Insurance won’t pay for anesthesia care if procedure goes beyond time limit

[aneftp]

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That’s how my new group is, will see how it turns out.

I will tell you, sitting your own cases may be boring, but its 10000x better knowing my decisions done by me, and not having to offend some nurses ego.

No issues sitting my own cases. I do have issues sitting my own case on hour 33-34 of a 48 beeper hr call. Saturday and Sunday. All solo cases. That’s brutal. We literally ran it to 3am Sunday night. Meaning I worked 8am-3am I had to turn around and do 8am cases to 10pm Sunday night.

I do get fatigue around 11pm if I’m doing continuous solo cases since 730am with maybe 60-90 min gaps for breaks. That’s brutal

I’m a machine but I do have my limits doing solo.

So when people say they love sitting their own cases. I don’t think anyone loves sitting own cases when they are consistently slammed like that.

Thus the high turnover rates of docs. Weekends are brutal

 

[jthedestroyr]

No issues sitting my own cases. I do have issues sitting my own case on hour 33-34 of a 48 beeper hr call. Saturday and Sunday. All solo cases. That’s brutal. We literally ran it to 3am Sunday night. Meaning I worked 8am-3am I had to turn around and do 8am cases to 10pm Sunday night.

I do get fatigue around 11pm if I’m doing continuous solo cases since 730am with maybe 60-90 min gaps for breaks. That’s brutal

I’m a machine but I do have my limits doing solo.

So when people say they love sitting their own cases. I don’t think anyone loves sitting own cases when they are consistently slammed like that.

Thus the high turnover rates of docs. Weekends are brutal

That’s way too much solo like that ! Yeah, current group doesn’t do that.

 

[sevoflurane]

No issues sitting my own cases. I do have issues sitting my own case on hour 33-34 of a 48 beeper hr call. Saturday and Sunday. All solo cases. That’s brutal. We literally ran it to 3am Sunday night. Meaning I worked 8am-3am I had to turn around and do 8am cases to 10pm Sunday night.

I do get fatigue around 11pm if I’m doing continuous solo cases since 730am with maybe 60-90 min gaps for breaks. That’s brutal

I’m a machine but I do have my limits doing solo.

So when people say they love sitting their own cases. I don’t think anyone loves sitting own cases when they are consistently slammed like that.

Thus the high turnover rates of docs. Weekends are brutal

that’s not healthy

 

[aneftp]

that’s not healthy

This is the reason these places have locums rolling in these days. It’s not sustainable

The former private practice was like that also. But it was incentivized. We agreed the first 12 hours would be a flat $3000 beeper knowing we would work most of those hours ($250//hr which was good in the mid 2010s) and anything after would be $300/hr. Again very fair compensation.

Management company took the contract. I left. First time tried to offer nothing for weekends even after cutting from 12 MDs to 10 MDs. So that increased the weekend work instead of once every 6 weekends it became once every 5 weekends. A significant change. Than they agree to offer $1500//24 hrs “extra pay”. This was back around 2017 probably the highest point of amc power in Florida

You get a revolving door of docs figuring our every 6 months the work load sucks for calls on weekends.

Fast forward to 2024. A new system where they pay the docs $3500 for the first 8 hrs on weekends gurantee. Then $300/hr after. So it does incentivize people to work more. But still they are short half the docs. Not that many people want to do solo cases like that on weekends. The sister hospital has crnas to 2/3pm on weekends. So that helps big time. Than the doc takes over solo.

But different entities usap, team health , hca still hang on to this same doc only model on weekends 48 hrs. It’s brutal. And the common thing they all
Have in common is they are short staff docs. Cause the docs see the solo cases on weekends as brutal. Maybe if it’s a flat $8000/24 hr as w2 someone will bite. Some place still offer nothing on weekends for the same type of calls and claim it’s part of their compensation package. Which is bs considering the comp package is in the low 500s with the standard 9 weeks off

 

[pgg]

that’s not healthy

Yeah the catch to his $80K weeks or whatever, is exactly this - unsafe, unhealthy.

 

[hopefulraddaddypls]

Wtf.


