Anesthesiology Digest – August 2023

August 24, 2023

Anesthesiology Digest: News from August 2023.

3 States Update CRNA Policy in 2023

By Patsy Newitt | August 23, 2023

Here are three states that have updated their policies for certified registered nurse anesthetists in 2023, according to the American Association of Nurse Anesthesiology:

1. In July, Oregon repealed “redundant provisions” and clarified guidelines for CRNAs practicing in the state with the passage of a bill. The bill reaffirms the Oregon State Board of Nursing’s authority to establish CRNA scope of practice. 

2. In June, Delaware opted out of federal regulations requiring physician supervision of CRNAs. 

3. In May, Wyoming opted out of federal regulations that require physician supervision of CRNAs for hospitals with 25 licensed beds or fewer. 

To read more, go to Becker’s ASC Review.


Employer-sponsored Insurance Costs to Rise 8.5% for 2024: Report

By Rylee Wilson | August 22, 2023

Employers will pay more than $15,000 on average for each employee’s healthcare in 2024, according to an analysis from consulting firm Aon. 

Employer-sponsored insurance costs will rise 8.5 percent in 2024, up from an average of $13,906 per employee in 2023, according to Aon’s estimates published Aug. 22. 

Though inflation has spiked in the past two years, employer-sponsored healthcare costs have stayed relatively stable because of multiyear contracts, Debbie Ashford, chief actuary for Health Solutions at Aon, said in a news release. 

“Even though inflation is subsiding, healthcare trend is growing as medical providers push insurers for larger cost increases to cover the higher costs of wages and supplies that they endured during the last couple years but were unable to pass on to payers,” Ms. Ashford said. 

“Other contributing factors adding pressure on healthcare cost trends are the proliferation of newly indicated weight loss drugs, new technologies, severity of catastrophic claims and increasing share of specialty drugs,” she added. 

In a tight labor market, employers will likely absorb most of the rising costs, rather than charging employees higher premiums, according to Aon’s report. 

Read the full report here


House Freedom Caucus Rolls Out Demand to Avoid a Shutdown

By Jordain Carney | August 21, 2023

The conservative House Freedom Caucus on Monday formally drew its red line on the looming government shutdown deadline.

The group of roughly three dozen Republican lawmakers said it would oppose any short-term stopgap unless leadership meets a slew of their demands. Senate Majority Leader Chuck Schumer and Minority Leader Mitch McConnell, earlier this month, publicly said a temporary fix will be necessary to avoid a shutdown at the end of September as Congress takes more time to hash out new spending bills.

“In the eventuality that Congress must consider a short-term extension of government funding through a Continuing Resolution, we refuse to support any such measure that continues Democrats’ bloated COVID-era spending and simultaneously fails to force the Biden Administration to follow the law and fulfill its most basic responsibilities,” the Freedom Caucus said in a statement.

The demands, while not unexpected, underscore the headache awaiting Speaker Kevin McCarthy, who told GOP members during a recent call that they would need a short-term spending fix before October.

In addition to vowing to oppose a so-called clean short-term funding bill, the Freedom Caucus is also planning to vote against any spending legislation that doesn’t meet certain priorities of the party’s right flank. That would mean including, according to the announcement, a sweeping GOP border bill that has stalled in the Senate; addressing “the unprecedented weaponization” of the Justice Department and FBI and ending “woke” Defense Department policies.

An official position from the Freedom Caucus requires the support of at least 80 percent of its members.

To read more, go to Politico.


Illinois Governor Signs Law Promoting Anesthesiologist Care in Medically Underserved Areas

August 16, 2023

Illinois Governor J.B. Pritzker signed into law SB 2130 , which amends the Underserved Health Care Provider Workforce Act to include an anesthesiologist in the definition of “eligible health care provider.” This change will make anesthesiologists eligible for certain grant programs, loan repayment programs, and other programs intended to be awarded to health care providers agreeing to care for patients in specified underserved jurisdictions. Specifically, the program allows for up to $50,000 in loan repayment for a two-year contract for full-time service or four-year contract for half-time service. The new law will become effective January 1, 2024.

The Illinois Society of Anesthesiologists (ISA) was instrumental in promoting this legislation and ensuring the bill made it to the governor’s desk. ASA applauds ISA’s leadership in this important space and its efforts to ensure patients throughout the state, especially those who live in areas where more medical care is needed receive physician-led anesthesia care. ASA also congratulates the Illinois Legislature and Governor Pritzker for prioritizing patient care and ensuring anesthesiologists have the necessary resources to care for patients in underserved areas.

