LUGPA Policy Brief - Anesthesia Policy Shifts and Independent Urology

September 2025

A combination of reimbursement reforms, workforce shortages, and evolving federal and state policies is reshaping the future of anesthesia care in the United States. While some legislative initiatives aim to protect access and ensure fair compensation, others erode provider autonomy, introduce insurer-driven limits on clinical judgment, and exacerbate financial pressures on Ambulatory Surgical Centers (ASCs), including those operated by LUGPA practices.

The result: Independent urology practices face mounting challenges securing reliable anesthesia coverage, sustaining financial viability, and maintaining patient access to high-quality outpatient surgical care.

Policies Supporting Anesthesia Providers

1. Ending Time-Based Reimbursement Caps

• Illinois: New law requires full reimbursement for anesthesia duration.
• Washington: Bill would prohibit insurer coverage limits based on time.

2. Strengthening No Surprises Act Enforcement

• No Surprises Enforcement Act: Triple damages plus interest for underpaid IDR awards, deterring “lowball” offers.

Policies Undermining Anesthesia Providers

1. Time-Limited Coverage in New York – Would allow insurers to pre-set anesthesia durations, undermining clinical judgment.
2. UnitedHealthcare Cuts – Eliminated physical status modifiers, CPT add-on payments, and imposed a 15% CRNA cut in underserved areas.

Workforce Pressures

• Aging Workforce: 57% of anesthesiologists are 55+; retirements looming.
• Training Bottleneck: 44% of applicants were unmatched in 2024.
• Rising Demand: Surgical volume projected to increase by 2–3% annually.

Why ASCs Are Paying Subsidies

Declining reimbursement, competition from corporate staffing groups, and unpredictable volume force ASCs to offer stipends or guarantees for anesthesia coverage, raising costs, regulatory scrutiny, and risk of surgery delays.

Implications for LUGPA Members

Without action, practices face:

• Reduced patient access to timely surgical care.
• Unsustainable anesthesia agreements.
• Higher overall costs in ASC settings.

Policy Recommendations

1. Expand Training Capacity – Increase residency slots and incentives for anesthesia and other high-demand specialties.
2. Promote Retention – Support burnout reduction, flexible scheduling, and wellness initiatives.
3. Ensure Fair Reimbursement – Align payments with cost and complexity in outpatient care.
4. Clarify Subsidy Rules – Ensure ASC subsidy arrangements are compliant, transparent, and sustainable.

Why it Matters

The convergence of payment cuts, restrictive insurer policies, and workforce shortages threatens anesthesia access in ASCs. LUGPA urges policymakers to address workforce expansion, fair reimbursement, and regulatory clarity to protect patient care and practice viability.