Medicare anesthesia conversion factor is scheduled to be reduced by nearly 10%

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
J

joshbc

Full Member
7+ Year Member
Joined
Sep 14, 2014
Messages
11
Reaction score
8
Members don't see this ad.
Can someone give me a synopsis as to how this could occur (I.e. why this would even be proposed)?

Did the surgeon general have any involvement in this?

I have to imagine that many republican anesthesiologists vote republican for financial reasons- curious how they feel about proposed fee structure under a republican administration?

I am not trying to trigger anyone- just truly a baffling proposal
 
Medicare is like a medieval torture machine:


https://www.planetdeadly.com/wp-content/uploads/crushing-torture.jpg


Every year, the screw tightens, the pressure on doctors increases.

In the end, American medicine will be crushed, but who cares, with all those trillions in the pockets of insurance companies (who use Medicare as a pretext to drop their own reimbursements), and all those satisfied dumb voters.
 
apparently there's been a "compromise" on surprise medical billing that is trying to be thrown in at the last second of this year. More thank you gifts for front line physicians!
 
The divide between Neal and the other committee heads centered on how to settle billing disagreements.

The House Energy and Commerce and Senate HELP package would settle billing disputes between providers and insurers by forcing doctors to accept the median in-network rate for their service, a system insurers and employers favored. Neal preferred having a third party decide what rate the provider must accept, a process known as arbitration that provider groups have pushed.

Committee leaders have tried to reconcile the two approaches.

The deal drawn up Friday leans closer to Neal’s bill, allowing providers to enter into arbitration to seek higher reimbursements from insurers. According to an outline of the bill, the legislation would direct the arbitrator to consider a host of factors: median in-network rate, information related to the training and experience of the provider, the market share of the parties, previous contracting history between the parties, complexity of the services provided, and any other information the parties submit.

The agreement would make patients responsible only for their in-network cost-sharing amounts for both emergency services, including air ambulances, and some non-emergency care, according to the outline.


about.bgov.com

All-in-one public affairs and government news platform - Bloomberg Government

Federal and state government public affairs software. Get breaking policy news, legislative updates, bill and regulation tracking, and directories.
about.bgov.com about.bgov.com
 
Must be nice to be an insurance company. Billions of dollars in unspent healthcare dollars due to shutdowns and changes in patient behavior while hospitals are losing millions. Now the insurance companies can spend their excess earnings on lobbying so these useless middlemen can make even more.
 
BLADEMDA said:
The divide between Neal and the other committee heads centered on how to settle billing disagreements.

The House Energy and Commerce and Senate HELP package would settle billing disputes between providers and insurers by forcing doctors to accept the median in-network rate for their service, a system insurers and employers favored. Neal preferred having a third party decide what rate the provider must accept, a process known as arbitration that provider groups have pushed.

Committee leaders have tried to reconcile the two approaches.

The deal drawn up Friday leans closer to Neal’s bill, allowing providers to enter into arbitration to seek higher reimbursements from insurers. According to an outline of the bill, the legislation would direct the arbitrator to consider a host of factors: median in-network rate, information related to the training and experience of the provider, the market share of the parties, previous contracting history between the parties, complexity of the services provided, and any other information the parties submit.

The agreement would make patients responsible only for their in-network cost-sharing amounts for both emergency services, including air ambulances, and some non-emergency care, according to the outline.


about.bgov.com

All-in-one public affairs and government news platform - Bloomberg Government

Federal and state government public affairs software. Get breaking policy news, legislative updates, bill and regulation tracking, and directories.
about.bgov.com about.bgov.com
Click to expand...

IDR where the arbitrator is directed to use median in network rate is a sham. It's no different from there not being any IDR in the first place. The whole point is that the insurance companies can manipulate the median in network rate downward by canceling contracts for anyone above the median and kicking people out of network. IDR is only good if they are directed to use market rates or neutral parties like FAIR Health.

If this passes it'll be devastating to multiple specialties, anesthesiology included.
 
GassYous said:
Must be nice to be an insurance company. Billions of dollars in unspent healthcare dollars due to shutdowns and changes in patient behavior while hospitals are losing millions. Now the insurance companies can spend their excess earnings on lobbying so these useless middlemen can make even more.
Click to expand...
Overall this pandemic has been a rousing success in terms of wealth consolidation. Healthcare workers are getting screwed left and right while insurance and health corps are raking it in. Wal-mart and Amazon profits are at an all-time high, meanwhile mom and pop shops are closing at alarming rates. Truly a good year for the 0.1%.
 