To read more, go to ASA’s website.


Another House Bill Takes Aim At Prior Authorizations

By Andrew Cass | August 16, 2023

Maryland Rep. Mark Green has introduced a bill targeting prior authorization requirements in Medicare and Medicare Advantage, as well as prior authorization fixes for Medicare prescription drug plans. 

The legislation would require that board-certified physicians in the relevant specialty are the ones making prior authorization determinations, according to an Aug. 15 news release from Mr. Green’s office. Medicare, Medicare Advantage and Medicare Part D plans would be directed to comply with requirements that restrictions must be based on medical necessity and written clinical criteria, as well as additional transparency obligations. 

A number of bills aiming to reform the prior authorization process have been introduced in the House this year. 

On July 31, two representatives introduced gold-card legislation that would exempt qualifying providers from prior authorization requirements for Medicare Advantage plans. 

Another bill, which would establish an electronic prior authorization process and require Medicare Advantage plans to report to CMS the extent of their use of prior authorization and the rate of approvals or denial, was included in a package of healthcare legislation that passed the House Ways and Means Committee on July 26 and is headed to the full House for consideration. 

To read more, go to Becker’s Payer Issues.


ASA Opposes Cuts Related to Medicare E/M G2211 Payment Code

August 14, 2023

ASA has announced its opposition to the planned January 1, 2024, implementation of a Centers for Medicare and Medicaid Services (CMS)-created supplemental payment code for primary care services. The add-on code, G2211, will result in an extra Medicare payment on top of the payment for certain evaluation and management (E/M) codes.

CMS intends to implement the code in a budget neutral manner, which will result in offsetting cuts to Medicare payments for anesthesia, pain, critical care, and surgical services.

The implementation of G2211, which was previously delayed, was announced as part of the recently released Medicare Physician Fee Schedule proposed rule, the draft regulation setting Medicare payment rates for 2024. CMS explained that the code is intended to reflect ““visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition.”  The add-on may only be used in conjunction with office and outpatient E/M billing codes.

CMS has calculated that as much as 90% of the over 3% CMS proposed 2024 cuts to both the anesthesia and resource-based related value scale (RBRVS) conversion factors are the result of the budget neutral implementation of the add-on code.  

ASA has partnered with the American College of Surgeons and other key surgical stakeholders in urging CMS and Congress to again halt the implementation of G2211. 

To read more, go to ASA’s website.


27 States with Concerning Rates of Procedural Medicaid Terminations, per CMS

By Rylee Wilson | August 14, 2023

CMS warned 36 states they were not meeting federal requirements for Medicaid call center wait times, application processing timelines and rates of procedural terminations. 
On Aug. 9, the agency sent letters to Medicaid directors in all 50 states and the District of Columbia, evaluating states’ performance on Medicaid call center wait times and call abandonment rates, rates of procedural terminations, and the average wait time for applications to be approved. 

CMS warned Medicaid directors in 27 states and Washington, D.C. their rates of procedural terminations — Medicaid beneficiaries removed from the paper because of missing paperwork or other red tape, rather than being determined ineligible for the program — were too high. 

“While CMS recognizes the significant steps that states have taken to prepare for unwinding and [simplifying] renewal processes, we urge you to take further action to reduce the number of terminations for procedural reasons as quickly as possible by adopting strategies to increase ex parte renewal rates, to support enrollees with renewal form submission or completion, and to facilitate reinstatement of eligible individuals disenrolled for procedural reasons quickly,” Annie Marie Costello, deputy director of CMS’ Center for Medicaid & CHIP Services, wrote to state Medicaid directors. 

The letters used May unwinding data states reported to CMS. Several states did not report data to the agency or had not yet begun the process of redetermining Medicaid members’ eligibility in May. 

See the 27 states, go to Becker’s Payer Issues.


CMS Again Pauses Out-of-Network Billing Arbitration After Judge Sides with Providers

By Dave Muoio | August 7, 2023

The Centers for Medicare & Medicaid Services (CMS) has again suspended arbitration of out-of-network payment disputes between providers and payers due to a court order that the agency’s implementation of the No Surprises Act had run afoul of proper notice-and-comment procedure.

The decision stems from a Texas Medical Association (TMA) complaint filed in the U.S. District Court for the Eastern District of Texas back in January. The provider group argued that an increase in administrative fees from $50 to $350 that was implemented earlier that month was “arbitrary and capricious” and would curtail certain physician organizations’ ability to contest a health plan’s reimbursement offer.

