Medicare: Payment Changes Are Needed for Assistants-at-Surgery

GAO-04-97 Published: Jan 13, 2004. Publicly Released: Jan 13, 2004.
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Medicare pays for assistant-atsurgery services under both the hospital inpatient prospective payment system and the physician fee schedule. Payments under the physician fee schedule are limited to a few health professions. In 2001, Congress directed GAO to report on the potential impact on the Medicare program of allowing physician fee schedule payments to Certified Registered Nurse First Assistants for assistant-at-surgery services. This report examines: (1) who serves as an assistant-atsurgery, (2) whether health professionals who perform the role must meet a uniform set of professional requirements, and (3) whether Medicare's payment policies for assistants-at-surgery are consistent with the goals of the program and, if not, whether there are alternatives that would help attain those goals. GAO analyzed information provided by physician and other health professional associations and Medicare payment data.

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Matter for Congressional Consideration

Matter Status Comments
Congress may wish to consider consolidating all Medicare payments for assistant-at-surgery services under the hospital inpatient prospective payment system.
Closed – Not Implemented
Congress did not act on GAO's recommendation. After GAO's report was issued, MedPAC concurred with the recommendation. However, bills that run counter to GAO's recommendation have not been enacted. 2006 Update: we are closing this recommendation because it is clear that Congress will never act on our suggestion.

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