Payments for Medically Directed Anesthesia Services Should Be Reduced

HRD-92-25: Published: Mar 3, 1992. Publicly Released: Mar 3, 1992.

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Pursuant to a legislative requirement, GAO reviewed whether: (1) payments to anesthesiologists are excessive for services provided when they concurrently direct certified registered nurse anesthetists (CRNA); and (2) reduced payments resulting from the Omnibus Budget Reconciliation Act (OBRA) of 1987 have affected the use and employment of CRNA.

GAO found that: (1) Medicare is providing an economic incentive for medically directed anesthesia, since it pays more for cases that involve medical direction of CRNA and residents than for cases where the anesthesiologist provides the service; (2) anesthesiologists received higher Medicare payments when they medically direct residents than when they personally provide anesthesia services or direct CRNA, since most Medicare carriers use 15-minute service intervals for time units when anesthesiologists direct residents and 30-minute intervals for direction of CRNA for the same medical procedures; and (3) the act had no discernible effect on CRNA use or employment because there is a nationwide CRNA shortage and decisions to use an anesthesiologist, a CRNA, or both are often dictated by the local availability of those professionals.

Matter for Congressional Consideration

  1. Status: Closed - Implemented

    Comments: Section 13516 of OBRA will equalize payments for anesthesia services regardless of which personnel provide the service. The change is being phased in over a 4-year period.

    Matter: Congress should amend the Social Security Act to limit Medicare payments for medically directed anesthesia services to the resource-based value that the Health Care Financing Administration establishes under the physician fee schedule.


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