Endee said:
IDR where the arbitrator is directed to use median in network rate is a sham. It's no different from there not being any IDR in the first place. The whole point is that the insurance companies can manipulate the median in network rate downward by canceling contracts for anyone above the median and kicking people out of network. IDR is only good if they are directed to use market rates or neutral parties like FAIR Health.

If this passes it'll be devastating to multiple specialties, anesthesiology included.
Click to expand...

Is it common for you guys to make a lot off medicare? I guess i’m only familiar with academic anesthesia attendings who were all salaried...and i assumed PP was mostly private insurance.
 
Sublimazing said:
Is it common for you guys to make a lot off medicare? I guess i’m only familiar with academic anesthesia attendings who were all salaried...and i assumed PP was mostly private insurance.
Click to expand...

Medicare pays very little. Medicaid pays even worse. Mostly private insurance would be nice. But even insurers will change their reimbursements based on what the government is doing. Most people getting surgery are old people that aren't working. Medicare makes up a large portion of patients. Who do you think are getting knee replacements? Healthy, productive 30 year olds or obese 70 year olds on the government dole? Vascular and cardiac patients are also obese elderly that smoke and did nothing about their diabetes. Maybe if you worked in a cash pay boutique eye or plastic surgery surgicenter...
 
Medicare for other specialties is still decent. They collect 70-80% of their usual and customary fees. A very busy Orthopedic surgeon could do quite well off Medicare while you collect 15th percentile MGMA for your region.
 
Sublimazing said:
Is it common for you guys to make a lot off medicare? I guess i’m only familiar with academic anesthesia attendings who were all salaried...and i assumed PP was mostly private insurance.
Click to expand...

Medicare pays for anesthesia on average 33% of private payers rates. Most specialties are 70-80% of private as Blade mentioned.

Give it a few years and this surprise billing legislation will lead to Medicare (rates) for all.
 
Endee said:
Medicare pays for anesthesia on average 33% of private payers rates. Most specialties are 70-80% of private as Blade mentioned.

Give it a few years and this surprise billing legislation will lead to Medicare (rates) for all.
Click to expand...

So why anesthesiology did not get this 70-80% deal?
 
So anesthesia is now faced with massive pay cuts.

#1 10 percent cms pay cut from $80/hr to $70 to keep patients alive while their surgeon attempts to kill them.

#2 Surprise medical billing legislation on the docket now in the end of year covid relief plan allows for payments by private insurers to be paid at CMS rates.

#3 Biden tax plan. God forbid Georgia falls to democrats. Then the several percent increase in taxation will hurt very much on top of #1 and #2. Biden also calls for limiting pretax retirement deferral from the current 19.5k, which if you’re only saving 19.5k a year it’s not enough in 30 years.

#4 Biden student loan forgiveness will not affect those who were smart enough to refinance at significantly lower rates than uncle sam profited from during medical school and residency. Anyone making less than around 120k will also not receive any relief, regardless. Refer to Warren and Sanders forgiveness plans.

Please email your congressmen and senators to correct #1 and #2. Let your voice be heard, especially during a time when anesthesiologists are at the forefront of covid healthcare.
 
Is it time to stop accepting CMS patients and shift to a two tier health system? One in which we only care for those who are willing to pay for better, private care? It’s coming. Just a matter of when and who will be first to create a functioning business model outside of the medicare for all system.
 
raztes said:
Is it time to stop accepting CMS patients and shift to a two tier health system? One in which we only care for those who are willing to pay for better, private care? It’s coming. Just a matter of when and who will be first to create a functioning business model outside of the medicare for all system.
Click to expand...

That's the problem, if the new legislation is passed, private insurers will have zero incentive to negotiate with groups. Right now the group can charge out of network rates if the insurer doesn't want to play ball but with the new legislation, insurers will be able to basically determine all the rates themselves. That's a potential loss of 66% of our income. I'm not working for that rate and I doubt most will.

It's amazing that various state and federal governments will throw millions at companies with zero expertise with payment upfront for being even slightly related to covid, but they have zero qualms about paying the people taking care of the patients less and less. They print out a bunch of signs talking about the "heroes" while their cronies make out like bandits. The sheer number of people buying jets and multi million dollar houses with stolen government money is disgusting.
 
Last edited:
Very concerning indeed. Are we all gonna go get critical care trained now? That reduced demand for critical care docs will drive the income down eventually as well. Better keep saving now at a high rate and look for other opportunities outside medicine for income stream.
 
In an ideal world, surprise billing legislation would narrowly target patients who are admitted through the ED for an emergent procedure or those who are inpatient already and then require surgery. There is no reason that patient who is scheduled for elective procedure can’t call up the anesthesia department at the hospital or surgicenter to see if they are in network.
 
