AANA Federal Government Affairs
HOTLINE Extra
Number 2007-24a – Monday, November 26, 2007



Following AANA Request, Medicare Corrects 2008 Anesthesia Fee Schedule

Anesthesia Work Value Boost of 32% Yields CRNAs a Corrected 10% Boost, Not 10% Cuts Other Specialties Face; Further Payment Fix Requires Congress to Act

By Frank J. Purcell
AANA Senior Director Federal Government Affairs
Washington, DC

The Medicare agency has issued a correction of its published 2008 anesthesia conversion factor (CF), resulting in a nearly 10% boost for anesthesia payments in 2008 instead of nearly flat payments, following a request from AANA President Wanda Wilson CRNA PhD. According to the Centers for Medicare & Medicaid Services (CMS), the 2008 mean national anesthesia CF will be $17.82 per unit, an increase from the 2007 level of $16.23 and from the agency’s November 1 published level of $16.33.

“Medicare’s correction will yield about $200 million more Part B anesthesia payments for CRNAs and anesthesiologists than the agency would have provided before making the correction,” said AANA President Wilson. “Since a major government study last summer found Medicare anesthesia payment is 67% below private reimbursements, and well below other specialties’ relative Medicare reimbursement levels, the agency’s positive response in this case is good news for the patients, practice and profession of nurse anesthesia.”

The new Medicare conversion factors, which vary by locality, take effect for services on and after January 1, 2008, and are attached below. CMS had on November 1 issued the 2008 physician fee schedule (PFS) final rule (CMS-1385-FC) in which the agency adopted its proposed 32% increase in the value of anesthesia work – a boost that effectively rescues CRNAs’ 2008 reimbursements from severe cuts that the rule imposes on almost every Medicare Part B service other than anesthesia. In comments to the Centers for Medicare & Medicaid Services (CMS) last summer, AANA and CRNAs as well as anesthesiologists had strongly advocated for the agency to increase anesthesia work values in concluding CMS’ most recent “five-year review” adjustment of relative values of all Part B services. However, because CMS’ calculated anesthesia payment boost of 0.6% fell short of what other CMS guidance had indicated, AANA President Wilson in November alerted CMS to this inconsistency and asked “to ensure CMS publishes and reimburses at the correct 2008 anesthesia CF, we request that the agency examine and spell out more fully its calculations, and publish an updated anesthesia CF as necessary.” Though the November 1 posted final rule will appear in the Federal Register November 27, the agency states it will formally report its updated calculations in the Federal Register later this year.

While CMS’ welcome change represents a 9.8% increase over 2007 payments, the new Medicare anesthesia CF is slightly above the 2006 level of $17.76. For CMS’ increase in anesthesia work values to be more noticeable in anesthesia practices, Congress must still act to reverse the scheduled 10% cut to all Medicare Part B payments in 2008, including anesthesia. If Congress acts to reverse next year’s scheduled cut, AANA estimates the 2008 anesthesia CF could rise to about $19.50 per unit.

“Now we turn to Congress to act by year’s end, to reverse the extreme cuts that Medicare’s flawed ‘sustainable growth rate’ (SGR) funding formula imposes on all Part B services, including CRNA services,” said President Wilson.

Read More:
o See AANA’s November 1 statement about CMS’ 2008 anesthesia payment final rule, at this link
o Read CMS’ 1,400-plus page final rule about 2008 physician and CRNA payments at 2008 physician fee schedule (PFS) final rule
o Read the Government Accountability Office (GAO) summer 2007 report on anesthesia payment



>> For More Information
The AANA Federal Government Affairs Hotline is published for the nurse anesthetist members of AANA each week Congress is in session by the AANA Office of Federal Government Affairs, Washington DC, 202-484-8400, info@aanadc.com, Frank Purcell, Senior Director. © 2007 American Association of Nurse Anesthetists.