Anesthesiology Digest – November 2023

November 16, 2023

Anesthesiology Digest: News from November 2023.

US Senate Passes Stopgap Funding Bill to Avert Government Shutdown

By David Morgan and Moira Warburton | November 16, 2023

The U.S. Senate took the risk of an impending partial government shutdown off the table on Wednesday as it passed a stopgap spending bill and sent it to President Joe Biden to sign into law before a weekend deadline.

The 87-11 vote marked the end of this year’s third fiscal standoff in Congress that saw lawmakers bring Washington to the brink of defaulting on its more than $31 trillion in debt this spring and twice within days of a partial shutdown that would have interrupted pay for about 4 million federal workers.

The last near-miss with shutdown led to the Oct. 3 ouster of Republican U.S. House of Representatives Speaker Kevin McCarthy that left the chamber leaderless for three weeks.

But lawmakers have bought themselves just a little more than two months’ breathing room. The Democratic-majority Senate and Republican-controlled House of Representatives’ next deadline is Jan. 19, just days after the Iowa caucuses signal the start of the 2024 presidential campaign season.

To read more, go to Reuters.


Demand—and Pay—Keep Growing for Nurse Practitioners, Physician Assistants

By Dave Pearson | November 16, 2023

Advanced practice providers have enjoyed a raise in total cash compensation of 16% over the last five years.

That’s a sharper upward pay trajectory than physicians or nurses have seen over that period, according to the healthcare business consultancy SullivanCotter of Chicago.

In a survey report on APP compensation released Nov. 15, the firm says the pay growth has been consistent across all specialties.

The most common jobs in the APP category are nurse practitioner and physician assistant.

The survey includes information from 816 organizations representing more than 124,000 individual APPs and more than 3,400 APP leaders, SullivanCotter says.

Compared with 2022’s year-over-year data on the same healthcare workforce segment, which showed higher-than-normal growth in primary care and hospital-based specialties, SullivanCotter’s 2023 findings show primary care, medical and surgical specialties setting the pace at 5% each. Hospital-based APPs have seen their pay rise by a more modest 2.5% over the past year.

Looking at the three-year period 2020 to 2023, SullivanCotter finds “a continuing market demand” for all APPs.

During that window, median total cash compensation—typically base salaries plus annual performance bonuses—rose 13.0% for primary care APPs, 10.2% for medical, 9.4% for surgical, and 10.9% for hospital-based specialties from 2020 to 2023, the company reports.

Other findings of interest from the 2023 APP report:
 Consistent with the past several years, the demand for anesthesiology providers remains high, which continues to put upward pressure on compensation.Certified Registered Nurse Anesthetists (CRNAs) saw a 9.6% increase in median total cash compensation in 2023.In looking at the 3-year trends for CRNAs, median total cash compensation rose 15.6% from 2020-2023, and median hourly rates increased from $89.62 in 2020 to $102.91 in 2023.CRNAs top all APPs in annual pay, with median total cash compensation of $218,000, according to a review of SullivanCotter data by Becker’s Hospital Review.
To read more, go to Health Exec.


Ways and Means Committee Republicans Tell Administration to Follow Surprise Medical Billing Law

November 10, 2023

Republican members on the House Ways and Means Committee sent a joint letter to Administration officials highlighting issues with the implementation of the No Surprises Act, a law to address surprise medical billing. 

In the letter, the lawmakers call on the Administration to follow the law’s intent on implementing the legislation, specifically on transparency and ensuring a fair and balanced arbitration process. The letter was sent to Health and Human Services Secretary Xavier Becerra, Treasury Secretary Janet Yellen, and Acting Labor Secretary Julie Su and follows a September 19 Committee hearing that highlighted ongoing problems with the law’s implementation. ASA applauds the members of the House Ways and Means Committee for their ongoing efforts to increase transparency and ensure accountability on the government’s implementation of NSA.

The American Society of Anesthesiologists has been closely involved in efforts to improve the NSA and its implementation, with a focus on fixing the unreasonable qualifying payment amounts (QPA), removing overly restrictive batching rules and prohibiting insurers’ refusal to pay physicians who prevail in the dispute resolution process and other abusive insurer activities.  There are four separate lawsuits led by the Texas Medical Association of which ASA has been involved targeting unfair or inappropriate implementation of the law.

