Anthem drops controversial new plan to cap anesthesia coverage after backlash(usatoday.com)
usatoday.com
Anthem drops controversial new plan to cap anesthesia coverage after backlash
https://www.usatoday.com/story/news/health/2024/12/05/anesthesia-policy-anthem-bcbs/76796002007/
38 comments
An Anesthesiologist does not determine the duration of an operation. It depends on the type of operation, how sick the patient is and how fast or slow is the surgeon. Anesthesiologist provides anesthesia for the full duration of the surgery. You cannot blame an anesthesiologist for a surgery than runs extra two hours because surgeons need extra time. It makes no sense.
They were going to still pay for longer than normal procedures. It was just that it would have to be shown than the overtime was medically necessary.
The time they were going to allow before justification was required is the same time the Medicare uses for deciding how much to pay.
The time they were going to allow before justification was required is the same time the Medicare uses for deciding how much to pay.
> was just that it would have to be shown than the overtime was medically necessary.
And then the insurance paid medical adjudicators will find it "not medically necessary". And the vicious cycle continues -- deny, delay, defend.
And then the insurance paid medical adjudicators will find it "not medically necessary". And the vicious cycle continues -- deny, delay, defend.
"don't worry, we were going to screw over a different innocent victim, not you, so we're cool right?"
This type of post is better suited for Reddit.
Something to keep in mind is healthcare providers are the main drivers of healthcare costs. The insurance company was not going to tell the doctor how long to put you under only how much time they would pay for.
I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties.
Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not seem proportional to the work they do. I mean they do some calculations for the amount of drugs to put you to sleep and then monitor your vitals. Seems like something a responsible and well-trained nurse could do.
I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties.
Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not seem proportional to the work they do. I mean they do some calculations for the amount of drugs to put you to sleep and then monitor your vitals. Seems like something a responsible and well-trained nurse could do.
This is not an informed perspective. Anesthesiologists are some of the most highly trained physicians in a hospital.
Human physiology is complicated and on the surface, any job can seem simple if you have no understanding of what is happening. While a large portion of the time, the surgeries go smoothly, sometimes it doesn’t and it can go downhill fast. In that moment, you want an anesthesiologist that can quickly and thoroughly think through a patients medical history, what drugs they’re on at home, the current surgery, variant anatomy, what drugs they’ve given so far, etc to decide on the correct next drug to give or action to take. That takes training and experience.
Human physiology is complicated and on the surface, any job can seem simple if you have no understanding of what is happening. While a large portion of the time, the surgeries go smoothly, sometimes it doesn’t and it can go downhill fast. In that moment, you want an anesthesiologist that can quickly and thoroughly think through a patients medical history, what drugs they’re on at home, the current surgery, variant anatomy, what drugs they’ve given so far, etc to decide on the correct next drug to give or action to take. That takes training and experience.
The assertion that physicians are a primary driver of excess US healthcare costs requires evidence.
See here https://www.commonwealthfund.org/publications/issue-briefs/2...
Physician salaries are a driver, but the far bigger portion lies with insurance’s take, and the administrative costs required to respond to insurance shenanigans.
See here https://www.commonwealthfund.org/publications/issue-briefs/2...
Physician salaries are a driver, but the far bigger portion lies with insurance’s take, and the administrative costs required to respond to insurance shenanigans.
Anesthesiology average salaries
US: $438k/yr Australia: $203k/yr UK: £112k/yr
That seems like a big difference to me.
US: $438k/yr Australia: $203k/yr UK: £112k/yr
That seems like a big difference to me.
This report, linked in a vox article a sibling post, comes to the opposite conclusion.
https://www.healthsystemtracker.org/brief/what-drives-health...
It calculates US's spending on healthcare to be 87% higher than "Comparable Country Average", and attributes only a 10 percentage point of the price increase to "administration" costs, as opposed the report you linked which estimates 30 percentage points.
https://www.healthsystemtracker.org/brief/what-drives-health...
It calculates US's spending on healthcare to be 87% higher than "Comparable Country Average", and attributes only a 10 percentage point of the price increase to "administration" costs, as opposed the report you linked which estimates 30 percentage points.
I don't understand why the insurance company is the one to decide when and how to cap the costs. If a doctor says I need X drug or Y procedure the insurance company shouldn't be allowed to just deny paying for it simply because they want to pad their margins. I have had doctors prescribe a certain drug for me, insurance denies it, then they switch me to something else which they say is inferior because it might cause other issues/side effects but that's what I have to do if the first option won't be covered. If someone smashes into the passenger door of my car can my car insurance company just say they don't feel like paying for it because I can still get into the car through the driver side?
Sure premiums will go up, but the conversation should then shift to why does a 15 min ambulance ride cost $5,000 instead of fighting about whether or not an insurance company is going to cover it.