In an unprecedented move, Anthem Blue Cross Blue Shield plans representing Connecticut, New York, and Missouri have unilaterally declared it will no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes

https://www.asahq.org/about-asa/newsroom/news-releases/2024/11/anthem-blue-cross-blue-shield-will-not-pay-complete-duration-of-anesthesia-for-surgical

WHat a joke

 

[Howard888]

No way I would ever do a 24 hour shift or even 12 hour overnight Md only again….at least at a busy hospital. Did that early in my career but since have had CRNAs at night. Although you often have to do some epidurals it’s so much better and sustainable than Md only, especially if you’re doing more than 3/4 calls a month. Crazy that model still exists in Florida. I’ve worked Texas, Arkansas, SC, Georgia and NC and all have had CRNAs at night. No Md only cases

 

[jwk]

No, we're not employees.

We still manage
- hiring and recruitment (and firing if it came to that)
- benefits, especially including choosing what benefits or options are offered
- far superior retirement planning (e.g. choice to max 401k via profit sharing; CBP; etc)
- decisions regarding division of group income amongst partners, e.g. how to value, allocate, and trade call
- vacation quantity and scheduling
- daily assignments
- call assignments
- not directly beholden to hospital admin or hospital HR or that foul ward RN with an axe to grind

Beyond that, there is the very important aspect of group culture. Employees don't really give a **** about each other - partners* have a vested interest in the success of other partners. It's the difference between working in the same building with some colleagues, and being part of an actual team. Yeah this is sort of touchy feely, but I've worked at a lot of places, from toxic to great.

We're a private group with a contract to a hospital system. Instead of collecting a stipend from the hospital plus billing 17 insurance companies and the government, we'll bill the hospital.

There's a world of difference between that and punching a clock for a hospital W2 paycheck. We're more akin to a gang of transactional mercenary locums dealing with a hospital client, than a bunch of loner employees with different pay scales and benefits and no idea who's making what, or who'll get hours cut or who's first to be laid off (not that anyone's getting laid off these days).

Yes, now that all money comes from the hospital there are implications concerning future contract negotiations. The leverage that they have vs what we have is different. But, possibly better for us. Honestly, we have more leverage against the hospital than we ever did against insurance companies or (ha!) the government.

In the meantime - more money for us, more predictability, no billing risk.

Of course, it could all blow up tomorrow. But that's true everywhere for everyone.


* At least, partners in a truly egalitarian group give a **** about each other; the existence of superpartner dinosaurs is toxic well beyond what a direct hospital employee would ever endure. Not ALL private groups are awesome, but mine is.

Curious what happens if you can't cover staffing. Who covers your locums costs? We're now hospital employees and happy - but the bodies we have is it and we hire a ton of folks each year. If there aren't enough bodies, the hospital has to cough up the $$$ to hire more.

 

[jwk]

No issues sitting my own cases. I do have issues sitting my own case on hour 33-34 of a 48 beeper hr call. Saturday and Sunday. All solo cases. That’s brutal. We literally ran it to 3am Sunday night. Meaning I worked 8am-3am I had to turn around and do 8am cases to 10pm Sunday night.

I do get fatigue around 11pm if I’m doing continuous solo cases since 730am with maybe 60-90 min gaps for breaks. That’s brutal

I’m a machine but I do have my limits doing solo.

So when people say they love sitting their own cases. I don’t think anyone loves sitting own cases when they are consistently slammed like that.

Thus the high turnover rates of docs. Weekends are brutal

I could do that in my 20s. No way in my 60s. 🙂

 

[teacher2md]

No way I would ever do a 24 hour shift or even 12 hour overnight Md only again….at least at a busy hospital. Did that early in my career but since have had CRNAs at night. Although you often have to do some epidurals it’s so much better and sustainable than Md only, especially if you’re doing more than 3/4 calls a month. Crazy that model still exists in Florida. I’ve worked Texas, Arkansas, SC, Georgia and NC and all have had CRNAs at night. No Md only cases

This attitude saddens me— why is taking care of a patient yourself in the OR so unbearable??

I agree that 24 hour call is terrible, but it has nothing to do with being in the OR vs supervising…

12 hour overnight call is part of our job as physicians.

 

[Howard888]

This attitude saddens me— why is taking care of a patient yourself in the OR so unbearable??

I agree that 24 hour call is terrible, but it has nothing to do with being in the OR vs supervising…

12 hour overnight call is part of our job as physicians.

So I don’t disagree that overnight call is our job and fully embrace that but having done both it’s night and day on how it effects you Md only vs direction and sustainability. Directing, you can go to bathroom when you want, eat or drink when you want, if case is cruising you can catch up on work, watch tv, etc. If a c section is closing and everything is stable I will make my way back to the call room saving 30 minutes of closing skin, cleaning patient, transport etc. if I need a coffee I can go get one.

