As a curious person, I often look for outliers in data because they frequently lead to interesting insights and researchable questions. Recently, I found the following curious outlier: A rural hospital conducting less than 600 surgeries per year and employing (or contracting with) a non-physician anesthetist (NPA)1 reported that the cost for this NPA exceeded one million dollars. Medicare's portion of this hospital's anesthesia-related costs was about 60%, potentially resulting in the Centers for Medicare & Medicaid Services (CMS) reimbursing the hospital more than $600,000 for the anesthesia-related professional services provided to the hospital's Medicare patients. In this month's column, I examine the NPA cost data reported by rural pass-through hospitals.
Qualifying hospitals can receive pass-through payments from Medicare for any services that the NPA is legally authorized to perform in the state in which the services are provided. That is, RPT hospitals receive cost-based reimbursement associated with the...
