Insurers Set to Ignore Sicker, More Complex Patients Starting July 15

A Disturbing Example of Insurers Putting Profits Over Patients

CHICAGO – The American Society of Anesthesiologists (ASA) calls on Aetna and Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas to reverse their profit-driven plans to cease payments for anesthesia care provided to sicker, more complex patients based on the ASA Physical Status Classification System (ASA PS). Beginning July 15, Aetna and August 14, Blue Cross Blue Shield plans will no longer take into consideration the unique health status of each patient when it comes to anesthesia care payment. 

“For years, Aetna and these Blue Cross Blue Shield plans have recognized the additional expertise and resources necessary to care for complex patients. We are surprised and disappointed that these insurance companies have taken this unwarranted action as a way to grow their profits,” said ASA President Ronald L. Harter, M.D., FASA.

By arbitrarily removing modified payments for complex patients, insurers are breaking with a meaningful trend in health care – that patient care be individualized. More efficient care can occur because of advanced patient preparation and planning as well as enhanced care coordination that anesthesiologists provide for the most medically complex patients. The ASA PS has been used since 1941 to classify patients’ overall health status prior to a procedure or surgery and has consistently been shown to be a predictor of anesthetic risk. 

For over 80 years, anesthesiologists have used the ASA PS classification system to describe and assess a patient’s preoperative status, existing diseases and medical conditions to determine the additional resources and medical expertise needed to care for the complex patient. From the ASA PS determination, the Anesthesia Care Team uses that information to determine the specific anesthesia care plan for that patient, appropriate personnel and setting to care for the patient intraoperatively and postoperatively, and the resources needed to optimize patient outcomes.

The physical status classification system begins with a healthy, normal patient or “ASA 1.” An ASA 2 is a patient with mild systemic diseases like high blood pressure, hypothyroidism, or pregnancy. An ASA 3 is a patient with severe systemic disease like poorly controlled high blood pressure, morbid obesity, active hepatitis or with an implanted pacemaker. An ASA 4 is a patient with severe systemic disease with a constant threat to life like a stroke, significant coronary artery disease, or end-stage renal disease.  An ASA 5 is a person at the point of death from severe trauma, multiple organ failure or similar diagnoses. An ASA 6 patient is one who is declared brain-dead whose organs are being removed for donor purposes.

“Insurers disregarding the needs of medically complex patients flies in the face of basic health care, in which a physician assesses a patient’s symptoms and conditions and creates a plan to treat the patient based on that assessment. One size definitely does not fit all,” said Dr. Harter. “It’s shameful that insurers are padding their profits at the expense of payments for those providing important care to complex patients.” 

With older and more complex patients undergoing an increasing number of surgical procedures, in both inpatient and outpatient settings, the impact of this policy change on health systems, hospitals and anesthesia practices is substantial and will affect patient access to an appropriate level of care, and limit opportunities to improve care coordination. ASA urges Aetna and Blue Cross Blue Shield plans to consider the impact of this policy change on patients, especially those with multiple diseases. Insurance companies must ensure patient access to anesthesia care that is safe, effective, and recognizes individual patient needs. 
 

About the American Society of Anesthesiologists
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with nearly 58,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook and follow ASALifeline on X.

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