When these things get passed, what’s generally the timeline for implementation and compliance?
 
dannyboy1 said:
There is no reason that patient who is scheduled for elective procedure can’t call up the anesthesia department at the hospital or surgicenter to see if they are in network.
Click to expand...
No there is not. The problem is when they are told by the surgeon or the staff that everything is in network. Patient doesn't worry about it after that.
 
Arch Guillotti said:
No there is not. The problem is when they are told by the surgeon or the staff that everything is in network. Patient doesn't worry about it after that.
Click to expand...
You call your insurance company. They will clearly tell you the price and coverage. Americans are lazy and too poorly educated to figure it out.
 
I don't blame the patient one bit. When I'm getting care, I'm not making phone calls to see if this guy or that guy is in network. How many people do you see? They just show up in your room. No one clearly tells you price or coverage. Is that a joke? Call up your insurance company right now and ask for the price of a gallbladder. The whole thing is smoke and mirrors and the issue is that there are too many middlemen with their hands in the pot. Get rid of the entire insurance system.
 
raztes said:
You call your insurance company. They will clearly tell you the price and coverage. Americans are lazy and too poorly educated to figure it out.
Click to expand...

very rosy viewpoint. had to have surgery as a medicine resident. surgeon and his office and my insurance company told me everything was ready to go. the insurance company was also the same entity that owned the hospital and employed the surgeon. i still got a surprise bill from a out of network surgical PA that took months to fight. multiple phone and website dead ends. phantom return calls. i can’t imagine fighting this kafkaesque system as layperson

edit: you rekindled how much of an ordeal that was. i remember having to get to work early so i would have time to call them during their banker’s hours and even swap some shifts around to get on nights so i could take calls. what a joke. this was roughly 7 years ago...probably worse now.
 
Last edited:
end stage fibro said:
very rosy viewpoint. had to have surgery as a medicine resident. surgeon and his office and my insurance company told me everything was ready to go. the insurance company was also the same entity that owned the hospital and employed the surgeon. i still got a surprise bill from a out of network surgical PA that took months to fight. multiple phone and website dead ends. phantom return calls. i can’t imagine fighting this kafkaesque system as layperson

edit: you rekindled how much of an ordeal that was. i remember having to get to work early so i would have time to call them during their banker’s hours and even swap some shifts around to get on nights so i could take calls. what a joke. this was roughly 7 years ago...probably worse now.
Click to expand...
What you went through is totally wrong and I don’t think anyone will argue that this aspect of surprise billing needs to be done away with. The concern is that insurance companies will use this as a pretext to decimate reimbursement- there’s a reason that they are heavily promoting this legislation.

But yeah, what you went through sounds like a nightmare, and when I went to the ER not long ago, I had this fear in the back of my mind...
 
If a patient has no input on who gets to see them or has no idea who is part of the team that treats them (at no fault of their own), they should not be responsible for these out of network and surprise costs. It's disgusting.
 
navi86 said:
If a patient has no input on who gets to see them or has no idea who is part of the team that treats them (at no fault of their own), they should not be responsible for these out of network and surprise costs. It's disgusting.
Click to expand...
Physicians agree with this the problem is that insurance companies will use this to force everyone to accept their network rate which they can set as low as they want since they'll never have to pay a dime above it.

Balance billing at least lets physicians try to collect a market rate and it's the insurance company screwing their subscriber but making it look like the doctor is doing it. If the insurance paid the doctor a market rate then turned around to collect the difference from their subscriber who would the villain be then?
 
Lecithin5 said:
What you went through is totally wrong and I don’t think anyone will argue that this aspect of surprise billing needs to be done away with. The concern is that insurance companies will use this as a pretext to decimate reimbursement- there’s a reason that they are heavily promoting this legislation.

But yeah, what you went through sounds like a nightmare, and when I went to the ER not long ago, I had this fear in the back of my mind...
Click to expand...
oh i totally understand and agree .

i meant to preface that the point of my story is that even calling the insurance company doesn’t get you anything , as raztes implied it would. if anything it gets you a conniption.
 
end stage fibro said:
very rosy viewpoint. had to have surgery as a medicine resident. surgeon and his office and my insurance company told me everything was ready to go. the insurance company was also the same entity that owned the hospital and employed the surgeon. i still got a surprise bill from a out of network surgical PA that took months to fight. multiple phone and website dead ends. phantom return calls. i can’t imagine fighting this kafkaesque system as layperson

edit: you rekindled how much of an ordeal that was. i remember having to get to work early so i would have time to call them during their banker’s hours and even swap some shifts around to get on nights so i could take calls. what a joke. this was roughly 7 years ago...probably worse now.
Click to expand...

