Medicare just showed its hand on your 2027 pay

The Anesthesia Brief  ·  Issue #6

If you're thinking it, we're talking about it.

By Marc Smith, DNP, CRNA & Shantall Ruiz Cummins, DNP, CRNA

Eight things worth knowing before today's first case. Let's get into it.

Medicare just showed its hand on your 2027 pay

Every anesthesia case you do gets scored in units. The case itself has a base value, every 15 minutes in the room adds more, and Medicare pays by multiplying your total by one dollar figure, the conversion factor. On July 16, CMS published the proposed rule that sets that figure for 2027. Strip the jargon away and that is what this document is, the federal government naming the price of a unit of your work.

Two things stood out to us. First, the messaging gap. CMS is pitching the rule as transformational reform that modernizes physician payment. Becker's, the trade publication hospital executives read, looked at the same document and called it a difficult reality that continues. When the agency writing the checks says reform and the people billing under it say another lean year, we trust the billers. Second, you do not have to bill Medicare yourself for this to reach you. The hospitals and groups that pay you do, and when one of their biggest payers holds the line on rates, that squeeze finds its way into staffing budgets and contract offers.

The part that matters this week, it is a proposal, not a final rule, and the public comment window is open until September 14. Congress is circling the same question too, a bill called the Medicare Access to Rural Anesthesiology Act moved in the House this week. Washington is deciding what anesthesia is worth. The open question is whether working CRNAs are in the room while it does.

Our take is at the bottom of this issue ↓

Tell Medicare what your work is worth

Quick translation if the last section still felt like another language. When a federal agency like Medicare wants to change what it pays, it cannot just do it. It has to publish the plan first, then give the public a set period to respond, and by law it has to read those responses and answer them before the plan becomes final. That response period is open right now, and it closes September 14.

So here is the whole move. The button below takes you to the official posting of the plan. Click Submit a Formal Comment and write what you see from inside an actual OR, plain English works. Say what you do, what a typical Medicare case looks like, and what happens to anesthesia access at your facility if pay keeps sliding. No legal language, five sentences is enough. Every comment becomes part of an official file the government has to answer, and a thin file reads as no objection. Comments from real clinicians are the hardest thing in that file to ignore.

The background check that cannot see everything

Picture a hire that looks completely fine. A provider lost their license in the spring, one state over, documentation case, nothing criminal, no headlines. That summer a facility runs its standard pre-hire check against the federal exclusion list and the name comes back clean. Everybody moves on. A year later the exclusion finally posts, and now every dollar that facility billed on that provider's cases is exposed. Nobody ran the check wrong. The check just cannot see paperwork that has not been filed yet.

That gap exists because two different systems can end a career in this field, and they run on their own clocks. Your state board controls the license, whether you can practice at all. The federal exclusion list, kept by the Office of Inspector General, the OIG, controls the money, whether Medicare or Medicaid will pay for anything you touch. The board moves first. The federal side catches up on paper months later, sometimes more than a year later.

So, depending on which side of the table you sit on:

• Credentialing someone? A clean check of the OIG's List of Excluded Individuals and Entities, the LEIE, is not a clean license history. The list lags the boards, call the state board directly.
• The one under investigation? Handing in your license does not stop the federal clock. An exclusion lands on a surrender the exact same way it lands on a revocation.

And we will keep saying this part, because it stays true, it is almost never the clinical error that ends a career, it is the cover-up. If something feels off, for you or for somebody in your room, there is confidential help before any of this starts. AANA Peer Assistance Helpline, 800-654-5167, free, 24/7.

→ More on protecting your license

One federal bill moving, two states holding

Congress just picked up a bill called the Medicare Access to Rural Anesthesiology Act, HR 9642. It started moving in the House on July 15, and it is about how Medicare pays for anesthesia in rural hospitals. Here is why that matters. In many rural hospitals the CRNA is the entire anesthesia department, so whatever this bill does to rural anesthesia payment, CRNAs feel it first. We have not read the full text yet, so we will not guess at what is inside. The moment it posts, we will break it down in plain English.

Two state bills stay in play with no new movement this week:

• New York S3820 would require insurers to cover anesthesia for the entire duration of a procedure a practitioner ordered, not a clock-defined slice of it.
• Oklahoma HB2298 is still moving, independent prescriptive authority for APRNs who meet the requirements.

The standing rule applies everywhere, state law is the ceiling, your facility decides whether you actually practice to it.

→ Full scope tracker + your state

Three familiar names back on the list

The churn did not slow this week, remifentanil, bupivacaine, and dexamethasone all picked up fresh shortage listings with openFDA, though most still show product available. Check the live tracker before you assume your usual concentration is on the shelf.

→ Full shortage list

Journavx meets its first real-world safety data

Suzetrigine, sold as Journavx, is the new non-opioid painkiller that arrived promising post-surgical pain control without the opioid baggage, and this week the journal Anesthesiology published a postmarketing analysis combing real-world reports for safety signals. That is the honest phase of any new drug's life, the jury is still out, so watch the data before your facility builds it into every multimodal order set.

→ Tech watch

On Medicare's 2027 pay proposal

Back to that CMS rule from the top of this issue. We have read enough of these proposals to notice a pattern, the word reform shows up every year and the math underneath it rarely moves in our favor. Anesthesia lives and dies by a conversion factor most of the public has never heard of, and every July, Washington proposes that number while the people it affects are busy doing cases. Whether or not the timing is deliberate, the effect is the same, the comment file stays thin.

Here is the part we keep coming back to. This profession just proved it can move policy, two states walked away from the federal supervision requirement this month because CRNAs organized and pushed. Payment is the same fight with a different address. Autonomy settles who can deliver safe anesthesia care, reimbursement decides whether the model survives, and we do not get to sit out the second half.

- 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.