Compounding financial pressures are threatening the stability of anesthesia practices across the country. In a May 1 Coronis Health blog post, Justin Vaughn, vice president of anesthesia compliance at Coronis, details these challenges — underscoring that while each issue alone may seem minor, together they represent a sustained, systemic decline in professional reimbursement.
Below are six of the most urgent and widespread challenges highlighted:
- Declining Medicare conversion factors
Anesthesia conversion factors under the Medicare Physician Fee Schedule have steadily decreased over the past two decades. While other specialties saw modest increases or temporary relief via congressional action, anesthesia rates continue to fall — creating a structural imbalance that undercuts compensation for critical care delivery.
- Limited gains despite hospital-based care
Although many anesthesia groups operate in hospital or ASC settings, professional fees have not kept pace with institutional payment increases. Providers remain locked out of inflation-adjusted gains that benefit facilities, leaving them with less financial leverage even as service complexity rises.
- Reduced payments for GI and cataract procedures
High-volume services like colonoscopies and cataract surgeries — historically stable sources of revenue — are seeing cuts. For GI cases, payers have tightened definitions of medical necessity and reduced base unit values. In ophthalmology, the ASA’s alignment with Medicare base units for cataract cases has triggered widespread reductions across commercial payers.
- Administrative burden and denial risk are growing.
Anesthesia billing teams report a rising tide of documentation requirements, authorization rules and creative denials. Even straightforward claims often require appeals, slowing payment timelines and increasing operational overhead.
- Reimbursement threats from the No Surprises Act
The implementation of the No Surprises Act has reshaped anesthesia contracting. Payers are lowering or terminating in-network agreements, knowing that median in-network rates now determine out-of-network reimbursement. The result: tighter margins and less flexibility for independent groups.
- Erosion of time-based billing practices
Changes in how payers count anesthesia time, such as excluding line placement or postoperative pain block time from the total, have chipped away at unit totals. These micro-adjustments compound quickly across high-volume cases, reducing overall reimbursement without a corresponding drop in workload.
The blog warns that without proactive strategy, these challenges could destabilize independent anesthesia groups — particularly those already operating under slim margins or in competitive payer markets — and encourages anesthesia leaders to engage with professional societies and stay closely attuned to evolving payer policies in order to safeguard their financial viability.
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