Budget Reconciliation Law contains single anesthesia fee cuts

Area of Science:

• Healthcare Policy
• Anesthesiology
• Nursing

Background:

• The Omnibus Budget Reconciliation Act of 1993 (OBRA93) introduced significant changes to healthcare reimbursement.
• Certified Registered Nurse Anesthetists (CRNAs) and anesthesiologists faced potential payment reductions within the anesthesia care team model.

Purpose of the Study:

• To analyze the impact of OBRA93 on CRNAs and anesthesiologists.
• To identify both the adverse effects and the key victories achieved by the American Association of Nurse Anesthetists (AANA) within OBRA93.

Main Methods:

• Analysis of legislative text and its implications for anesthesia providers.
• Review of AANA's advocacy efforts and outcomes related to OBRA93.

Main Results:

• OBRA93 mandates phased payment reductions for anesthesia care teams over several years.
• Key AANA victories include the defeat of RAP DRGs, retention of actual anesthesia time for Medicare billing, and restored payment parity for new physicians and CRNAs.
• Teaching anesthesiologists' supervision payments were standardized for residents and nurse anesthesia students.

Conclusions:

• OBRA93 presents a mixed outcome for anesthesia providers, with some financial reductions offset by significant AANA successes.
• Unaddressed AANA concerns, including TEFRA conditions and clinical privileges, will be pursued in future legislative efforts.