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Impact of Government Healthcare Policy and Clinical Practice Guideline on Obstetric Anesthesia Professional Reimbursement: Retrospective Review of Anesthesia Billing from 2002 to 2016
Abstract Number: SAT-55
Abstract Type: Original Research
In 2006, Mitt Romney’s health care insurance reform laws passed in Massachusetts. We hypothesize that healthcare related policies change may affect anesthesia professional billing.
We extracted professional billing data from Department of Anesthesiology, Brigham and Women’s Hospital for the year of 2002-2016. The data was organized by procedure, namely anesthesia for cesarean delivery only, neuraxial labor analgesia/anesthesia for planned vaginal delivery, and anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia. Kruskal-Wallis H test was used to analyze the unpaid charge (UC), difference between per patient charge and per patient pay.
Our data demonstrated that per patient charge and pay for anesthesia for cesarean delivery reached its nadir in between year 2003-2004. After a steady increase for a decade, the charge and pay decreased proportionally from 2015. (Figure 1) A similar trend was seen in anesthesia charge and pay for the labor analgesia. (Figure 2) There is an upward trend for the UC portion of labor analgesia anesthesia billing. There is a noted trend of decreased UC for the anesthesia for cesarean delivery following neuraxial labor analgesia during the first 10 years of this century. However, the UC portion increased significantly starting 2012. (Figure 3) The UC portion of charge after 2012 were significant higher than those of 2010 and 2011 (P=0.000). [2010: $620 (212, 1178) (n=4540); 2011: $572 (242, 1250) (n=7898); 2012: $704 (407, 1493) (n=5016); 2013: $780 (339, 1560) (n=5007); 2014: $741 (256, 1648) (n=4279)] (Median (Interquartile Range))
The data of per patient charge and per patient pay in neuraxial labor analgesia/anesthesia for planned vaginal delivery during the past a few years were inversely proportional. Several possibilities could be contributing to it. Firstly, the change of pay schedule might have an impact l. Secondly, it could be caused by the payer mix change shift. Interestingly, it is also coincidently aligned with the recent change of obstetric care in relation to the extended length of first and second stage labor recommended by ACOG in 2011. While insurance professional fee reimbursement caps by anesthesia time, extension of labor analgesia could lead to increased workload and labor cost.
1. http://obamacarefacts.com 2013
2. ACOG Consensus No. 1. Obstet Gynecol 2014;123:693