.
It may very well be a minority on here but it’s still too many.
 
Last edited:
Southpaw said:
This simply isn’t realistic for anyone that doesn’t care solely for kids (where Medicaid is the problem) or have a cosmetics practice. America > 65 is Medicare. That’s 44 million Americans. 15% of the US population. We will have Medicare for all in our lifetimes. The systemic and nationwide spread of greed/financial abuse by the suits (hospitals and insurance companies) has ruined any opportunity of affordable healthcare.

You can call me a socialist, which I’m not, but you can’t argue 100k bills to girls getting knee scopes. This nonsense happens everyday all across America.

Medicare for all will happen. We fight with our vote. Put physicians in the US congress and senate. People who see what we see and understand our lives and value to society. Physicians can understand that Americans need affordable healthcare AND physicians shouldn’t work in fear of yearly paycuts.
Click to expand...
I’ll take Medicare for all if we can enforce borders against illegal immigration and excessive legal immigration.
 
BLADEMDA said:
The future of medicine is a single payer system. I have always posted if your specialty can’t survive on Medicare rates then it is likely to fail at some point. Anesthesiology is an example of a specialty paid like an advanced practice nurse (Medicare). The reason the specialty is still doing Well is the 5 X rule. Private payers are reimbursing at 5 X Medicare rates for many practices. That gap in multiples will likely increases to 6-7 x before single payer sinks the specialty.

A Board Certified Anesthesiologist can do 6 Medicare cases over 10 hours and earn the same reimbursement as 1 private paying case at $115 per unit for 2 hours.
Click to expand...

If not anesthesia, where should students who dislike clinic/patient contact go?
 
chocomorsel said:
CRNAs. Yes too many people love them.
In general and on this board. So many statements on people hating to “stool sit” and we “don’t have enough providers to provide anesthesia and research shows no difference in Physcian only and ACT models. As they fill their damn pockets with extra cash from mid levels.
It may very well be a minority on here but it’s still too many.
Click to expand...
Don't care about the cash difference. Don't care for a lot of CRNA's. But you know what's more displeasing to me?...
Yup, "sitting on the stool." 🙂 Right up there with 24 hour call.
 
Last edited:
Yellow345 said:
If not anesthesia, where should students who dislike clinic/patient contact go?
Click to expand...
When I switched from clinical to anesthesia I would tell people, "The only better field than anesthesia is pathology. Our patients are asleep; their patients are dead."
 
Spikebd said:
I’ll take Medicare for all if we can enforce borders against illegal immigration and excessive legal immigration.
Click to expand...

Immigration is a key component of a successful economy. Just look at Japan...they are desperate for an influx of young working immigrants.

Who exactly do you think will be the ones working and contributing to social security to pay for all of the baby boomers to sit at home
 
We'llBeDoneIn15Minutes said:
Don't care about the cash difference. Don't care for a lot of CRNA's. But you know what's more displeasing to me?...
Yup, "sitting on the stool." 🙂 Right up there with 24 hour call.
Click to expand...
So why did you do an anesthesia residency then? Bet you were miserable sitting the stool in residency.
 
chocomorsel said:
CRNAs. Yes too many people love them.
In general and on this board. So many statements on people hating to “stool sit” and we “don’t have enough providers to provide anesthesia and research shows no difference in Physcian only and ACT models. As they fill their damn pockets with extra cash from mid levels.
It may very well be a minority on here but it’s still too many.
Click to expand...

Let it go why don't you?

This is the world we live in. There are many of us in ACT practices doing everything we can to maintain the status quo or even wrestle more back from the CRNA's and busting our hump.
 
Arch Guillotti said:
Let it go why don't you?

This is the world we live in. There are many of us in ACT practices doing everything we can to maintain the status quo or even wrestle more back from the CRNA's and busting our hump.
Click to expand...
Agreed. Some of us like the CRNAs we work with and how our job is set up: focusing on the important things and delegating menial tasks to the nurses. I enjoyed “stool sitting” as a resident. I enjoy supervising as an attending. I enjoy being in the room with a CRNA or resident for sick patients or a difficult case.

Let’s go back to blaming the government for our problems and not each other!
 
AdmiralChz said:
Um, are we hangin’ out in the same place?

Especially NPs/PAs which somehow (??) get a pay raise with this. Which makes me wonder if this isn’t bogus?
Click to expand...

I can’t figure out which NPs/PAs? Because the ASA letter said CRNAs were expected to take as big or bigger of a cut than we did.
 
chocomorsel said:
So why did you do an anesthesia residency then? Bet you were miserable sitting the stool in residency.
Click to expand...
Nah, even mundane cases had intrigue and excitement back then. Now if you remove "sitting the stool" from your sentence there were definitely many occasions that would fit that summation.
 
The real question for usap and former mednax American anesthesiology practice which generally had more than 50% private payor insurance

what are their private negotiated rates for 2021 fiscal year??

medicare is what? $17/unit? But those good payor mix which more than 50% payor mix of commercial insurance still average over $100/unit. That is the key.
 
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