Johnstone R E, Hosaflook C
Department of Anesthesiology and the College of Business and Economics, West Virginia University, Morgantown, West Virginia, USA.
Anesthesiology. 2000 Sep;93(3):852-7. doi: 10.1097/00000542-200009000-00037.
In 1992, Medicare changed its method for calculating physician payments. The resulting fee schedules have contained low payments for anesthesiologists. Now, other third-party (insurance) payers are using these schedules. The financial impact on anesthesiologists if all payers pay Medicare rates is unknown.
Payments from Medicare were compared with payments from other third parties in each clinical procedural terminology (CPT) grouping used by the West Virginia University Department of Anesthesiology during 1998. Changes in total Department of Anesthesiology receipts were determined if non-Medicare third-party payers paid Medicare rates. Then, the effect of adding payments at Medicare rates from patients without insurance was determined. Finally, potential changes in receipts of the Departments of Anesthesiology, Radiology, Surgery, and Medicine were compared by considering only patients with insurance and recalculating total payments to the departments using Medicare rates.
Medicare paid less than other third-party payers in every clinical procedural terminology group. Total Department of Anesthesiology payments would decrease by 31% if all non-Medicare third-parties paid Medicare rates. Adding payments at Medicare rates from patients without insurance still leads to a 21% decrease in total Department of Anesthesiology receipts. Considering only patients with third-party coverage, Medicare-rate payments would decrease total Department of Anesthesiology payments by 37%, whereas radiology, surgery, and medicine payments would decrease by 26, 22, and 13% respectively.
Universal payments at Medicare rates would substantially reduce revenue to anesthesiologists, proportionally more than to radiologists, surgeons, or internists.
1992年，医疗保险改变了其计算医生报酬的方法。由此产生的费用表对麻醉医生的支付较低。现在，其他第三方（保险）支付方也在使用这些费用表。如果所有支付方都按照医疗保险费率支付，对麻醉医生的财务影响尚不清楚。
将1998年西弗吉尼亚大学麻醉学系使用的每个临床程序术语（CPT）分组中医疗保险的支付与其他第三方的支付进行比较。如果非医疗保险第三方支付方按照医疗保险费率支付，确定麻醉学系总收入的变化。然后，确定加上无保险患者按照医疗保险费率支付的费用后的影响。最后，仅考虑有保险的患者，并使用医疗保险费率重新计算各科室的总支付，比较麻醉学、放射学、外科学和内科学科室收入的潜在变化。
在每个临床程序术语组中，医疗保险的支付都低于其他第三方支付方。如果所有非医疗保险第三方都按照医疗保险费率支付，麻醉学系的总支付将减少31%。加上无保险患者按照医疗保险费率支付的费用后，麻醉学系的总收入仍会减少21%。仅考虑有第三方保险的患者，按照医疗保险费率支付将使麻醉学系的总支付减少37%，而放射学系、外科学系和内科学系的支付将分别减少26%、22%和13%。
按照医疗保险费率统一支付将大幅减少麻醉医生的收入，与放射科医生、外科医生或内科医生相比，减少的比例更大。
