Michels K A
AANA J. 1993 Oct;61(5):493-6.
While OBRA93 will result in payment reductions for CRNAs and anesthesiologists involved in the anesthesia care team, the law also contained AANA victories. First, the anesthesia care team reductions will be phased in over several years rather than occurring immediately in 1994. Second, RAP DRGs were defeated. Third, the use of actual anesthesia time for purposes of Medicare billing was retained. Fourth, parity in payments for new physicians/new CRNAs was restored. Fifth, teaching anesthesiologists will receive the same payment for supervising two anesthesiologist residents as they do for working with two nurse anesthesia students beginning in 1994. The AANA concerns that were not addressed on OBRA93, such as the TEFRA conditions and access to clinical privileges, are not dead. They will be lobbied for again in future legislative vehicles, such as President Clinton's healthcare reform plan.
虽然《1993年综合预算调节法案》将导致参与麻醉护理团队的麻醉护士和麻醉医生的报酬减少，但该法律也包含了美国麻醉护士协会的胜利成果。首先，麻醉护理团队报酬的减少将在几年内逐步实施，而不是在1994年立即发生。其次，“资源利用分组”（RAP DRGs）被否决。第三，保留了将实际麻醉时间用于医疗保险计费的做法。第四，恢复了新医生/新麻醉护士报酬的平等。第五，从1994年开始，指导麻醉医生监督两名麻醉医生住院医生所获得的报酬，将与指导两名麻醉护士学生所获得的报酬相同。《1993年综合预算调节法案》未涉及的美国麻醉护士协会的关切问题，如《1982年税收公平与财政责任法案》（TEFRA）的条件和获得临床特权的机会，并未消失。未来将在诸如克林顿总统的医疗改革计划等立法提案中再次争取这些权益。
