CNN
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Anesthesiologists are concerned about an insurance company’s plan to cap the cost of anesthesia during surgeries and procedures. A large professional group of anesthesiologists is calling for an immediate reversal of the “unprecedented step,” calling it outrageous and uninformed.

Starting in February, Anthem Blue Cross Blue Shield insurance, which represents Connecticut, New York and Missouri, will deny all claims for anesthesia services that exceed certain deadlines set for surgeries and procedures.

Anthem said the change is part of an effort to make health care more affordable by reducing overbilling for anesthesia.

“At Anthem, we strive to make healthcare easier and more affordable,” the company said in an email to CNN. “One way to achieve this goal is to ensure that claims are accurately coded and providers receive fair compensation for the services they provide to members. Improper coding drives healthcare costs higher than they otherwise would be.”

The company said the standards it uses to determine how long a surgery takes are consistent with industry standards and formulas from the American Society of Anesthesiologists. Excluded from this change are obstetric care and pediatric services for patients under age 22 because the time needed for surgeries and procedures varies more for these groups, Anthem said.

However, the American Society of Anesthesiologists has called for an immediate reversal of that policy, saying Anthem has set an “arbitrary time limit” on surgeries that jeopardizes individual patient care.

“With this new policy, Anthem will not pay anesthesiologists to provide safe and effective anesthesia care to patients who may require special attention because their surgery is difficult or unusual, or because a complication occurs,” the organization said in a press release.

Anesthesiologists say Anthem’s new policy reflects a major misunderstanding of how things work in the operating room and places a significant undue burden on doctors and patients.

Dr. Gordon Morewood, vice chair of the American Society of Anesthesiologists’ Economic Committee, recently attended a meeting between the society and Anthem executives.

He said experts tried to explain how anesthesia billing works — that a given billing code could be used for nearly 200 different procedures, leading to wide variations in how long anesthesia lasts — and found that Anthem doesn’t review the claims but have done so. There is no evidence that a problem needed to be fixed.

“It is a cynical exercise to first find a way to deny further claims, knowing that some of them will simply go away and never be paid,” Morewood said.

Experts say it would be extremely difficult for anesthesiologists to bill for unnecessary time, particularly in the operating room, where many detailed time stamps are captured and using automated electronic health records.

Any additional time under anesthesia is usually related to ensuring that patients are cared for safely, e.g. B. to ensure a safe airway, or to respond to physiological changes that may occur due to surgery, e.g. B. Blood pressure or respiratory changes, said Dr. Rick van Pelt, board-certified anesthesiologist and chief clinical transformation officer at the University of Alabama at Birmingham Hospital.

“This approach (by Anthem) reflects a profound lack of understanding of the role of the anesthesiologist in providing safe, high-quality care to patients as an integral member of the surgical care team,” he said. “While no anesthesiologist would intentionally compromise the care they provide, it is inevitable that unwarranted time pressures increase the risk of adverse medical events and patient harm.”

Anesthesiology is often one of the biggest fears for surgical patients, and the added uncertainty about insurance coverage threatens confidence at a vulnerable moment, said Morewood, who is also chair and professor of clinical anesthesiology at Temple University’s Lewis Katz School of Medicine. Reassuring patients about insurance concerns can result in less time spent explaining the risks and benefits of actual medical care.

“You often meet your anesthesiologist on the day of the operation. And yet this is someone who you are literally putting your life in the hands of. You are responsible for your continued existence on this planet in one hour, two hours, six hours. So it’s a very charged environment,” he said. “It’s just unconscionable for insurance companies to say, ‘Okay, the meter is empty after an hour and a half’.”

For surgeries and procedures that require more time than specified by Anthem, providers may file a claim dispute. But that puts an even greater burden on the “army of people” working for providers to deal with the “paper war” with insurance companies, Morewood said — and that added burden impacts health care costs rather than trying to shorten anesthesia times.

“Health care offers numerous opportunities to improve quality, safety and efficiency. “The care environment is complex and there is a general lack of understanding of the interconnected systems that contribute to the problem,” van Pelt said. “Original efficiency cannot be achieved by treating a single component, and we know that working faster is not a sustainable solution.”