Influence of the type of anesthesia provider on costs of labor analgesia to the Texas Medicaid Program

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Abstract

Background: The Texas Medicaid Program (Medicaid) defines billable time for labor analgesia as face-to-face time; therefore, anesthesia providers determine billed time. The authors' goal was to determine the influence of anesthesia providers on labor analgesia costs billed to Medicaid. Methods: Under the Freedom of Information Act, Medicaid provided data on claims paid for 6 months in 2001 for labor analgesia administered during the course of a vaginal delivery. Claims were either time based (codes 00946 or 00955) or a flat fee (codes 26311 or 26319). Using modifiers, the authors grouped time-based claims as either anesthesiologist group or certified registered nurse anesthetist (CRNA) group. The cost to Medicaid was based on the 2001 fee schedule. The conversion factor was $18.21 per American Society of Anesthesiologists unit. The flat-fee reimbursement was $152.50. CRNA services were paid at 85% of the fee schedule. Average time per time claim, percent of providers with more than 4 h of billed time, and cost per claim were determined for each group. Providers with more than 120 claims (> 20 claims/month) were considered high-volume. Results: The database included 21,378 claims (anesthesiologist group: 12,698 claims from 219 providers; CRNA group: 8,680 claims from 117 providers). For time-based claims, the average time per case was significantly higher in the CRNA group (146 min) than in the anesthesiologist group (105 min). The CRNA group cost to Medicaid ($225.11) was 19% more per claim than the anesthesiologist group ($189.26). The difference in cost per claim was greater among high-volume providers-$213.10 for the CRNA group versus $168.76 for the anesthesiologist group. If a flat-fee program were instituted using the average cost per claim for all groups ($203.81), the Texas Medicaid program would save more than $500,000 annually. Conclusions: The costs of labor analgesia billed to Texas Medicaid were 19% to 26% less per patient when provided by anesthesiologists than by CRNAs, despite lower per-unit reimbursement of CRNAs.

Original languageEnglish (US)
Pages (from-to)991-998
Number of pages8
JournalAnesthesiology
Volume101
Issue number4
DOIs
StatePublished - Oct 2004

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Medicaid
Analgesia
Nurse Anesthetists
Anesthesia
Costs and Cost Analysis
Nurses
Fees and Charges
Fee Schedules
Anesthesiologists
Databases

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

@article{7c765237ef2c45279e22e578fbe0c427,
title = "Influence of the type of anesthesia provider on costs of labor analgesia to the Texas Medicaid Program",
abstract = "Background: The Texas Medicaid Program (Medicaid) defines billable time for labor analgesia as face-to-face time; therefore, anesthesia providers determine billed time. The authors' goal was to determine the influence of anesthesia providers on labor analgesia costs billed to Medicaid. Methods: Under the Freedom of Information Act, Medicaid provided data on claims paid for 6 months in 2001 for labor analgesia administered during the course of a vaginal delivery. Claims were either time based (codes 00946 or 00955) or a flat fee (codes 26311 or 26319). Using modifiers, the authors grouped time-based claims as either anesthesiologist group or certified registered nurse anesthetist (CRNA) group. The cost to Medicaid was based on the 2001 fee schedule. The conversion factor was $18.21 per American Society of Anesthesiologists unit. The flat-fee reimbursement was $152.50. CRNA services were paid at 85{\%} of the fee schedule. Average time per time claim, percent of providers with more than 4 h of billed time, and cost per claim were determined for each group. Providers with more than 120 claims (> 20 claims/month) were considered high-volume. Results: The database included 21,378 claims (anesthesiologist group: 12,698 claims from 219 providers; CRNA group: 8,680 claims from 117 providers). For time-based claims, the average time per case was significantly higher in the CRNA group (146 min) than in the anesthesiologist group (105 min). The CRNA group cost to Medicaid ($225.11) was 19{\%} more per claim than the anesthesiologist group ($189.26). The difference in cost per claim was greater among high-volume providers-$213.10 for the CRNA group versus $168.76 for the anesthesiologist group. If a flat-fee program were instituted using the average cost per claim for all groups ($203.81), the Texas Medicaid program would save more than $500,000 annually. Conclusions: The costs of labor analgesia billed to Texas Medicaid were 19{\%} to 26{\%} less per patient when provided by anesthesiologists than by CRNAs, despite lower per-unit reimbursement of CRNAs.",
author = "Amr Abouleish and Donald Prough and Rakesh Vadhera",
year = "2004",
month = "10",
doi = "10.1097/00000542-200410000-00026",
language = "English (US)",
volume = "101",
pages = "991--998",
journal = "Anesthesiology",
issn = "0003-3022",
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TY - JOUR