Sure premiums will go up, but the conversation should then shift to why does a 15 min ambulance ride cost $5,000 instead of fighting about whether or not an insurance company is going to cover it.
>I don't understand why the insurance company is the one to decide when and how to cap the costs.
Because the insurance company is basically the only entity who has skin in the game.
>Sure premiums will go up, but the conversation should then shift to why does a 15 min ambulance ride cost $5,000 instead of fighting about whether or not an insurance company is going to cover it.
And the response if this is all covered would be "who cares? my insurance is covering it anyways". The patient doesn't have any incentive to choose a cheaper hospital, because he won't see any of the savings.
Because the insurance company is basically the only entity who has skin in the game.
>Sure premiums will go up, but the conversation should then shift to why does a 15 min ambulance ride cost $5,000 instead of fighting about whether or not an insurance company is going to cover it.
And the response if this is all covered would be "who cares? my insurance is covering it anyways". The patient doesn't have any incentive to choose a cheaper hospital, because he won't see any of the savings.
This is a straw man argument. Yes they shouldn't deny a prescription if your doctor says you need it.
What I'm talking about is capping the costs of a supporting doctor for a surgical procedure. From my quick research, there is no significant cost basis for surgery running longer than planned besides the anesthesiologist's time. So the doctor would make $400k instead of $500k per year.
Here is some perspective. The anesthesiologist's bill for my wife's colonoscopy in 2023 was $2k. This is a routine procedure that takes less than an hour. Also, the place was just filled with patients and there was one guy handling them all.
What I'm talking about is capping the costs of a supporting doctor for a surgical procedure. From my quick research, there is no significant cost basis for surgery running longer than planned besides the anesthesiologist's time. So the doctor would make $400k instead of $500k per year.
Here is some perspective. The anesthesiologist's bill for my wife's colonoscopy in 2023 was $2k. This is a routine procedure that takes less than an hour. Also, the place was just filled with patients and there was one guy handling them all.
I agree. I'm just saying that instead of reducing healthcare costs by having insurance companies deny necessary procedures and medications seemingly randomly, there should be serious regulations capping healthcare costs. Generally speaking I am against any form of government-set price controls, but healthcare costs are so completely out of control that I don't know of any other way to deal with it. It's also a unique situation where the customer has no way of shopping around for a competitor - if you're having an emergency, your only choice is the nearest hospital - they should not be taking advantage of that situation and making you pay through the nose.
Remove / equalise the reasons that it makes sense for your employer to control your insurance provider. It was an act of government that caused it in the first place.
ACA needs 2 sequels before anything resembling a market can emerge.
ACA needs 2 sequels before anything resembling a market can emerge.
Everyone is free to buy whatever insurance they want. But they won't be able to pay for it with pre-tax income like their employer is able to.
It's an explicit pro-big business tax policy that hurts businesses that aren't big enough to afford the paperwork and HR involved with administering insurance and other benefits, and also to prevent people from being able to easily compare compensation offers from various employers.
It's an explicit pro-big business tax policy that hurts businesses that aren't big enough to afford the paperwork and HR involved with administering insurance and other benefits, and also to prevent people from being able to easily compare compensation offers from various employers.
Just passing along some heresay here... I'm not fit to judge but this thread does have some support if trying to reel in anesthesiologist billings. Second hand report of an anesthesiplogist being in support of BCBS trying to limit unneeded expenses.
https://bsky.app/profile/nemoblue.bsky.social/post/3lcllzxje...
The problem is that the proposed solution made no sense. If the surgery is taking longer than expected, that is not something driven by the anesthesiologist. And yet the proposal would be complicating the billing/payment relationship of the anesthesiologist & the patient. Meanwhile the actual surgeon is not at all affected.
There is a specific type of nurse called a CRNA that is basically a replacement for anesthesiologists. And half the nurses I know are going to school for that. It seems like hospitals and insurers want to replace the MD here.
> I mean they do some calculations for the amount of drugs to put you to sleep and then monitor your vitals. Seems like something a responsible and well-trained nurse could do.
https://xkcd.com/793/
Are there any countries in the world where they've replaced anesthesiologists with nurses? What's the data on outcomes for that look like?
https://xkcd.com/793/
Are there any countries in the world where they've replaced anesthesiologists with nurses? What's the data on outcomes for that look like?
I'm guessing they were worried someone might die
Just how is the U.S. healthcare system so broken that this can even be considered? It sounds like some dystopian fiction.
The profit margin of anthem insurance is ~5%. The profit margin of all state insurance is ~7%.
The us health INSURANCE system is not hugely profitable. as care costs go up, the insurance deductible/premium must also go up or the amount of services covered needs to decrease.
The way to fix this is to fix the system. Lower Doctor pay, lower drug cost, showing pricing up front, allowing medical suicide, removal of middle-parties, ..etc all would allow the Us to get more care for money they spend.
