Nurse anesthesia services are crucial to rural healthcare, with Certified Registered Nurse Anesthetists (CRNAs) being the sole anesthesia providers in the vast majority of rural hospitals, affording these facilities surgical, obstetrical, trauma stabilization, interventional diagnostic and pain management capabilities. Without CRNA services, many U.S. rural and Critical Access hospitals (CAH) would not be able to offer care at all.
Value of the Medicare Part A Reasonable Cost Based Pass-Through Program
The Medicare Part A reasonable cost based pass-through program for the services of nurse anesthetists (42 CFR §412.113(c)) exists to ensure the availability of CRNA services in rural hospitals for Medicare beneficiaries where the facility’s case volume is insufficient for Part B to economically sustain such services. For decades, this program has successfully and safely ensured the availability of anesthesia services for Medicare patients, and all services that anesthesia enables, by reimbursing qualifying hospitals the reasonable and necessary costs of such services.
However, Medicare administrators have twice overruled the agency’s Provider Reimbursement Review Board (PRRB) and wrongly denied rural hospitals pass-through payment for CRNAs’ standby and on-call services even though such payments are clearly permissible and necessary to rural hospitals’ emergency care and trauma stabilization capabilities. These CMS rulings have denied rural hospitals’ claims for tens of thousands of dollars each in annual Medicare funding that they had come to rely upon to serve their communities. Hospitals must be able to keep their doors open and continue to provide obstetrical, surgical and trauma stabilization services to people in rural communities. Traveling long distances to the nearest hospital is not an option when dealing with trauma stabilization and, in many instances, obstetrical care as well. In addition, traveling long distances for interventional diagnostic and pain management care is difficult, particularly for elderly patients.
Support Sec. 23 of S. 1680, the Craig Thomas Rural Hospital and Provider Equity Act
Introduced by Sen. Kent Conrad (D-ND) on Oct. 11, 2011, Sec. 23 of the Craig Thomas Rural Hospital and Provider Equity Act would help restore rural healthcare by making necessary improvements to the Medicare Part A reasonable cost based pass-through program for nurse anesthesia services in rural and critical access hospitals (CAH). It would restore nurse anesthetist standby and on-call payment eligibility to the Part A reasonable cost based pass-through program.
Oppose Unnecessarily Increasing Anesthesia Costs in Rural Settings
Legislation pending in the U.S. House (HR 1044, Jenkins, R-KS) would expand the Medicare Part A rural hospital reasonable cost passthrough program to also cover the services of anesthesiologists. Because the labor cost of an anesthesiologist is about three times that of a nurse anesthetist, enactment of such legislation could triple Medicare rural anesthesia costs in a hospital without expanding patient access to care or improving quality.