The pa is superfluous for many surgeries and sometimes you don't meet them until you get to the or. What are you gonna say, no I don't want you in my or? You aren't really offered a choice.
 
I have sent an email to my surgeon that I give absolutely no consent for an out of network provider to be involved in my care. If someone sends me a surprise bill they will drop it or be reported to the medical board for battery...
 
dannyboy1 said:
I have sent an email to my surgeon that I give absolutely no consent for an out of network provider to be involved in my care. If someone sends me a surprise bill they will drop it or be reported to the medical board for battery...
Click to expand...

I would send back: I cannot guarantee that this condition can be met. If this is unsatisfactory, go seek care elsewhere.
 
dannyboy1 said:
I have sent an email to my surgeon that I give absolutely no consent for an out of network provider to be involved in my care. If someone sends me a surprise bill they will drop it or be reported to the medical board for battery...
Click to expand...
Even better, on the day of surgery write that on YOUR consent. If that started happening widely it would force some serious consideration.
 
gasdoc77 said:
Even better, on the day of surgery write that on YOUR consent. If that started happening widely it would force some serious consideration.
Click to expand...
What if we also started revoking consent for specific aspects of care (eg transverse incision only, no opiate in anesthetic etc)? But saved it until the day of surgery for a high pressure sales tactic. That sound good too?
 
chessknt said:
What if we also started revoking consent for specific aspects of care (eg transverse incision only, no opiate in anesthetic etc)? But saved it until the day of surgery for a high pressure sales tactic. That sound good too?
Click to expand...
This was me, as someone who knows the system just trying preempt problems. My concern was some OON PA would show up. Or the pathology lab would end up being OON. a quick email to the surgeons office on the morning of surgery would give me some ammunition if a bill was ever sent. Luckily it was all covered.
 
dannyboy1 said:
This was me, as someone who knows the system just trying preempt problems. My concern was some OON PA would show up. Or the pathology lab would end up being OON. a quick email to the surgeons office on the morning of surgery would give me some ammunition if a bill was ever sent. Luckily it was all covered.
Click to expand...
You know the system and thought this was a reasonable approach? What if there was a problem during the operation and surgeon needs an assist--keep you under while he dials your insurance company to make sure the assist is in network? And you think the pathologist has any idea you sent that email when he/she reads the slides then you refuse to pay?
 
Last edited:
Anyone want to weigh in on the legal underpinnings of surprise billing legislation ? If I am OON, what is happening is a patient is coming for a services and I am sending a bill. Then congress passed a law that says I only get paid X. Let’s extrapolate this to other industries. Suppose I hire someone to do home construction. Can congress pass a law stating that the construction guy only gets paid the median rate similar work as comparable to what the neighbors paid?? By what right? I only ask this because legal challenges are certain to come....
 
dannyboy1 said:
Anyone want to weigh in on the legal underpinnings of surprise billing legislation ? If I am OON, what is happening is a patient is coming for a services and I am sending a bill. Then congress passed a law that says I only get paid X. Let’s extrapolate this to other industries. Suppose I hire someone to do home construction. Can congress pass a law stating that the construction guy only gets paid the median rate similar work as comparable to what the neighbors paid?? By what right? I only ask this because legal challenges are certain to come....
Click to expand...

No other industry has the kind of government entanglements and regulatory capture as healthcare does. I don't see that changing much. The defense of prohibiting surprise billing from the patients side is if an unconscious, very sick, or injured patient comes emergently to your hospital and winds up having emergency surgery, they didn't exactly have the opportunity to check who was in network, and laws like EMTALA requires treating and stabilizing patients coming in for an emergency. That seems reasonable from a public policy standpoint, and thats why ASA supported holding patients harmless for what is often a unilateral decision by the insurance companies to keep narrow networks because of not wanting to pay market rates.



This Twitter thread sounds like things didn't turn out as bad as they were telegraphing though. The sky didn't fall, yet.
 
You must log in or register to reply here.

Similar threads

S
Change to Anesthesia after IM Subspecialty. Is it worth it?
2
Replies
71
Views
5K
lancer474
L
S
Anesthesia
Replies
2
Views
933
SuxDrugs&Rocuronium
SuxDrugs&Rocuronium
N
Anesthesia as a Career for Physicians is Over!
2
Replies
67
Views
8K
AppTrail
AppTrail
L
Emory Anesthesia
Replies
24
Views
4K
We'llBeDoneIn15Minutes
W
S
Anesthesia Resident Arrested
Replies
22
Views
3K
aneftp
A
Top