On July 1, UnitedHealthcare issued a policy update that will cut reimbursements for independently practicing certified registered nurse anesthetists by 15%, effective Oct. 1.
The update has drawn criticism from the American Association of Nurse Anesthesiology, who told Becker’s that the policy will have damaging effects to healthcare cost and access at a time when anesthesia providers are already under pressure from staffing shortages and increasing demand.
“It benefits the insurance companies and their bottom line — who it doesn’t benefit are the patients,” Janet Setnor, MSN, CRNA, president of the AANA, told Becker’s.
A white paper from Medicus Healthcare Solutions suggests the negative consequences of this policy will be amplified in rural and underserved communities, many of which rely heavily on CRNAs for perioperative care. The paper found that 75% of CRNAs reported practicing without physician oversight, as of 2023. Additionally, CRNAs now account for over 80% of anesthesia providers in rural counties and administer more than 50 million anesthetics annually in the U.S., according to the report.
“Hospitals and ASCs are going to have to absorb the higher cost for dealing with possible staffing shortages, which we’re already facing with anesthesia,” she said. “It’s extremely concerning, and this is discriminatory toward independent CRNAs. Independent CRNAs are the ones who are mainly providing care in rural hospitals, underserved and critical access areas. This could result in longer travel time for patients, canceled procedures, surgical delays … there’s a bunch of things this could negatively affect.”
The policy is specifically targeted toward anesthesia services appended with the QZ modifier, meaning CRNAs working independently and “legally working at the top of their license,” according to the AANA. Ms. Setnor said this is in direct conflict with the federal non-discrimination provision of the ACA, which prohibits payers and health plans from discriminating against providers on the basis of licensure.
In September 2024, the AANA filed a petition for a writ of mandamus in a federal court in Ohio, asking the court and the secretary of HHS to enforce this nondiscrimination provision against payers in the case of CRNA reimbursement cuts.
“The training that CRNAs get is equivalent to that of our physician colleagues,” Ms. Setnor said. “We come to the practice of anesthesia through nursing, and they come through the school of medicine. However, once we enter into the training, we use the same textbooks, the same equipment, the same medications. And at graduation, CRNAs have close to 10,000 clinical hours prior to taking their boards, and we are expected to practice to the same standards of care as our physician colleagues. To decrease our reimbursement by 15% is extremely discriminatory.”
Furthermore, Ms. Setnor said the policy update will also negatively impact physician anesthesiologists and practice owners.
“It totally exacerbates the provider shortage that we’re experiencing right now for all anesthesia providers — it’s not just CRNAs that we’re short of. It’s our physician colleagues as well,” she said. “This is the time when we need all hands on deck, where health equity and discrimination concerns need to be eliminated, and we need to provide that type of support for the CRNAs who are providing the care in a majority of cases.”
Given that the policy’s effective date is still months ahead, Ms. Setnor said there is still time for a reversal, but for now, AANA strongly condemns the policy.
“It’s just unconscionable. The reimbursement policy actually prioritizes the profits of their company over patients, and patients and patient safety should always come first,” she said. “It’s just shameful, absolutely shameful.”
In a statement emailed to Becker’s, a UnitedHealth spokesperson said that the 15% reduction in reimbursement aligns CRNA pay with how other independent advanced practice providers are reimbursed, and even suggested the reduction could save plan members’ out-of-pocket costs.
“Healthcare affordability is one of the most pressing challenges Americans are facing today. We are committed to being a responsible steward of our customers’ and members’ healthcare dollars,” the statement reads. “These changes are designed to help ensure claims are paid accurately and fairly, helping to control rising healthcare costs without affecting the quality of anesthesia services our members receive. In many cases, members may even see a reduction in their out-of-pocket expenses.”
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