"No One Is Coming to Save Us" — But We’re Not Waiting Anymore

Opinion by: Jean Covillo, DNAP, CRNA

Randy Moore nailed it.

In his recent Substack article, “No One Is Coming to Save Us: The Anesthesia Strategy Crisis,” he lays bare what many of us have known for far too long but haven’t said out loud:
“We’ve all been played.”

While anesthesiologists and CRNAs duke it out in association echo chambers — AANA vs. ASA, scope vs. supervision, tribal posturing vs. political paralysis — commercial payers are sneaking up to wipe out reimbursement from the side- like coyotes circling distracted dogs.

This isn’t incompetence.
It’s calculated.

Divide-and-conquer isn’t just their strategy — it’s their business model.
And we’re being ambushed.

The Reality We’re Living

Premiums continue to rise.
Reimbursements continue to fall.
And it’s about to get worse.

The latest federal tax budget includes a projected 6% cut to Medicare payments.
And news flash: most commercially contracted anesthesia reimbursement rates are tied directly to Medicare — as a percentage.

So… what do you think is going to happen to your commercial rates?

United we stand. Divided, we’re priced out.

This isn’t a policy squabble.
It’s economic warfare — and we’re getting carpet bombed.

This Isn’t a Debate — It’s Survival

Anesthesiologists and CRNAs need to stop acting like rivals and start acting like allies.

We need a Unified Anesthesia Coalition with one objective: economic survival.

CRNAs. MDAs.
Practice owners. Legal experts. Policy strategists.
Working together. Right now.

The threat isn’t across the OR.
It’s across the negotiating table.

It Has to Start at Home

At Excel Anesthesia, We’re not waiting for a national fix.

Our initial efforts have focused on building the Synergy Model — a real-world, collaborative anesthesia delivery framework that’s lean, efficient, and fiercely protective of both patient access and provider sustainability.

This isn’t theory. It’s implementation.

We’ve built a structure where CRNAs and MDAs collaborate — not compete.
One that maximizes scheduling efficiency, removes redundant overhead, and ensures full OR coverage without burnout or bloat.

But let’s be honest:
Cost-effective anesthesia models don’t work if efficiency is penalized.

We’ve seen it: the more streamlined and responsible our delivery becomes, the more payers slash the rates.

We’ve done our part. Now it’s time to fight for its value.

The Failures That Got Us Here

We need to face the ugly truth: our leadership failed us.

ASA and AANA have produced zero cohesive strategy on reimbursement.
The No Surprises Act is a trap:
• Its QPA (Qualified Payment Amount) rules artificially suppress CRNA-led reimbursements by creating “dual-provider” categories that distort market rates.
• Its arbitration process is a delay mechanism — no timeline, no penalties, no accountability when payers ignore awards.
- It fosters anti-competition and hinders cost-effective efforts.
Monopolistic insurers like BCBS exploit regional dominance with “take-it-or-leave-it” contracts that force full-network participation at unsustainable rates.
Medicare-indexed private contracts give commercial payers cover to mirror federal cuts without negotiation.
The outdated “supervision” policy pays less for team-based care — actively discouraging collaboration and cost-effective efforts.
CRNAs are singularly excluded from Locum Tenens rules — limiting flexibility, especially in small and rural practices.

This is not a comprehensive list. But it’s more than enough to prove the point.

Our Response: The 8-Pillar Strategy

This isn’t a manifesto. It’s a battle plan:

1. Provider Unity
• Build a joint CRNA–MDA task force of folks educated in reimbursement policy, focused solely on reimbursement and survival.

2. Coalition Building
• Form a broad-based coalition of stakeholders — hospitals, ASCs, national private groups, PE-backed groups, and small independents — aligned around one economic agenda: protecting value in anesthesia care.

3. Legal Strike
• File federal lawsuits to challenge discriminatory QPA calculations and anti-competitive contract language.

4. Regulatory Enforcement
• Enforce timely arbitration with automatic penalties for payer noncompliance.

5. Contract Reform
• End Medicare-indexed private payment models. Commercial rates should reflect regional market value — not federal austerity.

6. Monopoly Pressure
• File FTC and DOJ complaints against dominant insurers engaging in predatory, anti-competitive practices.

7. Medicare Policy Overhaul
• Challenge the flawed “supervision” penalty.
• Expand Locum Tenens eligibility to include CRNAs — to create equitable flexibility for all providers.

8. Legislative Firepower
• Draft and support state legislation to protect independent practices, mandate contract transparency, and hold payers accountable.