Read more about the ongoing NSA issues here.


ASA Joins 53 Other Organizations to Oppose Medicare Cuts

November 7, 2023

On Monday, November 6, the American Society of Anesthesiologists joined 53 other organizations representing physicians and other healthcare providers in a formal communication to Congressional leaders asking for action to stop a drastic Medicare payment cut based on the 2024 Medical Physician Fee Schedule final rule that was released November 2. These significant cuts will compound the financial strain anesthesia groups are already facing and harm seniors’ access to surgical care.
In the letter (PDF), the organizations ask for Congress to take action immediately to stop the full 3.4% cut in the absence of long-term reform to fix Medicare’s broken payment system.  Specifically, due to budget neutrality requirements, the majority of the cut is created by the decision to increase payments for primary care services through the creation of the new G2211 code – a special bonus payment for evaluation and management services in primary care services. 

While ASA acknowledges a desire for additional investments in primary care, these increases are being paid for by an across-the-board cut to surgical, anesthesia, pain, critical care, radiology and other non-primary care services.  It is imperative that Medicare patients have access to the full range of essential healthcare services.  
ASA is committed to advocating for changes to the broken Medicare payment system and ensuring that anesthesiologists and pain medicine physicians are paid fairly. In the meantime, ASA strongly urges immediately Congressional action to avert these steep cuts in 2024.
Please take action by sending a message to your lawmakers on the importance of stopping these drastic cuts.

To read more, go to


7 Prior Authorization Updates

By Andrew Cass | November 7, 2023

From UnitedHealthcare starting its second wave of cuts to lawmakers urging CMS to increase its oversight of artificial intelligence used in Medicare Advantage prior authorizations, here are seven updates on prior authorization Becker’s has reported since Sept. 18. 

1. CMS is proposing new health equity changes for prior authorization policies and procedures at Medicare Advantage organizations to better determine any disproportionate impact on underserved populations that may delay or deny access to services. 

2. A group of lawmakers is asking CMS to increase its oversight of artificial intelligence used in Medicare Advantage prior authorization. 

3. Blue Cross Blue Shield of Massachusetts is removing 14,000 prior authorization requirements for home care services for its 2.6 million commercial members beginning Jan. 1. 

4. The second and final wave of UnitedHealthcare’s prior authorization cuts began Nov. 1.

5. The Better Medicare Alliance is recommending a set of policies to Congress and CMS to improve prior authorization, behavioral health access, equity and more in the program. 

6. Blue Cross Blue Shield of Michigan intends to cut 20 percent of its prior authorization requirements. James Grant, MD, the payer’s senior vice president and chief medical officer, told Becker’s the changes are part of an evolving process. 

7. UnitedHealthcare and Cigna’s prior authorization cuts are steps in the right direction, but the American Medical Association is “careful not to confuse positive developments with major progress,” the organization’s immediate past president Jack Resneck, MD, said. 

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


Consumer Credit Scores Improve After Medical Debt is Wiped from Reports

By Victoria Bailey | November 6, 2023

After major credit bureaus stopped reporting medical debt collections less than a year old and less than $500, consumers saw improvements in their credit scores, according to data from the Urban Institute.

Medical debt can lead to financial challenges, especially when unpaid debt is sent to collections and winds up on consumer credit reports.

Medical debt does not accurately predict a person’s credit risk, as unpaid bills could reflect issues with understanding healthcare billing and reimbursement processes. However, having medical debt in collections could impact someone’s ability to get insurance, find a job, or rent a home.

Last year, three major credit bureaus—Equifax, Experian, and Transunion—announced that starting July 1, 2022, they would increase the time before past-due medical debt collection appears on a consumer credit report from six months to one year.

In August 2022, the Vantage score consumer credit model, one of the country’s most used models, stopped using medical debt in collections to calculate credit scores. Furthermore, in April 2023, the three major credit bureaus removed medical collections under $500 from consumer credit reports.

According to the Urban Institute’s credit bureau data, these changes have eliminated medical debt in collections from most consumers’ credit reports.

