In November, Kaiser Permanente announced it would require specific modifiers to identify anesthesia providers for reimbursement under its Washington health plans, causing alarm for ambulatory surgery center (ASC) operators and stakeholders, many of whom are struggling amid a national anesthesiologist shortage.
Additionally, the reimbursement rate for QZ services performed by Certified Registered Nurse Anesthetists (CRNAs) was to be reduced to 85% of the Physician Fee Schedule.
QZ is a billing modifier used in anesthesia services, which indicates that the service was performed by a CRNA working independently, without supervision by a physician anesthesiologist.
Yet many operators and stakeholders said they rely on CRNAs to administer anesthesia.
“This new anesthesia reimbursement policy will devastate healthcare delivery as it impedes access to healthcare for patients, especially in rural and underserved areas and directly conflicts with the existing federal provider nondiscrimination law for commercial health plans,” The American Association of Nurse Anesthesiology (AANA) said in a statement when the decision was first released.
However, after drawing backlash from the industry, the decision was rescinded within 72 hours. Similarly, Anthem’s recent plan to cap anesthesia coverage was also quickly reversed after industry blowback.
“While we will continue our focus on keeping care affordable for our members, we will not implement changes in reimbursement rates for anesthesia services provided by Certified Registered Nurse Anesthetists,” Kaiser Permanente told ASC News in an email. “We have returned to previous reimbursement rate levels, retroactive to November 1, 2024.”
The rapid reversal of Kaiser’s policy is an encouraging recognition of the critical role that all anesthesia providers, both physician anesthesiologists and CRNAs, play in patient care, Dr. Josh Lumbley, chief quality officer at NorthStar Anesthesia, told ASC News.
Lumbley attributed Kaiser’s initial decision to a broader trend among payers seeking cost-saving measures, often without fully understanding their downstream effects.
“This was a decision that was made purely to define cost savings,” he said.
The swift reversal highlighted the power of stakeholder advocacy and the recognition of anesthesiology’s integral role in safe, efficient patient care, he added.
“There was some negative feedback and backlash from the respective specialty societies,” Lumbley said. “Similarly, I think there was also a recognition that anesthesiologists and nurses play a critical role in taking care of patients in ambulatory surgery centers, delivering safe anesthesia care.”
Specifically, the use of differential rates based on QZ modifiers, a key focus of the Kaiser proposal, posed a threat not only to anesthesia providers but also to the broader operational stability of ASCs, Lumbley said.
“This move might have an untoward effect in reducing access to safe anesthesia care and, frankly, put an undue burden on ambulatory surgery centers, the surgeon owners, and potentially the patients,” he said.
Using the QZ modifier for anesthesia is appropriate for lower-complexity cases with minimal sedation needs, provided patients are carefully selected and undergo thorough pre-anesthesia testing to ensure they are optimized for the ASC environment, Lumbley said.
“There are environments where utilizing or deploying the QZ modifier with nurse anesthetists is safe, efficient, and the right choice,” he said.
Still, similar payer-driven proposals are likely to resurface, as reimbursement cuts tend to remain a focus across specialties for insurers, Lumbley said. Yet what the industry needs is collaboration.
“We don’t want to be antagonistic,” he said. “We aim to work with payers to ensure decisions support patient safety and access to care while addressing efficiency and quality.”