It’s just more sustainable, especially if you’re going 4 or more calls a month and these are busy hospitals.

I can tell you I will take call much longer in my career because of direction than I would be able to Md only. So it’s not that I wouldnt do Md only overnight, it’s just that given a choice, direction vs Md only overnight it’s no choice at all. The decision is easy

 

[nimbus]

So I don’t disagree that overnight call is our job and fully embrace that but having done both it’s night and day on how it effects you Md only vs direction and sustainability. Directing, you can go to bathroom when you want, eat or drink when you want, if case is cruising you can catch up on work, watch tv, etc. If a c section is closing and everything is stable I will make my way back to the call room saving 30 minutes of closing skin, cleaning patient, transport etc. if I need a coffee I can go get one.

It’s just more sustainable, especially if you’re going 4 or more calls a month and these are busy hospitals.

I can tell you I will take call much longer in my career because of direction than I would be able to Md only. So it’s not that I wouldnt do Md only overnight, it’s just that given a choice, direction vs Md only overnight it’s no choice at all. The decision is easy

Generally if you work MD only, there are more MDs to spread out the calls. We do 18-20 nights per year, 5pm-7am. Usually sleep midnight to 6am. OB is completely optional. Some people do it for the $$ while others don’t. All the night calls are incentivized so they can be given away within 10min if you blast a group text.

So it’s a trade off. Anesthesiologists at our local Kaiser do 3-4 overnights per month with CRNAs. We do 1-2 per month solo.

 

[Howard888]

Sounds like a joke hospital with minimal volume in California. California doesn’t have con so it’s literally more like Canada than rest of US in regards to case volumes and productive pressure. In that situation sure. In southeast a hospital in major city runs ors through the night 50% of time. No downtime 12-6. usually has cases and OB part of the deal. Trauma hospital almost every night cases. I don’t know any group in southeast outside of academics that has call just 1-2 times a month. Northeast either.

I’m guessing you all also have a significant stipend, good luck when that runs out

 

[psychbender]

Sounds like a joke hospital with minimal volume in California. California doesn’t have con so it’s literally more like Canada than rest of US in regards to case volumes and productive pressure. In that situation sure. In southeast a hospital in major city runs ors through the night 50% of time. No downtime 12-6. usually has cases and OB part of the deal. Trauma hospital almost every night cases. I don’t know any group in southeast outside of academics that has call just 1-2 times a month. Northeast either.

I’m guessing you all also have a significant stipend, good luck when that runs out

Ours in the mid-Atlantic region has in-house physician- only call about that frequency. Nights can be really busy, but 7p-7a, with the second call getting up for maybe an epidural, pee break, or section, after having worked the full day until the first call arrived. When I still took call, I really didn't mind those nights, one the CRNAs went home at 11pm.

 

[nimbus]

Sounds like a joke hospital with minimal volume in California. California doesn’t have con so it’s literally more like Canada than rest of US in regards to case volumes and productive pressure. In that situation sure. In southeast a hospital in major city runs ors through the night 50% of time. No downtime 12-6. usually has cases and OB part of the deal. Trauma hospital almost every night cases. I don’t know any group in southeast outside of academics that has call just 1-2 times a month. Northeast either.

I’m guessing you all also have a significant stipend, good luck when that runs out

Believe it or not we’re a 550 bed L1TC and stroke center. When I started in the early 2000s, our city had a gang problem and we’d often work through the night with penetrating traumas. But that basically dried up 10-15 years ago. Nowadays on trauma call, I’m up past 1am maybe 2-3 times per year. I have 2 overnights left this year so now I’ve jinxed myself😉.

Another downside of MD only that I didn’t mention is that you have more frequent late calls. We’re committed to run 7 rooms until 7pm and 3 rooms until 11pm. All staffed by MDs. It’s not usually busy in the evening but sometimes it is.

I’ve never worked in the South so I have no reason to question your experience but I don’t find our MD only calls to be very taxing.

Also 15% of all anesthesiologists in this country work in California and most hospitals in the state are not as busy as ours at night. So it’s relevant to at least some SDN members.

