Message from the ASA President

Good afternoon,

As many of you read in my November 11 Monday Morning Outreach, Anthem has proposed a policy change for its plans in Connecticut, Missouri, and New York to withhold payments for documented anesthesia time that exceed a new, arbitrary Anthem-mandated time for anesthesia services. Not only are they proposing to use an unreliable and unvalidated Centers for Medicare & Medicaid Services Physician Work Time Value data set, Anthem (also known as Elevance) erroneously announced that the policy will "not change industry standard coding requirements or the American Society of Anesthesiologists' (ASA) anesthesia formula" in their announcements.

That is flat out ridiculous.

Unfortunately, Anthem's latest attack on anesthesia payments-and the patients who hold Anthem policies-demonstrate its lack of concern for our health care system and the greater good. The proposed Anthem policy reflects a significant disconnect between Anthem, its patients, and their needs.

On Tuesday, I sent a letter to the President of Anthem as well as their Chief Health Officer requesting an urgent meeting. The letter detailed multiple issues with such a policy change, including how the policy will cut off anesthesia payments when a patient may need anesthesia services the most-for necessary care that exceeds Anthem's arbitrary anesthesia time limits, when complications arise, or when other surgical and patient circumstances demand continued vigilance and action by an anesthesiologist.

The proposed policy does not contemplate how individual anesthesia codes may apply to different surgical procedures with correspondingly wide variations in surgical time. The policy betrays patient agency and safety on the part of Anthem. In effect, if a patient has a surgery which lasts longer than the standards mandated by Anthem, Anthem has absolved itself of responsibility to pay for the anesthesia that is needed for the rest of the encounter.

The policy change is wrong on so many levels.

ASA will be working with the state component societies on this matter. There are many ways anesthesiologists can draw attention to this flawed policy, especially by communicating your concerns with your hospitals and among your fellow physicians. In the coming weeks, we'll provide additional recommendations on how best to engage and what we all can do to push back on this policy.

For those who do not live in those states, please be vigilant with your contracts and pay attention to these schemes to reduce your payments. Please contact [email protected] to offer your time to fight back against this proposed policy change and other payment issues.

Donald Arnold, MD, FACHE, FASA
President, American Society of Anesthesiologists