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    New House Health Reform Bill Offers Low Medicare Payment Rate for Anesthesia

    By Phil Miller, contributor

    The implications of the health care reform bill that emerged from the U.S. House of Representatives in mid-July, christened H.R. 3200, the “Americans Affordable Health Choices Act,” are still being sifted, but one aspect of the bill seems clear: the bill would perpetuate and expand Medicare’s payment level for anesthesia services.

    This is one aspect of the bill to which the American Society of Anesthesiologists (ASA) has taken particular exception.

    On July 15, the ASA released a position statement on H.R. 3200 that lauded the bill for some of the delivery reforms it would mandate, including expanding access to insurance for those with no coverage. However, the statement then indicated that “much to the disappointment of ASA, the bill contains provisions expanding Medicare’s flawed payment level for anesthesia services.”

    At issue is the new government-sponsored insurance plan called the “public health insurance option” that would be implemented through H.R. 3200. The public plan would be the principal mechanism for providing those currently uninsured with affordable coverage. However, costs would be born to a significant extent by physicians because payment for medical services under the public plan would be based on Medicare rates.   As ASA points out, Medicare provides an “unacceptably low” anesthesia conversion factor, a payment level calculated to be only 33 percent of commercial/private insurance levels.

    The ASA is urging members to write their Congressional representatives and to relay to them two messages about the proposed bill:

    1. It would be unsustainable for the medical specialty of anesthesiology to operate with a public plan option based on Medicare payment rates.

    2. Payment levels for anesthesia services proved through the new “public health insurance option” must be fixed.

    The ASA is encouraging members to act while the Senate considers pending health reform bills that also include the public plan option.

    The issue of physician payment has been seen as a vital one since then Senator Obama began floating the concept of a new public plan during the Presidential campaign.  It has been observed by physician groups and other concerned parties that a public plan could only provide extended coverage through widespread physician participation.  Due to low reimbursement and problematic collections procedures, many physicians already have been compelled to drop patients on existing publicly supported plans, such as Medicare and Medicaid.  

    A survey of some 12,000 physicians conducted by physician search firm Merritt Hawkins & Associates on behalf of the Physicians Foundation, a physician advocacy group, asked physicians if they have had to close their practices to any category of patient due to reimbursement issues.   Fifty-three percent of physicians answered yes.  Of these, 34 percent have closed their practices to Medicare patients and 12 percent have closed their practices to Medicaid patients.  

    Should a significant number of physicians decline to participate in a new public plan, newly insured patients could have access to healthcare in name only, the Physicians Foundation survey suggests.   Complete results of the survey can be viewed at

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