November 16, 2020

There is nothing more unsettling than not knowing.  That is especially true where the information being withheld is critical to your interests, to your wellbeing.  It’s one thing to be unable to find the box scores relating to your favorite sports team or to be forced to wait until next season to see what happens in the most binge-worthy television series (think Stranger Things).  These are reasons for nervous impatience, to be sure.  However, it’s a whole other matter to spend weeks or months worrying about whether you’re going to lose ground as it pertains to your financial security.  Real life involving real uncertainties—that’s the state that anesthesiologists and anesthetists find themselves in mid-autumn 2020. 

Anxious Moments

You’ll recall that some months ago we published an alert concerning the 2021 Medicare Physician Fee Schedule (PFS) Proposed Rule.  The Rule, as proposed, caused quite a stir in the anesthesia community due to its indication that the Centers for Medicare and Medicaid Services (CMS) intended to substantially cut Medicare reimbursement for anesthesia services to the tune of 10 percent.  In response, many of our readers fired up their laptops and fired off their comments to Medicare, seeking a rescinding of these payment reductions.  The American Society of Anesthesiologists (ASA) also expressed their displeasure with Medicare’s intention and has continued to implore the agency to reconsider their proposal.

Would all this lobbying and cajoling and letter-writing from America’s anesthesia community have any effect on policymakers in Washington?  That was something we were supposed to find out two weeks ago, as the PFS Final Rule typically comes out the first of November.  That was not to be the case in 2020.  The year that has brought so much uncertainty to so many in our specialty has continued its unpredictable ways.  According to multiple sources, the current target date for the release of the 2021 PFS Final Rule is December 1, 2020.  That means more nail biting and more floor pacing for a fortnight.  As the late Tom Petty once reminded us, “the waiting is the hardest part.”

It doesn’t help matters much when one adds to this uncertainty over reimbursement rates the further uncertainty caused by the resurgence of COVID in recent weeks.  Becker’s Hospital Review reported on November 12 that 29 hospitals were postponing or canceling elective procedures due to the increase of the virus in their locales.  Some hospitals have discussed retaining elective surgeries in the outpatient setting only in order to free up more inpatient beds for potential COVID cases.  Each day brings new circumstances and new decisions for hospital executives. 

All this cannot help but to generate a certain exasperation and not a few questions.  How long will this scourge continue?  What effect will it have on Q4 reimbursement levels?  Will my facility once again limit elective surgery volumes?  What will be the effect of potential new policies coming out of the nation’s capital in 2021?  With so much up in the air and so much at stake, many are reaching a breaking point.  So, this may be a good time to issue a brief note of reassurance.

The contention of this article is that the next few weeks may be trying but not beyond our clients’ capacity to overcome.  When uncertainty abounds, hold on to that which is certain; and, here, we’re not referring to death and taxes, or anything else that has a negative connotation.  Rather, hold on to those things that are immovable in your life, that provide motivation and meaning.  Incomes may rise and fall; public policies may come and go; but who you are at your core is what counts.  We, at the MiraMed family of companies, are honored to serve individuals who have dedicated their lives to the easing of physical pain.  This is a high calling and is what drives our clients to continue on in spite of the inconstancy of this current period.

Reason to Be Hopeful

Our readers not only are able to draw encouragement from their own deep well of resolve, they can retain a real measure of hope that things will turn out okay.  After all, in the many years we’ve reported on the proposed versus the final conversion factors (CFs)—whether the general RBRVS CF or the anesthesia-specific CF—we have seen instances where a proposed decrease in a CF was actually increased when the final rule was published.  Accordingly, there is a precedent for CMS changing its stated intention to reduce reimbursement rates.  Precedents count—in both jurisprudence and regulatory rulemaking. 

There is further reason to remain hopeful that CMS will be willing to change its planned 10-percent reduction in the anesthesia CF for 2021.  The ASA is reporting that U.S. Reps. Ami Bera, MD and Larry Bucshon, MD, along with a bipartisan group of more than 200 members of Congress, sent a formal letter to leaders of the U.S. House of Representatives, urging action to address the proposed payment cuts.  The letter urged House leaders to “explore possible solutions to address the Medicare payment cuts many medical specialties, including hospital-based specialties, will face beginning January 1 if Congress does not act before the end of the year.” 

The president of the ASA, Beverly K. Philip, MD, FACA, FASA, praised the efforts of this group of representatives, stating “We are grateful for this action by a bipartisan coalition in Congress, and hope that leadership will take action to end the outdated mandate for budget neutrality and instead create stability and support for health care providers on the front lines.”

There is also reason to be cautiously optimistic (to use the old chestnut) about the future of case volumes in the coming year.  As of this writing, the federal government has announced the development of a COVID-19 vaccine that purportedly has a 90-percent efficacy rate.  CMS has indicated that it intends to make the vaccine available at no cost to certain population groups.  If this vaccine turns out to be safe and reliable and is accessed by a sufficient number of Americans, our long COVID nightmare may soon be over.  This, in turn, should allow hospitals and other facilities to increasingly devote space and resources to all case types, including elective procedures.

We realize this alert is equal parts information and inspiration, and sometimes that is exactly what the doctor ordered.  All of us need a word of encouragement from time to time, especially when uncertainty saps our energy and tests our patience.  As your business partner, we will be there for you to ensure you get the most out of your practice.  If you have a comment or question, please contact your account executive or reach out to us at info@anesthesiallc.com.

With best wishes,

Tony Mira
President and CEO