 

[caligas]

Sounds like a joke hospital with minimal volume in California. California doesn’t have con so it’s literally more like Canada than rest of US in regards to case volumes and productive pressure. In that situation sure. In southeast a hospital in major city runs ors through the night 50% of time. No downtime 12-6. usually has cases and OB part of the deal. Trauma hospital almost every night cases. I don’t know any group in southeast outside of academics that has call just 1-2 times a month. Northeast either.

I’m guessing you all also have a significant stipend, good luck when that runs out

We have a VERY significant stipend. Lots of folks think it puts us at some sort or risk but it hasn’t “run out” in 20 years…in fact it keeps gettin’ juicier!!

 

[Howard888]

Until they realize that running 3 md only rooms versus 1 Md and 3 CRNAs costs 20% more. Not all markets but most still. Or just they can’t find enough MDs and they go to Crna only.

 

[psychbender]

Until they realize that running 3 md only rooms versus 1 Md and 3 CRNAs costs 20% more. Not all markets but most still. Or just they can’t find enough MDs and they go to Crna only.

It only costs more if a physician makes the same to medically direct 3:1 vs be solo. Let's take some lower end numbers and say CRNAs making $150/hr and directing physician $300/hr. That's $750/hr in personnel costs, which could also pay three solo physicians $250/hr. The 17% higher rate for medical direction seems appropriate with the higher liability risk and greater stress from covering multiple rooms.

Your point about not enough physicians, though, is the real issue in many places. In some markets, however, there are enough physicians to make this model work.

 

[dannyboy1]

It only costs more if a physician makes the same to medically direct 3:1 vs be solo. Let's take some lower end numbers and say CRNAs making $150/hr and directing physician $300/hr. That's $750/hr in personnel costs, which could also pay three solo physicians $250/hr. The 17% higher rate for medical direction seems appropriate with the higher liability risk and greater stress from covering multiple rooms.

Your point about not enough physicians, though, is the real issue in many places. In some markets, however, there are enough physicians to make this model work.

Wake up. The easiest guy to cut out is the one making 300/hour drinking coffee while he “supervises”. Higher ratios or CRNA only will be coming soon for facility employed physicians.

 

[psychbender]

Wake up. The easiest guy to cut out is the one making 300/hour drinking coffee while he “supervises”. Higher ratios or CRNA only will be coming soon for facility employed physicians.

No, I realize that. We were not talking about "extended care team" or independent CRNAs. We were specifically talking about solo physician vs standard ratio medical direction. Any employer is going to want to maximize income for the non-working owners/administrators, and since the income cannot be increased by increasing insurance reimbursement, they can only grow the delta by decreasing pay for labor. This is true whether AMC, hospital-employed, and even private groups getting subsidies from the hospitals. This has been a constant and is the primary driver for moving practices to to the ACT model, nor safety or efficiency.

 

[nimbus]

No, I realize that. We were not talking about "extended care team" or independent CRNAs. We were specifically talking about solo physician vs standard ratio medical direction. Any employer is going to want to maximize income for the non-working owners/administrators, and since the income cannot be increased by increasing insurance reimbursement, they can only grow the delta by decreasing pay for labor. This is true whether AMC, hospital-employed, and even private groups getting subsidies from the hospitals. This has been a constant and is the primary driver for moving practices to to the ACT model, nor safety or efficiency.

Are ACT models increasing? Or is extended ratio and independent CRNAs?

 

[amyl]

All I can offer is anecdotal evidence…. When I began anesthesia over ten years ago medical direction was the norm for most places with some md only geographically…. Northstar aka deathstar was the only place routinely doing this extended care team. My first job was md only in Indiana. That job is now mostly direction. Now the extended care team model is used extensively by sound and USAP (most of north Texas at least), premier anesthesias contracts, musc (Florence at least). It seems to me the general practice is degrading- what was md only is now traditional care team (direction) and what was care team has gone extended. Just my observations

 

[ryanjmy]

https://www.axios.com/2024/12/05/blue-cross-blue-shield-anesthesia-anthem-connecticut

Looks like they changed their mind. Wonder what made them reconsider.

 

[anbuitachi]

https://www.axios.com/2024/12/05/blue-cross-blue-shield-anesthesia-anthem-connecticut

Looks like they changed their mind. Wonder what made them reconsider.

seems to be only for connetict though

 

[nimbus]

seems to be only for connetict though

NY too.

• "We pushed Anthem to reverse course and today they will be announcing a full reversal of this misguided policy," New York Gov. Kathy Hochul said Thursday in a statement. "Don't mess with the health and well-being of New Yorkers — not on my watch."

