American Society of Anesthesiologists Urges Congress to Act to Fix Broken Medicare Payment System

CHICAGO – The American Society of Anesthesiologists (ASA) announced it has provided no-nonsense solutions to members of the U.S. House of Representatives, on behalf of the Society’s 56,000 members, outlining ways to fix the broken Medicare physician payment system and improve the Quality Payment Program. The formal communication stresses the need for Congress to take action to ensure that anesthesiologists and other clinicians can be fairly paid for the care they provide to the important Medicare patient population and to implement reforms that create real opportunities to successfully participate in Medicare quality programs.

ASA’s letter, dated Oct. 31, 2022, is in response to a congressional request seeking information on the effectiveness of Medicare Access and CHIP Reauthorization Act (MACRA) and recommendations for how best to “keep our patients safe and our workforce strong.” ASA is concerned that continued declines in Medicare payment will have a devastating impact on anesthesiologists’ practices, while the country continues to struggle with the COVID-19 pandemic, evolving variants, rising inflation, health care worker burnout, staffing shortages, and regulatory requirements that increase administrative burden on practices. The letter supports patching the proposed 2023 cut to the Anesthesia Conversion Factor, waiving the 4% PAYGO sequester, and providing inflationary support to physician practices.

“For anesthesiologists and pain medicine physicians, the Medicare physician payment system is especially unsustainable. Current Medicare payment rates for anesthesia are less than 33% of commercial payment rates,” said ASA President Michael W. Champeau, M.D., FASA. “Without congressional action, anesthesiologists and their groups may be facing a combined 10% payment cut to their 2023 Medicare payments. Congress must add additional resources to the Medicare payment system to support reasonable payment rates.”

The letter also highlights that the passage of MACRA has not fulfilled its promise to pay for health outcomes or to transform how improved patient quality and care can result in more stable payments to physicians and their groups. Anesthesiologists and their groups have participated in the MACRA Quality Payment Program for nearly five years and the highest performing groups have only received about a 2% bonus for their work. ASA recognizes that there simply is not a financial return on investment for groups to participate in Merit-based Incentive Payment Systems (MIPS) and, oftentimes, successful participation in the program can still result in overall negative costs. Significant reforms, including additional resources, are needed. 

In the letter, ASA recommends that Congress extend the exceptional performance bonus for MIPS participants, reward MIPS participants who exceed the performance threshold but fall short of the exceptional performance bonus, and encourage the Centers for Medicare & Medicaid Services (CMS) to provide a better pathway for MIPS participants to join Alternative Payment Models (APMs). Likewise, ASA supports the continuation of the 5% bonus for APM participation and requests Congress ensure that APM incentives are equitably divided among members of the patient’s care team.

About the American Society of Anesthesiologists
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook and follow ASALifeline on Twitter.

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