|  The Anesthesia Brief · Issue #10 If you're thinking it, we're talking about it. By Marc Smith, DNP, CRNA & Shantall Ruiz Cummins, DNP, CRNA Six things worth knowing today. Let's get into it. | Delaware says same anesthesia, same pay, no exceptionsYou do the same case, the same drugs, the same monitor, the same outcome, and the insurer still pays less because the claim says CRNA instead of MD. Delaware just made that illegal. The governor signed HB435 on August 31, after it passed both chambers unanimously, 41 to 0 in the House and 20 to 0 in the Senate. Individual, group, state employee, and Medicaid plans in Delaware can no longer set a lower reimbursement rate for a service just because a CRNA provided it instead of a physician.
This isn't an opt-out fight. Opt-out is about who signs off on the anesthesia plan. This is about what you get paid once the case is done, and a unanimous, bipartisan vote says the pay gap wasn't actually controversial once lawmakers looked straight at it.
Watch whether Delaware's payers actually comply once the law takes effect, and watch which state's CRNA association picks this fight up next. Our take is at the bottom of this issue ↓ | Payer audit warning, CT, NY, MOAct This Week: If you bill anesthesia in Connecticut, New York, or Missouri, pull your last few cases and check your documented time units against the actual chart. Anthem and Elevance are auditing anesthesia time against CMS physician work-time values in those three states right now, and claims that run over the allotted minutes are getting denied. Tighten your documentation before a denial finds you first. | $20.4976 the 2026 Medicare rate a state law can't touch That's the federal Medicare conversion factor for anesthesia in 2026, up just 0.88% from last year. After CMS's RVU rebalancing, the real-world impact nets out closer to a 1% cut, and that's the one gap a state law like Delaware's can't touch: Medicare rate-setting sits with Congress, not a state legislature.
Here's why that matters. The same case, run by the physician down the hall, gets reimbursed off this exact conversion factor. So the fight now isn't just, can you practice fully. It's, are you paid the same as the physician doing the identical case next door? Watch whether that question follows Delaware's law into other states. → Find your state on the map |
| Only two bills actually movedDelaware's HB435, signed August 31, bars insurers from paying a CRNA less than an anesthesiologist for the same anesthesia service. In Congress, the Medicare Access to Rural Anesthesiology Act (HB9642) is still active, aimed at Medicare reimbursement and access to anesthesia care at rural facilities. Nothing else moved on scope this week. → Full scope tracker + your state | Six drugs went tight at once● Etomidate● Sufentanil Citrate● Ropivacaine● Remifentanil● Lorazepam● Hydromorphone Etomidate, sufentanil citrate, ropivacaine, remifentanil, lorazepam, and hydromorphone all went newly tight in the last two weeks. If any of these are your go-to for induction or a block, confirm with pharmacy now and have your substitute and dose ready before you're mid-case. → Full shortage list | The nociception monitor proof gapA monitor that claims to guide your opioid dosing only matters if acting on it changes what the patient feels, and that's still the open question with objective nociception, or pain, monitoring. Nearly 700 papers since 2020 show the index tracks pain reasonably well, the harder proof, that dosing off it beats standard vigilance, hasn't landed yet. → Tech watch | What Delaware's law actually means for youWe think the real test of Delaware's law isn't in Delaware. It's in whatever state you're licensed in right now. A bill that already survived a unanimous vote is the easiest version of that fight to have, you're not asking your state association to gamble on something untested, you're asking them to copy something that already worked. If HB435 isn't on your own association's agenda yet, that's a real question worth asking at the next meeting, not a hypothetical one.
It matters at your own negotiating table too. Every time a payer or a facility has justified a lower rate by pointing at your credentials instead of the care you actually delivered, Delaware's legislature just went on record disagreeing with that logic, in a statute, unanimously. That doesn't rewrite your contract by itself. But it's a real precedent to bring into the room the next time that conversation happens. | - Marc & Shantall All episodes · Blog · Rate Calculator | Legislative data, LegiScan & OpenStates (CC BY 4.0). Drug shortage data, ASHP / openFDA. Federal regulatory data, FederalRegister.gov (public domain). Compensation, Marit Health, BLS, AANA. You're receiving this because you subscribed to The Anesthesia Brief. | |
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