Also do realize the U.S. doesn’t have healthCARE but health INSURANCE. Insurance is geared towards covering unexpected large cost events. Americans use their health insurance as health care.
The us health INSURANCE system is not hugely profitable. as care costs go up, the insurance deductible/premium must also go up or the amount of services covered needs to decrease.
The way to fix this is to fix the system. Lower Doctor pay, lower drug cost, showing pricing up front, allowing medical suicide, removal of middle-parties, ..etc all would allow the Us to get more care for money they spend.
Also do realize the U.S. doesn’t have healthCARE but health INSURANCE. Insurance is geared towards covering unexpected large cost events. Americans use their health insurance as health care.
Given that a lot of the reoccurring is not just for emergency coverage but standard healthcare services and purchases. It might also be interesting if there was an investing account that you could withdraw from tax free to use for those types of things. This might minimize some of the incentive to lean on your employment and insurance as a middle man for this.
Elevance Health (aka Anthem) has a profit margin of 3% to 4% most years:
https://www.macrotrends.net/stocks/charts/ELV/elevance-healt...
It is funny to see discussions about managed care organizations earning too much money on a forum where most presumably work for businesses that earn 20%+ profit margins.
Although, this doesn’t take away from the fact that MCOs have been getting away for too long with criminal prior authorization practices that waste a lot of people’s time (and health). But I bet fixing this would involve spending a lot more on labor, which people also would not like (higher premiums/deductibles/taxes).
https://www.macrotrends.net/stocks/charts/ELV/elevance-healt...
It is funny to see discussions about managed care organizations earning too much money on a forum where most presumably work for businesses that earn 20%+ profit margins.
Although, this doesn’t take away from the fact that MCOs have been getting away for too long with criminal prior authorization practices that waste a lot of people’s time (and health). But I bet fixing this would involve spending a lot more on labor, which people also would not like (higher premiums/deductibles/taxes).
> It is funny to see discussions about managed care organizations earning too much money on a forum where most presumably work for businesses that earn 20%+ profit margins
Hilarious!!! Or it would be, if making margins by denying lifesaving care, weren't totally different from making margins on a bag of juice.
Hilarious!!! Or it would be, if making margins by denying lifesaving care, weren't totally different from making margins on a bag of juice.
Why is that relevant? The important piece of information is operating a business at low profit margins is hard (obviously because a zero or negative profit margin is a charity and not a business).
People working for software companies with enormous lock in pricing their products (and we can talk about Epic healthcare software’s profit margins here) complaining about profits earned by businesses under much more competitive pressure is funny, because they obviously would have no better solution than what the executives of the business barely eking out a profit are doing.
And on top of that, all insurance pricing has to be approved by the government.
The conclusion is only that people like to complain. They complain about high premiums/deductible, they complain about prior authorizations, they complain about fraud, they complain about denied coverage.
And then they will still choose to purchase from the company offering the lowest premiums.
People working for software companies with enormous lock in pricing their products (and we can talk about Epic healthcare software’s profit margins here) complaining about profits earned by businesses under much more competitive pressure is funny, because they obviously would have no better solution than what the executives of the business barely eking out a profit are doing.
And on top of that, all insurance pricing has to be approved by the government.
The conclusion is only that people like to complain. They complain about high premiums/deductible, they complain about prior authorizations, they complain about fraud, they complain about denied coverage.
And then they will still choose to purchase from the company offering the lowest premiums.
> Why is that relevant?
Thank you for asking. I would be happy to help you understand here.
The answer to your question is: The important piece of information is that people should not be denied lifesaving care just to increase or maintain margin. Thus, someone who does the former is bad, and someone who criticizes a bad person is totally okay in doing so.
Compare to marking up a bag of juice at 100%, which is also totally okay because you aren't effectively killing people by doing so. Thus, no contradiction exists.
To dig even deeper: because a life is worth more than the markup on a bag of juice. A thousand bags of juice marked up 100% would be morally better than denying lifesaving care just to increase margins 1%.
> people like to complain
This type of commentary is better suited for Reddit.
Thank you for asking. I would be happy to help you understand here.
The answer to your question is: The important piece of information is that people should not be denied lifesaving care just to increase or maintain margin. Thus, someone who does the former is bad, and someone who criticizes a bad person is totally okay in doing so.
Compare to marking up a bag of juice at 100%, which is also totally okay because you aren't effectively killing people by doing so. Thus, no contradiction exists.
To dig even deeper: because a life is worth more than the markup on a bag of juice. A thousand bags of juice marked up 100% would be morally better than denying lifesaving care just to increase margins 1%.
> people like to complain
This type of commentary is better suited for Reddit.
>The important piece of information is that people should not be denied lifesaving care just to increase or maintain margin.
