Effective October 1, UnitedHealthcare implemented a 15 percent cut in reimbursement for claims submitted for services provided by a Certified Registered Nurse Anesthetist (CRNA). The American Association of Nurse Anesthesiology (AANA) condemned UnitedHealthcare’s decision and called the new policy discriminatory in a news announcement on October 1.
AANA has urged the Administration to enforce federal provider nondiscrimination laws, specifically calling on the Secretaries of the Department of Labor (DOL), Health and Human Services (HHS), and the Department of the Treasury (IRS) to investigate and intervene with commercial payers who violate provider nondiscrimination, a stance supported by nine other healthcare organizations and patient advocacy groups. The letter writers highlighted that patients and facilities throughout the country, particularly those in rural areas, rely heavily on the care delivered by CRNAs.
Healthcare Innovation recently spoke with AANA’s President Jeff Molter, MSN, MBA, CRNA, about why UnitedHealthcare’s policy is unlawful and a threat to patient access.
What are the consequences of UnitedHealthcare’s new policy?
The QZ billing modifier is a policy that is completely discriminatory. It violates federal law. There's a non-discrimination piece in the Affordable Care Act (ACA) that says you cannot discriminate against providers based on their education and training. UnitedHealthcare is essentially violating this non-discrimination law.
There are going to be a lot of consequences. CRNAs are the majority of anesthesia providers in America. We deliver the majority of anesthetics to communities nationwide. We ensure safety, value, and quality care for everybody. There are many hospitals, surgical centers, dental offices, oral surgical offices, and rural facilities that rely on CRNAs, and this 15 percent cut in reimbursement to CRNA-only care is going to affect the bottom lines of those facilities. It's really going to put many facilities at risk of closing. These facilities already operate on razor-thin margins. Many of them are already operating in the red, and this is only going to make it worse for facilities and patients.
What do you think is behind this new policy?
Hundred percent greed; it’s about money. UnitedHealthcare stands to make more than $400 million extra by cutting reimbursement to CRNA care. It's really a money grab by UnitedHealthcare.
Could this policy still be turned around?
I believe the federal government, if it enacted the law, could turn this around. We're calling on HHS Secretary Kennedy to enact and enforce the law that was already created. We do have a lawsuit that we filed in federal court last year. The case was dismissed by the judge, but we are appealing that.
I believe they will revisit it. I'm not sure what the odds are of them compelling the government to take action. Nevertheless, I believe that we have a really good case of provider discrimination. CRNAs, we deliver care just as effectively as physician anesthesiologists. We do not give 15 percent less care. We work to the same standard of care as physician anesthesiologists; therefore, cutting our pay by 15 percent or our reimbursement by 15 percent is complete discrimination.
What is the potential impact on patients?
It absolutely has an effect on patients because it puts facilities in rural communities at risk of closing. It's going to affect possible access to care.
What do you foresee will happen?
I'm hoping that UnitedHealthcare reverses its discriminatory policy. If they don't, I would like to see the federal government take action and enforce the law.
Is this policy unique to UnitedHealthcare?
Cigna insurance, about a year and a half ago, enacted a policy like this. We knew that if the federal government did get involved, other insurance companies would follow. Anthem has also followed, and Medical Mutual has followed. United is one in a long list, but it is a major power player in the health insurance industry. They could possibly profit an extra $400 million by cutting a 15 percent reimbursement to CRNA care.
CRNAs deliver high-quality care across America. We're the number one anesthesia providers, and we serve rural communities and offices. We're going to continue to provide that care. It's just unfortunate that our services are being devalued, devalued illegally, by UnitedHealthcare.
