Medicare:

Variations in Payments to Anesthesiologists Linked to Anesthesia Time

HRD-91-43: Published: Apr 30, 1991. Publicly Released: Apr 30, 1991.

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Pursuant to a legislative requirement, GAO reviewed anesthesia times that physicians reported to Medicare to verify their accuracy.

GAO found that: (1) there was no consistent time schedule or average Medicare payment among anesthesiologists who performed identical procedures; (2) while Medicare paid other doctors based on procedure instead of time, it paid anesthesiologists based on the amount of time they spent with the patients; (3) while anesthesiologists could not control the length of surgery or the occurrence of complications, there should be a more uniform pre- and post-operative schedule for anesthesiologist services; (4) Medicare lacked internal controls to ensure that anesthesiologists' reported times were accurate; and (5) in 13 percent of the claims GAO reviewed, anesthesiology service time on medical records differed from the times reported on the Medicare claims.

Recommendation for Executive Action

  1. Status: Closed - Not Implemented

    Comments: HHS agreed with the recommendation. The Administration has proposed that the law be amended to pay for anesthesia, pathology, and radiology physician services as a bundle, with rates based on average payments. Because of congressional opposition, HHS action to eliminate actual time from the computation of anesthesia payment amounts has been postponed. The Congress has not indicated that a change in policy is likely to occur.

    Recommendation: The Secretary of Health and Human Services should direct the Administrator, Health Care Financing Administration, to establish a fee schedule for reimbursing physician anesthesia services that eliminates the direct link between anesthesia time and payment for anesthesia services.

    Agency Affected: Department of Health and Human Services

 

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