A lesser-known provision tucked inside the Affordable Care Act has the potential to reshape how anesthesia services are reimbursed across the United States. Despite being part of the law for years, it has never been meaningfully enforced.

That gap between policy and enforcement still shows up in real-world settings—especially in ambulatory surgery centers (ASCs), where financial pressure and staffing challenges tend to overlap. It’s not something most patients ever see, but administrators deal with it constantly in the background.

At the center of the discussion is Jeff Tieder, MSN, CRNA, a clinical assistant professor at the University of Tennessee at Chattanooga. His perspective highlights a reimbursement imbalance that many administrators quietly account for in day-to-day operations.

The Core Issue

Freepik | An overlooked ACA provision could play a major role in anesthesia reimbursement but remains largely ignored.

Anesthesia services provided by CRNAs are typically reimbursed at about 85% of the physician rate. On paper, that gap may seem manageable. In practice, it subtly influences how facilities make financial decisions.

Many administrators focus on that missing 15% as a lost opportunity. But the bigger picture is more complicated. In a lot of ASC settings, neither CRNAs nor physicians generate enough reimbursement to fully cover their compensation. That’s why stipends are so common—they help close a gap that exists regardless of who provides care.

That shifts the conversation. The issue becomes less about revenue and more about consistency. When identical services are valued differently, it introduces uncertainty into the system.

A Law That Exists, But Isn’t Applied

The Affordable Care Act includes a non-discrimination provision designed to prevent this kind of discrepancy. It prohibits reimbursement differences based solely on credentials when the service is the same.

Despite that, enforcement has never fully materialized. The Office of the Inspector General has not issued a final ruling, leaving the provision inactive in real-world practice.

That leaves the policy in a kind of limbo. If it were enforced, it could standardize payments for anesthesia services and remove some of the uncertainty that currently exists in ASC operations.

Why Enforcement Has Stalled

The hesitation appears to come down to economics. Equal reimbursement would likely increase what insurers have to pay, and controlling costs remains a priority for them. Keeping the 85% structure in place allows insurers to limit spending while shifting some of the financial pressure onto providers and facilities.

Efforts to cap anesthesia payments more aggressively have already faced pushback at the state level. As a result, maintaining reduced reimbursement rates has become a more practical workaround.

That approach doesn’t stay contained. ASCs feel the impact first, then adjust through staffing, operations, or pricing. Over time, those adjustments affect service availability and patient access.

What Lies Ahead

Freepik | Equalizing anesthesia reimbursement could bring more consistency to how providers are paid.

For now, the 85% model is likely to stick around. It offers insurers a relatively simple way to manage costs without inviting major regulatory challenges.

At the same time, the workforce is shifting. More CRNA programs are expanding the pipeline, while physician shortages continue to develop. Over the next few years, that could create a more balanced provider landscape.

Regional differences will matter. Areas like the Southeast may see tighter competition as new graduates enter the field, though overall stability may improve compared to current conditions.

The Bigger Picture for Healthcare Systems

Standardizing reimbursement would align payment with the service itself, rather than the provider’s title.

It would also reinforce the role of CRNAs within the healthcare system. Their contribution is already well established. Equal reimbursement would simply reflect that reality more clearly.

The non-discrimination provision in the Affordable Care Act offers a path forward. But without enforcement, it remains largely theoretical.

Until that changes, the imbalance will continue to shape decisions quietly—behind the scenes, but with real consequences for the future of anesthesia care.

Helen Hayward

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