Starting in February, the latest limits by Anthem Blue Cross Blue Shield on anesthesia will be based on pre-defined times for various surgeries in Connecticut, New York, and Missouri-a move that has outraged physicians-particularly the anesthesiologists-who see such a move as increasing harm to patients and bureaucratic layers associated with delivering care.
The insurer-which-argues that the policy will prevent overbilling and make healthcare more affordable-argued that the guidelines mirror those from the American Society of Anesthesiologists. The company also does not believe that the guidelines would impact maternity-related care or pediatric patients under the age of 22, because those groups represent variable needs.
However, the American Society of Anesthesiologists countered that it was an arbitrary and injurious policy and should be rescinded forthwith. The practice of anesthesia often requires flexibility by providers in the event of complications or during cases that are considered complex. Limiting reimbursement to longer anesthesia times may constrain providers.
Implications for Patient Safety and Care
Those opposing Anthem’s decision argue that surgical procedures are never this simple. The time taken for anesthesia normally depends on the condition of the patient, the nature of the surgery, and complications arising during the surgery. This strict imposition of time negates these variables and could affect the quality of care.
Analysts further stress that the process of anesthesia billing is highly detailed, with automated mechanisms and minute-by-minute time tracking, hence reducing any possibility of overbilling. Thus, this becomes a contradiction to the reason stated by the insurer. The policy could create undue stress for patients and anesthesiologists. For the patients, it introduces uncertainty about the coverage, thus possibly eroding trust at critical moments. For anesthesiologists, it creates administrative burdens, taking that away from patient care.
Administrative Burdens and the Effect on Industry
Health-care providers feel that the new Anthem policy would increase the disputes arising in the claim. Insurance company provide exceptions through the disputes; the dispute will require more resources, which could essentially drive up the administrative costs, which defeat a very important aim of health-care cost containment.
Anesthesiologists also warn of possible long-term effects on healthcare efficiency. Systems issues in operating rooms call for comprehensive solutions-not policies that take a piecemeal approach to particular aspects, such as anesthesia duration.
Broader Industry Reactions
The outrage over Anthem’s policy underlines larger frustrations within the healthcare industry regarding the increased influence that health insurers are having on medical decision-making. Many providers feel these decisions too often put cost-cutting ahead of patient welfare.
Going forward, these tensions can only be resolved through a collaboration of insurers, medical professionals, and policy makers to ensure that cost-efficiency measures do not undermine patient care.