In August 2022, 11.6 percent of consumers had medical debt in collections on their credit reports. By August 2023, the share declined to 5.0 percent. Urban Institute researchers estimated that more than 15 million consumers have benefitted from the debt erasure in the past year.

Additionally, consumers’ credit scores have increased since the changes were implemented. Between August 2022 and August 2023, the average credit score among consumers with medical debt collections in August 2022 rose from 585 to 615 points. This shifted many consumers from a subprime level (below 600) to near prime level (between 601 and 660).

At the same time, the average credit score for consumers without medical debt on their records remained largely the same, going from 712 to 711 between August 2022 and August 2023.

These findings indicate that future medical debt reporting restrictions could continue benefiting consumers. The Consumer Financial Protection Bureau (CFPB) recently proposed a rulemaking process that aims to remove all remaining medical bills from consumer credit reports.

Additionally, two states have taken legislative action to address the issue. Colorado’s law banning medical debt from appearing on credit reports went into effect in August 2023, while New York’s law passed the state legislature in June 2023 and is currently being reviewed by the governor.

Although these policies may help consumers have better credit scores, they do not address the numerous other challenges accompanying medical debt, including the fact that consumers will still owe the debt to their healthcare providers.

Most hospitals, providers, and collection agencies can still sue patients for not paying medical bills. In addition, removing medical debt from credit reports may cause these entities to increase their efforts to receive upfront payments before delivering care, the report mentioned.

To read more, go to Revcycle Intelligence.


CMS Finalizes Deep Cuts to Medicare Payment in 2024

November 2, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) finalized its Calendar Year (CY) 2024 Medicare Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rules. Within the fee schedule, CMS finalized cuts to the Anesthesia Conversion Factor that will only compound the financial strain that anesthesiologists are facing. Unless Congress acts to fill the gap, anesthesiologists will face significant Medicare payment cuts beginning on January 1.

The payment cuts underscore how the Medicare payment system is broken. ASA continues to engage legislative stakeholders and work across multiple medical specialties to minimize and reverse these cuts prior to the end of the year.

Fee Schedule Provisions:

The 2024 anesthesia conversion factor (CF) will be $20.4349, representing a decrease of 3.27% from the 2023 anesthesia CF of $21.1249. The 2024 RBRVS CF is $32.7442. This represents a decrease of 3.37% from the 2023 CF of $33.8872.

The CFs will affect physician payments in several ways:

– This negative adjustment also results from a statutorily mandated budget neutrality adjustment to account for changes in work Relative Value Units (RVUs). This means spending in one year needs to be balanced by reductions and CMS cannot increase or decrease expenditures by more than $20 million without triggering automatic budget neutrality adjustments.

– Unfortunately, CMS finalized the use of G2211 for the 2024 payment year. CMS previously noted that approximately 90 percent of the negative adjustment that anesthesiologists and other physicians would face is attributable to the new bonus payments for office and outpatient Evaluation and Management (E/M) codes. ASA opposed this code, noting that it is duplicative of work already accounted for by existing codes and will inappropriately result in overpayments for some physicians at the expense of payments for other important services.

To read more, go to


Medicaid Disenrollments Top 10 Million

By Rylee Wilson | November 2, 2023

More than 10 million people have been disenrolled from Medicaid since continuous coverage requirements ended in April, according to KFF. 

In April continuous coverage requirements put in place during the COVID-19 pandemic ended, and states began redetermining Medicaid beneficiaries’ eligibility for the program for the first time since March 2020. 

As of Nov. 1, at least 10,046,000 people had been disenrolled from Medicaid coverage, according to KFF. Of those disenrolled, 71 percent had their coverage terminated for procedural reasons, rather than being determined no longer eligible for the program. 

Disenrollment stats vary widely by state. In Texas, 65 percent of individuals up for renewal have had their coverage terminated, while just 10 percent of individuals up for renewal in Illinois have lost their coverage. 

Texas has the largest number of disenrolled individuals, at 1.2 million, according to KFF. States have 12 months to complete the Medicaid unwinding process. Four states began in April, with most states beginning in June or July. 

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

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