The Real Reason Anesthesia Keeps Getting Targeted

Not incompetence. Not politics. A structural vulnerability we’ve allowed to linger.

A LinkedIn graphic made the rounds this week showing several major commercial insurers reducing CRNA reimbursement by fifteen percent. It did not explode across the internet, and it wasn’t meant to. It was a quiet indicator of something deeper.

What we’re seeing is not a cut. It’s a diagnostic result.

This is what happens when a margin-driven industry tests a specialty that struggles to present a unified economic strategy. The fifteen percent reduction is not surprising, and it is not random. It is the predictable outcome of years of fragmentation that commercial payors have studied, understood, and finally acted on.

Why CRNAs Were Targeted First

Commercial payors do not pick targets at random. They look for leverage, vulnerability, and the path of least resistance. In anesthesia, the place where advocacy is most fractured is CRNA reimbursement.

Not because CRNAs are less valuable.
Not because the work is less essential.
But because anesthesiology and nurse anesthesiology often respond to external pressure on parallel tracks instead of a single strategic lane.

Payors are not reacting to our clinical excellence. They are reacting to our structural alignment.

And they have made a bet. They are betting the professional split will hold.

This is not emotional. It is strategic.
This is not personal. It is math.

The Slow Creep We Didn’t Want to See

Commercial payors rarely make bold moves out of the gate. They probe the edges. They test contract language. They adjust reimbursement locally. They push just far enough to see whether the response will be rapid and coordinated or slow and fragmented.

For years, anesthesia has given them the same answer.

Multiple organizations. Multiple narratives. Multiple timelines. Multiple priorities.
All valid. All understandable. All strategically limiting.

A fifteen percent cut is not a number. It is a message about leverage, unity, and whether the profession has either.

The Comparison No One Likes But Everyone Understands

Consider how this would unfold in cardiology or orthopedics or radiology. A fifteen percent targeted reduction would trigger a rapid, unified, profession-wide response. There would be one narrative, one legal strategy, one mobilization plan. No ambiguity. No parallel tracks.

Anesthesia?

We issue a statement.
We argue with one another on Facebook.
We repeat “advocacy” until the word stops meaning anything.

Commercial payors are not malicious. They are behaving rationally. They see a specialty that does not speak with one economic voice, so they act in the gap between the voices.

Rational actors exploit predictable weaknesses.

The Organizational Reality

This is not an indictment of the ASA or the AANA. Both are filled with talented professionals who care deeply about the field. Both have advanced advocacy, education, and safety for decades.

The problem is structural, not personal.

Two large organizations with different histories, priorities, and constituencies are not built for rapid alignment during a fast-moving economic threat. Their governance processes are deliberate, thoughtful, and thorough. That serves members well in most contexts. It does not serve them well in moments that require speed.

Payors do not interpret the parallel responses as failure. They interpret them as disunity. And they move accordingly.

A Quiet Image With a Loud Message

The LinkedIn graphic showing the fifteen percent CRNA reduction is not a crisis alert. It is a mirror. It shows how payors believe the next few years will unfold. They do not expect a unified pushback. They do not expect a shared economic strategy. They do not expect a coordinated narrative.

Fragmentation creates predictable outcomes in a margin-driven world.

The Next Two Years Will Define the Next Ten

Fifteen percent is not the end. It is the probe. Payors test boundaries slowly, then escalate if the response is weak or scattered. If anesthesia continues moving in parallel instead of in alignment, deeper cuts are likely.

This is not about merging organizations or resolving decades of philosophical battles. It is about recognizing that the reimbursement environment now rewards collective action and punishes division.

The next move does not belong to payors. It belongs to us.

A Playbook That Could Change the Trajectory

The path forward does not require reinvention. It requires shared discipline.

1. A joint economic stance
A narrow, coordinated commitment to defend anesthesia reimbursement.

2. A unified narrative centered on patient access
Lower reimbursement reduces access, destabilizes coverage, and eventually shows up in burnout and staffing crises. That is the story policymakers understand.

3. Shared modeling and data
One set of numbers. One set of projections. One set of economists.

4. Coordinated legal strategy
Payors respond to risk, not rhetoric.

5. A five-year shared roadmap
A limited partnership focused on reimbursement would fundamentally shift the balance of power.

None of this undermines the missions or identities of the ASA or AANA. It simply aligns the strategy where the stakes are highest.

The Closing Reality

Anesthesia does not have a talent problem. It has a coordination problem. Across CRNAs, anesthesiologists, executives, and educators, people see the same threat, feel the same pressure, and want the same stability.

What we lack is the shared economic playbook this moment demands.

The fifteen percent cut is the warning shot.
The real fight is what comes next.

If we keep moving separately, we will keep absorbing cuts.
If we move together, this entire trajectory changes.

The views expressed here are my own personal views and opinions and do not reflect the views of NorthStar Anesthesia