T1 - Influence of the type of anesthesia provider on costs of labor analgesia to the Texas Medicaid Program

AU - Abouleish, Amr

AU - Prough, Donald

AU - Vadhera, Rakesh

PY - 2004/10

Y1 - 2004/10

N2 - Background: The Texas Medicaid Program (Medicaid) defines billable time for labor analgesia as face-to-face time; therefore, anesthesia providers determine billed time. The authors' goal was to determine the influence of anesthesia providers on labor analgesia costs billed to Medicaid. Methods: Under the Freedom of Information Act, Medicaid provided data on claims paid for 6 months in 2001 for labor analgesia administered during the course of a vaginal delivery. Claims were either time based (codes 00946 or 00955) or a flat fee (codes 26311 or 26319). Using modifiers, the authors grouped time-based claims as either anesthesiologist group or certified registered nurse anesthetist (CRNA) group. The cost to Medicaid was based on the 2001 fee schedule. The conversion factor was $18.21 per American Society of Anesthesiologists unit. The flat-fee reimbursement was $152.50. CRNA services were paid at 85% of the fee schedule. Average time per time claim, percent of providers with more than 4 h of billed time, and cost per claim were determined for each group. Providers with more than 120 claims (> 20 claims/month) were considered high-volume. Results: The database included 21,378 claims (anesthesiologist group: 12,698 claims from 219 providers; CRNA group: 8,680 claims from 117 providers). For time-based claims, the average time per case was significantly higher in the CRNA group (146 min) than in the anesthesiologist group (105 min). The CRNA group cost to Medicaid ($225.11) was 19% more per claim than the anesthesiologist group ($189.26). The difference in cost per claim was greater among high-volume providers-$213.10 for the CRNA group versus $168.76 for the anesthesiologist group. If a flat-fee program were instituted using the average cost per claim for all groups ($203.81), the Texas Medicaid program would save more than $500,000 annually. Conclusions: The costs of labor analgesia billed to Texas Medicaid were 19% to 26% less per patient when provided by anesthesiologists than by CRNAs, despite lower per-unit reimbursement of CRNAs.

AB - Background: The Texas Medicaid Program (Medicaid) defines billable time for labor analgesia as face-to-face time; therefore, anesthesia providers determine billed time. The authors' goal was to determine the influence of anesthesia providers on labor analgesia costs billed to Medicaid. Methods: Under the Freedom of Information Act, Medicaid provided data on claims paid for 6 months in 2001 for labor analgesia administered during the course of a vaginal delivery. Claims were either time based (codes 00946 or 00955) or a flat fee (codes 26311 or 26319). Using modifiers, the authors grouped time-based claims as either anesthesiologist group or certified registered nurse anesthetist (CRNA) group. The cost to Medicaid was based on the 2001 fee schedule. The conversion factor was $18.21 per American Society of Anesthesiologists unit. The flat-fee reimbursement was $152.50. CRNA services were paid at 85% of the fee schedule. Average time per time claim, percent of providers with more than 4 h of billed time, and cost per claim were determined for each group. Providers with more than 120 claims (> 20 claims/month) were considered high-volume. Results: The database included 21,378 claims (anesthesiologist group: 12,698 claims from 219 providers; CRNA group: 8,680 claims from 117 providers). For time-based claims, the average time per case was significantly higher in the CRNA group (146 min) than in the anesthesiologist group (105 min). The CRNA group cost to Medicaid ($225.11) was 19% more per claim than the anesthesiologist group ($189.26). The difference in cost per claim was greater among high-volume providers-$213.10 for the CRNA group versus $168.76 for the anesthesiologist group. If a flat-fee program were instituted using the average cost per claim for all groups ($203.81), the Texas Medicaid program would save more than $500,000 annually. Conclusions: The costs of labor analgesia billed to Texas Medicaid were 19% to 26% less per patient when provided by anesthesiologists than by CRNAs, despite lower per-unit reimbursement of CRNAs.

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