Still leaves Missouri.

 

[CopaceticOne]

Still leaves Missouri.

It’s all states.

https://www.kansascity.com/news/business/health-care/article296635489.html

 

[sevoflurane]

It’s all states.

https://www.kansascity.com/news/business/health-care/article296635489.html

Thank gawd. That was insurance companies "testing" the waters.
What a BS move on their part. I trust insurance companies the least.

 

[abolt18]

It’s all states.

https://www.kansascity.com/news/business/health-care/article296635489.html

Anthem Blue Cross says it's reversing a policy to limit anesthesia coverage

Anthem will reverse a policy that would have capped insurance coverage for anesthesia after objections from doctors and lawmakers.

www.cbsnews.com

Yup.

 

[pastafan]

We're going to have to follow what The Gomer Blog predicted in 2016.

Anesthesiologist, Tired of Inaccurate Surgical Time Estimates, Tells Surgeon How Much Anesthesia Time is Left | GomerBlog

Anesthesiologists are now informing Surgeons how much time they have left to operate before the patient will start waking up

gomerblog.com

Years ago I was working with an orthopod who was average speed until it came to closure. He would start talking and take 3X as long as he should to finish a case. One day I had had enough. I extubated a patient early and as I pulled the tube I told him that he needed to finish up. He had never seen anything like this and he shut up and closed. I was decades ahead of the times.

 

[DesiredMemberName?]

Years ago I was working with an orthopod who was average speed until it came to closure. He would start talking and take 3X as long as he should to finish a case. One day I had had enough. I extubated a patient early and as I pulled the tube I told him that he needed to finish up. He had never seen anything like this and he shut up and closed. I was decades ahead of the times.

This is a classic move for resident surgeons trying to practice their plastics closure on the middle of the night ex lap.

Nah bro… tubes out… times up. As they say on the golf course: suck faster.

 

[DirtDocMD]

Years ago I was working with an orthopod who was average speed until it came to closure. He would start talking and take 3X as long as he should to finish a case. One day I had had enough. I extubated a patient early and as I pulled the tube I told him that he needed to finish up. He had never seen anything like this and he shut up and closed. I was decades ahead of the times.

Yeah, I did the same thing to a HORRIBLE general surgeon we used to have, who was “explaining” to a 3rd year med student (at 2 in the morning) how to close his lap chole trochar incisions. (He had already put local in all the incisions, so I wasn’t at risk of the patient feeling anything). After 3 hours of watching him try to find his ass with both hands, I’d had enough. He stopped talking, and finished his closure in less than 2 minutes…

 

[MTGas2B]

This is a classic move for resident surgeons trying to practice their plastics closure on the middle of the night ex lap.

Nah bro… tubes out… times up. As they say on the golf course: suck faster.

Sorry. Ran out of quarters for the machine.

 

[Twiggidy]

Until they realize that running 3 md only rooms versus 1 Md and 3 CRNAs costs 20% more. Not all markets but most still. Or just they can’t find enough MDs and they go to Crna only.

CRNAs are always getting floated, until admin is reminded of nursing unions, mandated breaks, strict 8hrs shifts etc, versus just paying an MD group some version of a stipend and that doc will sit that 12hr case, not complain, and like just read the entire internet. If they have decent partners they’ll get their break, they’ll get their lunch, and quite honestly I believe things run smoother. The caveat is pay people well and they will do the work and some admins haven’t figured that part out.

I’ve always questioned i could put my career in another person’s hands and I guess I won’t know unless I try but it’s definitely less stressful not needing to hope someone else knows what they’re doing at 2am

 

[TheLoneWolf]

They backed off

Insurance company halts plan to put time limits on coverage for anesthesia during surgery

After sharp criticism from anesthesiologists, an insurance company is halting its plan to limit the amount time it would cover anesthesia used in surgeries and procedures. Anthem Blue Cross Blue Shield said on Thursday it would no longer move forward with the policy change.

www.yahoo.com

 

[Ashers]

Years ago I was working with an orthopod who was average speed until it came to closure. He would start talking and take 3X as long as he should to finish a case. One day I had had enough. I extubated a patient early and as I pulled the tube I told him that he needed to finish up. He had never seen anything like this and he shut up and closed. I was decades ahead of the times.