So you want a business to go out of business? This discussion is not about whether or not the government should pay for everyone's healthcare, no matter the cost. The American public has already decided that should not be the case, and there should exist a business that adjudicates whether or not an appropriate amount of healthcare and cost is being distributed.
>This type of commentary is better suited for Reddit.
Not really. The root of the issue is that the American public wants something it cannot afford (or at least wants it for themselves but not for others). This manifests as nonsensical complaints about the entity that earns the lowest profit margins. The MCO raises the premium/deductible, complaints. The MCO denies coverage, complaints. And this will actually go all the way back to an untenable population histogram where fewer and fewer young people will be bled to support more and more old people.
So you want a business to go out of business? This discussion is not about whether or not the government should pay for everyone's healthcare, no matter the cost. The American public has already decided that should not be the case, and there should exist a business that adjudicates whether or not an appropriate amount of healthcare and cost is being distributed.
>This type of commentary is better suited for Reddit.
Not really. The root of the issue is that the American public wants something it cannot afford (or at least wants it for themselves but not for others). This manifests as nonsensical complaints about the entity that earns the lowest profit margins. The MCO raises the premium/deductible, complaints. The MCO denies coverage, complaints. And this will actually go all the way back to an untenable population histogram where fewer and fewer young people will be bled to support more and more old people.
> So you want a business to go out of business?
I didn't say that. They can raise premiums, or they can decide that being in a position where you effectively kill people for profit isn't a great place for a company to operate, and abdicate to the government. Either way, profiting off death you contribute to, is generally a Bad Thing. Based off the UHC CEO's murder and the reactions to it, it seems I am not the only one who thinks this.
> This discussion is not about whether or not the government should pay for everyone's healthcare
Actually, that's precisely one of the options I'm discussing! :)
Point being, pointing out "this is hard for a corporation to do and still make money" doesn't excuse the badness of profiting off your contributions to killing people. Like maybe don't do it as a corporation if it's so hard?
> The American public has already decided that should not be the case, and there should exist a business that adjudicates whether or not an appropriate amount of healthcare and cost is being distributed.
Have they? I must have missed that individual question was explicitly on the ballot as you describe.
I didn't say that. They can raise premiums, or they can decide that being in a position where you effectively kill people for profit isn't a great place for a company to operate, and abdicate to the government. Either way, profiting off death you contribute to, is generally a Bad Thing. Based off the UHC CEO's murder and the reactions to it, it seems I am not the only one who thinks this.
> This discussion is not about whether or not the government should pay for everyone's healthcare
Actually, that's precisely one of the options I'm discussing! :)
Point being, pointing out "this is hard for a corporation to do and still make money" doesn't excuse the badness of profiting off your contributions to killing people. Like maybe don't do it as a corporation if it's so hard?
> The American public has already decided that should not be the case, and there should exist a business that adjudicates whether or not an appropriate amount of healthcare and cost is being distributed.
Have they? I must have missed that individual question was explicitly on the ballot as you describe.
Pricing up front is a start. Hospital overbilling is probably a bigger issue than doctor pay. They have billing departments equivalent to a corporation’s team of accountants, but instead of paying no tax, their mission is to maximize what you’ll pay. Procedure costs vary wildly, and hospitals will often bill for a doctor’s time when an NP or technician did the work.
The government itself is who came up with the anesthesia guidelines and what the government will and will not pay for if someone’s healthcare is paid by the government (Medicare/Medicaid/etc):
https://www.cms.gov/files/document/chapter2cptcodes00000-019...
But that is one the purposes of the managed care organizations (MCOS, aka health insurers). They take the heat off the politicians for reducing quantity and quality of healthcare, because pay has been going down for 10+ years for doctors.
In the UK, it is easy for people to blame the government for long wait times or less credential provider, since the government is directly offering it. But US leaders are in a better position, they can cut remuneration via myriad billing code changes and prior authorization policies, and people’s eyes will glaze over before they get to the end of this paragraph.
https://www.cms.gov/files/document/chapter2cptcodes00000-019...
But that is one the purposes of the managed care organizations (MCOS, aka health insurers). They take the heat off the politicians for reducing quantity and quality of healthcare, because pay has been going down for 10+ years for doctors.
In the UK, it is easy for people to blame the government for long wait times or less credential provider, since the government is directly offering it. But US leaders are in a better position, they can cut remuneration via myriad billing code changes and prior authorization policies, and people’s eyes will glaze over before they get to the end of this paragraph.
Any sensible thing can be discarded in the name of freedom. Any improvement is communism.
Additionally, according to Vox,
> Critically, contrary to Sen. Murphy’s claims, this policy would not have saddled patients with surprise bills, if their operations went over time. The burden of this cost control would have fallen on participating anesthesiologists
https://www.vox.com/policy/390031/anthem-blue-cross-blue-shi...