You refer to Anthem walking back its decision to charge anesthesiologists according to Medicare standards (average time of procedure, rather than recorded time). I agree that the timing of the new policy announcement (if not the policy change itself) was probably influenced by the recent murder and public reaction.
But I’m not convinced this is actually a positive thing.
Notice that word in my previous paragraph: Medicare. One of the promises of single‐payer healthcare like Medicare is to lower bloated procedure costs by having a powerful, unified negotiator (the government) on the side of the patient. The fact that Medicare charges anesthesia this way seems to be an intentional example of this.
Is cutting costs here justified? Obviously it would be unjustified if the anesthesia were necessary. On the other hand, it would be justified if the anesthesia charges didn’t actually reflect the cost of the procedure. Personally, I don’t assume Medicare is in the business of maliciously cutting necessary healthcare to lower costs (the “death panels” argument famously put forth by Sarah Palin), at least not without evidence. So what does the evidence show? Well, it’s easy to find stats saying recorded anesthesia procedure times are considered unreliable, that an unusual number of procedure times are measured in round numbers, that the unusual procedure times are consistently and significantly longer than average procedure times, and suggesting (though not proving) fraud on the part of anesthesiologists and doctors.
The main group I’ve seen advocating against BCBS following Medicare’s charging rules has been the American Society of Anesthesiologists. Which makes sense—of course anesthesiologists would be against policies that decrease their pay. (By the way, the mean anesthesiologist salary in the US is $340,000 per year. https://www.bls.gov/oes/2023/may/oes291211.htm) This walkback is a great PR victory for them.
Insurance companies are, of course, evil grifters. They have incentive to lower costs by cutting necessary care. But this particular policy is copied from Medicare, which doesn’t have the same incentives as an insurance company. Part of the dysfunction of the US health care system is that our procedure costs are unreasonably high. That doesn’t come from insurance companies and Medicare, it comes from doctors and hospitals. We can’t paper over that.
You refer to Anthem walking back its decision to charge anesthesiologists
according to Medicare standards (average time of procedure, rather than
recorded time).
Medicare reimburses anesthesia providers for the entire time the patient was under anesthesia. This is captured by time units. Anthem was planning to implement a hard cap based on Physician Work Time which is entirely different. In essence Anthem is weaponizing Medicare in an attempt to deflect blame.
You're right, I misunderstood how Medicare covers anesthesia. But the GAO report you shared strengthens Anthem's argument: they pay far more for anesthesia compared to Medicare, a sign that the providers are overcharging. And the stats about unreliability of recorded procedure times are still compelling.
Or a sign that private insurance companies are too burdensome. UHC is well known both for constantly changing the claims process and for preemptively denying valid claims. Arguably private insurance companies need to pay more because they are a significantly bigger hassle to deal with than Medicare and require a legion of support staff.
Notice that word in my previous paragraph: Medicare. One of the promises of single‐payer healthcare like Medicare is to lower bloated procedure costs by having a powerful, unified negotiator (the government) on the side of the patient. The fact that Medicare charges anesthesia this way seems to be an intentional example of this.
Is cutting costs here justified? Obviously it would be unjustified if the anesthesia were necessary. On the other hand, it would be justified if the anesthesia charges didn’t actually reflect the cost of the procedure. Personally, I don’t assume Medicare is in the business of maliciously cutting necessary healthcare to lower costs (the “death panels” argument famously put forth by Sarah Palin), at least not without evidence. So what does the evidence show? Well, it’s easy to find stats saying recorded anesthesia procedure times are considered unreliable, that an unusual number of procedure times are measured in round numbers, that the unusual procedure times are consistently and significantly longer than average procedure times, and suggesting (though not proving) fraud on the part of anesthesiologists and doctors.
• https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
• https://pmc.ncbi.nlm.nih.gov/articles/PMC6324364/
The main group I’ve seen advocating against BCBS following Medicare’s charging rules has been the American Society of Anesthesiologists. Which makes sense—of course anesthesiologists would be against policies that decrease their pay. (By the way, the mean anesthesiologist salary in the US is $340,000 per year. https://www.bls.gov/oes/2023/may/oes291211.htm) This walkback is a great PR victory for them.
Insurance companies are, of course, evil grifters. They have incentive to lower costs by cutting necessary care. But this particular policy is copied from Medicare, which doesn’t have the same incentives as an insurance company. Part of the dysfunction of the US health care system is that our procedure costs are unreasonably high. That doesn’t come from insurance companies and Medicare, it comes from doctors and hospitals. We can’t paper over that.