Not long ago, we received a communication from one of our clients whom we’ll refer to as “Dr. X.” He was responding to an alert we had published that reported on yet another Medicare policy that would negatively affect anesthesia reimbursement. The way he expressed his disappointment over the news was priceless. “Wonderful news! That’s right, let’s keep undercutting and denying and lowering physician reimbursement!” The sarcasm was thick, and the ire was evident.
Then, Dr. X had an inspired idea. He suggested we chronicle all the ways in which physicians, and anesthesia providers in particular, have been undercut over the last 20 years from a reimbursement perspective. He wanted us to show how “this little snowball is becoming an avalanche” and to summarize all that’s transpired “to cause our death by a thousand cuts.” Well said, Dr. X. The following is our summary.
The List of Grievances
Here are just a few of the challenges with which the anesthesia community has had to contend over the last two decades:
The Long Game
The above represents just a few of the developments that have taken place over the past 20 years or so that compromised provider revenue—especially in terms of the anesthesia space. Gradualism is a term that can be applied to science, politics and other disciplines. For example, a gradualist approach to political change involves incremental adjustments in law and policy implemented over a multi-year period, so as to avoid civil unrest and revolt that can break out in response to sudden dramatic change. From the perspective of many, there appears to be a gradual process in place, where—over a period of time—incremental hits to anesthesia reimbursement are creating a real financial and psychological hardship: the drip, drip, drip of bad news, the final piece of straw that causes the camel’s collapse. I like the way Dr. X puts it:
It’s pretty evident “they” are [set] on destroying independent physician practices so that we all are employed in some fashion, so that we go out of business and become a controlled widget, a commodity.
So, from the perspective of Dr. X and others, this is what it’s like to experience death by a thousand cuts. So, what can anesthesia providers do to combat this discouraging trend? Two suggestions come to mind. First, voice your concerns to the ASA and your other specialty organizations. They maintain a lobbying effort with Congress and federal regulatory agencies. Second, take full advantage of the opportunity to submit your comments to Medicare when these proposed rules come out. If you see something in their proposals that will be detrimental to anesthesia reimbursement, that’s your chance to make your voice heard.