Tariq Naseem, MD, anesthesiologist and interventionist at Los Angeles-based Smidt Heart Institute, joined Becker's to discuss the changes needed to the anesthesia reimbursement model.
Editor's note: This response was edited lightly for clarity and length.
Question: What changes would you like to see in regard to anesthesia reimbursements?
Dr. Tariq Naseem: So the most important thing would be that at a federal level, especially with the Medicaid office, they have to reevaluate the anesthesia reimbursements. It is so bad, something like $0.33 on a dollar, and it's impractical to do that. If institutions were paying anesthesiologists like that, every operating room would just shut down. And the way that is now being dealt with, fortunately or unfortunately, is that they're being paid for value. And while that makes sense, it does not align with what the federal and insurance standards are. This is where CMS really needs to get its act together. This has been going on for a while, and still every year we see cuts in physician reimbursements. The reimbursements absolutely make no sense with reality. It's just not practical.
And it has already become a value-based thing because it was always true that you needed an anesthesiologist to run the perioperative machine of any institution, but because they were always available, it was never a problem. For the first time we're realizing that without anesthesiologist, the entire perioperative machinery comes to a halt. And for most institutions, by that I mean hospitals and medical centers, I wouldn't be wrong if I said 30% to 40% of revenue comes from the perioperative production line — operating rooms, catheterization labs, gastrointestinal suite, interventional radiology, interventional neuroradiology, anywhere procedures being placed.
I think this is so important for the overall safety of our patients. Because the problem is that eventually people will need care, anesthesiologist corners will get cut and patients will suffer. That's the part that scares me the most. I'm also an intensivist, so I do a lot of critical care medicine, and it's always the subtle things that I see. Patients aren't going to die on the operating table, but it's the little things — his ICU stay will get extended or a patient will get 80% as good of care. Nothing really can be pointed to one person, but overall the patients will start suffering. That's the part I'm worried about.