A little-known clause within the Affordable Care Act has the potential to change how anesthesia services are paid across the United States. Yet, despite being on the books for years, it remains largely untouched.

This gap in enforcement continues to affect reimbursement models, especially in ambulatory surgery centers (ASCs), where financial pressure and staffing challenges often intersect.

At the center of this discussion is Jeff Tieder, MSN, CRNA, a clinical assistant professor at the University of Tennessee at Chattanooga. His perspective sheds light on a payment imbalance that many administrators quietly factor into daily operations.

The Core Issue

Freepik | An unutilized ACA rule holds the key to reforming anesthesia pay but remains neglected by regulators.

Anesthesia services provided by Certified Registered Nurse Anesthetists (CRNAs) are typically reimbursed at 85% of the physician rate. On paper, that difference appears manageable. In practice, it shapes decision-making in subtle but meaningful ways.

Administrators often focus on that missing 15%, viewing it as a lost opportunity for revenue. However, the broader financial reality tells a different story. Neither CRNAs nor physicians generate enough reimbursement to fully cover their salaries in many ASC settings. As a result, stipends are commonly used to bridge the gap, regardless of provider type.

This context shifts the conversation. The difference between 85% and 100% becomes less about immediate revenue and more about perception. A system that values identical work differently creates uncertainty, even when the financial impact is relatively small compared to overall costs.

A Law That Exists—But Isn’t Applied

Buried within the Affordable Care Act is a non-discrimination provision that addresses this exact issue. The law prohibits reimbursement differences based solely on the provider’s credentials when the same service is delivered.

Despite this, enforcement has never taken shape. The Office of the Inspector General has yet to issue a final ruling, leaving the provision inactive in real-world practice.

This lack of action keeps the policy in a gray area. If enforced, it could standardize payments for anesthesia services, regardless of whether a physician or CRNA provides care. The result would likely bring consistency to ASC operations and remove uncertainty tied to reimbursement expectations.

Why Enforcement Has Stalled

The hesitation to implement this provision appears tied to financial interests. Equal reimbursement would increase payouts from insurance companies, which operate with a focus on managing costs. By maintaining the 85% model, insurers limit expenses while shifting financial pressure onto healthcare providers and facilities.

Previous attempts to cap anesthesia payments entirely have faced resistance at the state level. As a result, alternative methods—such as maintaining reduced reimbursement rates—continue to gain traction.

This approach has a ripple effect. ASCs absorb the financial strain first, then pass it along through operational adjustments or patient costs. Over time, this pattern influences staffing decisions, service availability, and overall access to care.

What Lies Ahead

Freepik | Standardizing anesthesia pay ensures fair compensation based on the service provided.

Looking forward, the 85% reimbursement structure is likely to remain in place, at least in the near term. It offers insurers a straightforward way to control spending without triggering widespread regulatory pushback.

At the same time, workforce trends are shifting. A growing number of CRNA programs are expanding the talent pool, while a physician shortage continues to develop. Within the next five years, these factors may create a more balanced supply of anesthesia providers.

Regional differences will likely play a role. Areas such as the Southeast may experience tighter competition as new graduates enter the market. Even so, the broader outlook suggests improved stability compared to current conditions.

The Bigger Picture for Healthcare Systems

Standardizing reimbursement for anesthesia services could bring clarity to an area that often feels fragmented. It would align payment with the actual service delivered rather than the title of the provider. For administrators, this change could simplify financial planning and reduce uncertainty tied to staffing models.

At the same time, such a shift would highlight the value of CRNAs within the healthcare system. Their role in delivering safe, effective anesthesia care is already well established. Equal reimbursement would reinforce that reality in a measurable way.

The non-discrimination provision within the Affordable Care Act presents a clear path toward fairer anesthesia reimbursement. Yet, without enforcement, it remains a missed opportunity.

Equal payment for equal work could ease financial pressure on ASCs, support workforce stability, and create a more predictable system for providers. Until action is taken, the imbalance continues to shape decisions behind the scenes—quietly influencing the future of anesthesia care.