Four anesthesia practices are suing the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS), among other parties, over CMS’s methodology for calculating reimbursements. The lawsuit, filed on December 18 by U.S. Anesthesia Partners of Texas, Florida, Colorado, and Physicians Anesthesia Service, alleges that CMS’s reimbursement calculations illegally include costs associated with nonphysician practitioners.
Key Points from the Article:
- Allegations Against CMS: The complaint asserts that CMS’s methodology for calculating reimbursements under the merit-based incentive program is unlawful. It includes nonphysician practitioners, such as nurse practitioners and physician assistants, in its calculations, even if they only furnish services in medical groups comprised of excluded physician types.
- Impact on Specialty Practices: The lawsuit argues that specialty practice groups are unfairly held responsible for every cost because they employ nonphysician practitioners for routine tasks. This inclusion of nonphysician practitioners in the reimbursement calculation is seen as contrary to law and arbitrary.
- Violation of the Eighth Amendment: The suit claims that CMS’s new measurement method, introduced in 2019, results in a fine for excluded specialties like anesthesiologists. This is alleged to violate the excessive fines clause of the Eighth Amendment.
- Financial Implications: The lawsuit alleges that the new reimbursement method will cut a combined $3.7 million from the four practices’ Medicare reimbursement rate in 2024.
- CMS’s Exclusion of Specialties: When CMS changed its total per capita cost calculation in 2019, it excluded certain specialties, including anesthesiologists. The lawsuit contends that this change unfairly penalizes these specialties.
In summary, the lawsuit filed by four anesthesia practices challenges CMS’s reimbursement methodology, arguing that it unlawfully includes costs associated with nonphysician practitioners and unfairly penalizes certain medical specialties. The practices are seeking legal redress for what they perceive as a significant financial and legal injustice.