RangelMD looks at a recent discussion he had with a friend of his who practices anesthesia. This anesthesiologist is being paid 40% less by Medicare for doing long, difficult heart bypass procedures than private insurers would pay for doing short and simple knee operations. As a result, Medicare patients in that locale have difficulty finding anesthesiologists who are willing to do anesthesia for these cardiac cases, since their level of compensation by Medicare for doing them is not adequate.
Imagine you need a life saving cardiac operation for your severely diseased and failing heart. Then imagine your surprise when you find out that your Medicare government health insurance pays less than 40% of what private insurances reimburse anesthesiologists for the same procedure! Now imagine your concern when you learn that because of such poor reimbursement rates only a scant few anesthesiologists in your area will provide services for cardiac surgical cases when the insurer is Medicare!
The anesthesia services provided during these long procedures can be ridiculously complex and challenging even for the most seasoned “sandman”. Open heart procedures require that the heart be literally stopped (cardioplegia) and the patient is kept alive by use of an artificial pump (bypass). During the procedure the patient often requires multiple invasive monitoring modalities like swan-ganze catheterization and the anesthesiologist is required to interpret complex real-time clinical data and apply combinations of multiple medications based on this data in order to keep the patient stabilized.
Does it bother you that Medicare pays less for this life saving procedure then most private insurances will pay for anesthesia services for a knee replacement!?!?!? Well it should. This is what I was stunned to discover while talking to a good anesthesiologist friend of mine. He is an excellent gas-passer (and physician) only a few years out of residency who loves cardiac surgical cases for the challenges they bring (and he’s young, enthusiastic, and hungry).
But he recently he expressed his frustration when he realized that while private insurance paid him well over $1,000 for his services during a basic knee replacement he got only about $600 from Medicare for a cardiac bypass procedure. Since these operations can take up to 6-8 hours this meant that he was earning less than $100/hour. In order to find anesthesiologists to staff open heart cases many hospitals have resorted to subsidizing their reimbursement. It’s another example of cost shifting in our heterogeneous payer system.