The No Surprises Act gives payers and providers 30 days to settle any disputes on an out-of-network charge. If an agreement can’t be reached, both parties submit a preferred amount to a third-party arbitrator, which then chooses one—a process referred to as Independent Dispute Resolution (IDR).

CMS said its fee increase was necessary to cover expenses related to the arbitration process.
Additionally, TMA took issue with CMS’ updated requirement that joint consideration of multiple disputed items and services, a process referred to as “batching,” must be billed under the same or comparable code. The change, which CMS said was made to enable greater efficiency, would force providers to submit for multiple IDR processes, which, combined with the price hike would be prohibitive for certain providers, TMA argued.

In an order signed Aug. 3, Judge Jeremy Kernodle granted-in-part TMA’s motion for summary judgment. The court struck the higher fee and vacated and remanded three portions of the rule outlining the IDR process.

“In sum, the Court holds that the Departments improperly bypassed the [Administrative Procedure Act]’s notice-and-comment requirement in issuing the Fee Guidance and the September Rule’s batching regulations,” Kernodle wrote in the order. “The Court finds that vacatur of these rules is the proper remedy.”

TMA had also sought a refund of previously paid fees and an extension of the IDR deadline, though the judge ruled that the plaintiffs had not done enough to demonstrate that these were warranted under his court’s jurisdiction.

“While the court declined to provide deadline extensions and certain other requested relief, we remain pleased with the overall outcome,” TMA President Rick Snyder, M.D., said in a Friday release. “Yesterday’s decisions on batching rule provisions and administrative fees will aid in reducing barriers to physician access to the law’s arbitration process, which is vital to both patient access to care and practice viability.”

As a result of the decision, CMS wrote in an online notice that it has “temporarily suspended the Federal IDR process, including the ability to initiate new disputes until the Departments can provide additional instructions,” effective immediately.

To read more, go to Fierce Healthcare.


Texas Court Rules Against Government’s NSA Fee Increase and Batching Rules

August 4, 2023

Yesterday, the United States District Court for the Eastern District of Texas ruled in favor of the Texas Medical Association (TMA) in its challenge to the No Surprises Act’s $350 administrative fee and flawed batching rules.  

In the decision on “TMA IV,” the courts ruled that the government acted unlawfully when it unilaterally raised the independent dispute resolution (IDR) administrative fee from $50 to $350 for 2023 and established restrictive batching rules, both without following proper public notice and rulemaking processes.

ASA joined the American College of Emergency Physicians (ACEP) and the American College of Radiology (ACR) in and amicus brief filed in support of the TMA IV lawsuit. 

With the ruling, the IDR fee will return to $50 and the batching rules will be vacated until such time as the Departments can appropriately notify the public and permit stakeholders to comments on the two subjects.  The Departments may also choose to appeal this decision, as they did for TMA II.  

To read more, go to ASA’s website.


Your Patient’s Medicare Beneficiary Identifier (MBI) May Change

August 3, 2023

CMS sent letters to people with Medicare who may have been affected by a recent data breach. CMS is mailing approximately 47,000 new Medicare cards with a new MBI to those affected. Learn what to do if your patient’s MBI changes. 

Ask your patient for their new Medicare card if you get “invalid member ID” when checking Medicare eligibility. Access your Medicare Administrative Contractor’s secure internet portal to use the MBI look-up tool if your patient didn’t get a new Medicare card yet.

To read more, go to


35% of Medicaid Enrollees Say Their Health Plan Hasn’t Reached Out About Redeterminations: Survey

By Jakob Emerson | August 2, 2023

A large number of Medicaid enrollees, especially seniors, say their health plan has not reached out about how to renew coverage amid redeterminations, according to a new survey.
The survey was conducted by The Harris Poll on behalf of digital engagement platform Icario from July 18 to 20. The results were published July 31 and include responses from 957 Medicaid enrollees over 18.

Among all respondents, 35 percent said their health plan has not reached out about renewing coverage, and 55 percent of enrollees 65 and older said the same.

Among those that have heard from their health plan, 93 percent said they received appropriate information and the resources needed to complete the renewal process.

As of July 27, at least 3.79 million people have been disenrolled from Medicaid through the redeterminations process, according to KFF. Of those disenrolled, 73 percent are due to procedural reasons, rather than being determined ineligible for the program. 

To read more, go to Becker’s Payer Issues.

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