In 2024, major developments in insurance and healthcare policies have sparked significant changes affecting ASCs and physicians.
From shifts in anesthesia coverage to adjustments in Medicare Advantage plans and physician pay, here are five payer moves that shifted the industry in 2024:
1. Blue Cross Blue Shield Massachusetts had planned to no longer cover the use of monitored anesthesia for certain gastrointestinal patients undergoing endoscopic, bronchoscopic or interventional pain procedures, starting in 2024.
Monitored anesthesia would not have been considered "medically necessary" for these procedures by the insurer, unless a patient receives documentation by the operating physician or anesthesiologist/certified registered nurse anesthetist that specific risk factors or significant medical conditions are present. On Jan. 24, BCBSMA officially postponed the policy.
2. In September, Cigna Healthcare announced it would exit Medicare Advantage markets or make service area reductions in eight states for 2025. In total, 36 plans and about 5,400 members are impacted. The majority of the markets have low membership and alternative MA plans available, with the exception of four full county exits.
3. In November, CMS finalized a 2.83% physician pay cut in its 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System released. The physician fee schedule conversion factor for 2025 is $32.35, down from $33.29 in 2024.
4. On Dec. 5, Anthem Blue Cross Blue Shield of Connecticut, New York and Missouri reversed a controversial update to its anesthesia reimbursement policy. The policy update applied to procedures billed under CPT codes 00100 through 01999 and would have introduced a new reimbursement structure based on CMS physician work time values. Claims exceeding these predetermined time limits would have been denied.
5. Then, on Dec. 16, Kaiser Foundation Health Plan announced it had reversed an anesthesia reimbursement policy introduced in Washington state in November. The now-rescinded plan required anesthesia services to include specific modifiers identifying who performed the service for reimbursement. Additionally, the policy reduced payments for QZ services — those rendered by certified registered nurse anesthetists — to 85% of the physician fee schedule.