One of my friends is a general surgeon. When we were both faculty, I was soloing her case, and she had an intern with her. When I started waking the patient up, and the intern had to redo the sutures, she told me to keep going. The intern asked for the patient to stop breathing. She said, "you're going to have to learn to suture on a moving patient." I miss working with her.

I didn't extubate [edit: until he was done suturing]. Good on you!

 

[caligas]

Anthem BCBS Reverses Policy That Would Have Limited Anesthesia Periods

Anthem Blue Cross Blue Shield officials had planned to roll out the changes nationwide but said they were misunderstood.

www.nytimes.com

In this article they are trying to gaslight us about what the changes were 😂

 

[centdoc]

https://www.axios.com/2024/12/05/blue-cross-blue-shield-anesthesia-anthem-connecticut

Looks like they changed their mind. Wonder what made them reconsider.

I wonder if NY events made them reconsider

 

[GravelRider]

A big insurer backed off its plan to pay less for anesthesia. That’s bad.

What the fight between Anthem and anesthesiologists was really about.

www.vox.com

Mainstream Media calling us greedy millionaires who commit fraud to cost patients more money.

 

[cchoukal]

A big insurer backed off its plan to pay less for anesthesia. That’s bad.

What the fight between Anthem and anesthesiologists was really about.

www.vox.com

Mainstream Media calling us greedy millionaires who commit fraud to cost patients more money.

That piece is garbage! Exaggerating how long the case was? Is the author ignorant (answers own question). I wish there were a comment section.

 

[DolphinVA]

ASA should respond to this article and it's baseless allegations that we inflate anesthesia time.

 

[DolphinVA]

That piece is garbage! Exaggerating how long the case was? Is the author ignorant (answers own question). I wish there were a comment section.

Let him know what you think: [email protected]

Let the ASA know you expect a strong response: [email protected] and [email protected]

 

[nimbus]

Let him know what you think: [email protected]

Let the ASA know you expect a strong response: [email protected] and [email protected]

Padding time aka billing fraud aka falsifying medical records is a fireable offense in our practice. He should spend a day with an actual anesthesiologist before pulling s*** out of his ass. Clueless.

 

[crna2006]

I already sent him an email explaining little he knows

 

[rowsdower88]

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2713030

The article he cites as evidence for fraud committed by anesthesiologists.

 

[abolt18]

Let him know what you think: [email protected]

Let the ASA know you expect a strong response: [email protected] and [email protected]

I already sent him a long email that I smashed out on my phone between cases. Didn't even throw any insults, as I figured he'd be more likely to read it if it was less targeting him and more focused on the content of the article.

 

[anonperson]

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2713030

The article he cites as evidence for fraud committed by anesthesiologists.

He cites an invited commentary that is mainly composed of nurses that doesn't even state there is fraud. Just that the anesthesia times have a lot of 0s and 5s and that could be seen as irregular.

And a lot more patients that have higher ASA levels. Can't be that people are fatter and sicker now vs 20 years ago.

What's funny is that the IRS is perfectly fine with tax payers rounding their taxes to the whole dollar so 0.49 is 0 and 0.5 is 1. No fraud there.

What a hack journalist.

 

[rowsdower88]

He cites an invited commentary that is mainly composed of nurses that doesn't even state there is fraud. Just that the anesthesia times have a lot of 0s and 5s and that could be seen as irregular.

And a lot more patients that have higher ASA levels. Can't be that people are fatter and sicker now vs 20 years ago.

What's funny is that the IRS is perfectly fine with tax payers rounding their taxes to the whole dollar so 0.49 is 0 and 0.5 is 1. No fraud there.

What a hack journalist.

It's funny that the proposed change by Anthem/BCBS wouldn't really even affect the anesthesiologists who are inflating anesthesia times rounding up a few minutes.

 

[caligas]

I don’t think most insurers pay ASA class modifiers anymore

 

[nimbus]

It's funny that the proposed change by Anthem/BCBS wouldn't really even affect the anesthesiologists who are inflating anesthesia times rounding up a few minutes.

It’ll hurt folks in academics who work with “professors” and surgical trainees the most. Where I trained there was a hand surgeon who would do 3 carpal tunnels from 7-3.

 

[abolt18]

It’ll hurt folks in academics who work with “professors” and surgical trainees the most. Where I trained there was a hand surgeon who would do 3 carpal tunnels from 7-3.

That's shameful. It's a 15-20 minute procedure skin to skin.