The U.S. Government Accountability Office’s (GAO) report on anesthesia services missed the mark, according to the American Society of Anesthesiologists (ASA). Instead of a full and comprehensive review of a longstanding problem of unusually low Medicare payment rates for anesthesia services, the GAO made no effort to analyze the crux of the problem, the Medicare anesthesia payment system, which in itself is flawed.
“Instead of looking at the real problem, the anesthesia payment system known as the conversion factor, the GAO conducted a study assuming the Medicare rate to be reasonable, something physician anesthesiologists have challenged for decades,” said ASA President Beverly K. Philip, M.D., FACA, FASA. “Medicare payments for anesthesia have been undervalued compared to other medical specialties since 1992. This report was an opportunity to address this flaw, but assuming a payment rate of 33% of what health insurers pay to be reasonable started the study off on the wrong foot, resulting in nothing but inaccurate and misleading conclusions.”
The report includes no analysis of how the payment system was formulated, no investigation into methodological flaws, and no exploration into how current Medicare payment rules continue to be a longstanding barrier to implementing a payment system that, at a minimum, keeps pace with the increasing costs of providing health care, according to ASA.
The GAO report also reflects a lack of understanding of the unbalanced negotiations between anesthesiology groups and health insurers. Market forces are discounted as are the negotiating dynamic in many areas of the country in which a single insurer may dominate the marketplace. These insurers use that dominance to unfairly negotiate with anesthesiology practices, often offering the anesthesia group a “take it or leave it” contract. Recent ASA surveys have captured insurers canceling contracts, even recently negotiated contracts, and forcing physician anesthesiologists out of network.
Finally, the use of Medicare beneficiary access is an unrealistic metric of payment adequacy for Medicare payment rates for anesthesia services. It is without any foundation as a measure and reflects a lack of understanding of anesthesiology practices. Medicare participation is a condition of securing contracts at virtually every facility in the U.S. that accepts Medicare beneficiaries. As the GAO report cited correctly, only 67 physician anesthesiologists opted-out of providing services to Medicare beneficiaries. More than 30,000 physician anesthesiologists practice in the U.S.
