On January 13, the GAO issued a report explaining its findings that the Medicare program needs to reform how it pays for assistants-at-surgery. The GAO found three flaws in Medicare's current payment policy. First, because Medicare pays for this service both through hospital inpatient PPS and the physician fee schedule, Medicare may be paying too much for some surgical care when the cost of assistants-at-surgery is not adjusted when the hospital is paid under the physician fee schedule. Second, the report stated that paying a health care professional under the physician fee schedule as an assistant-at-surgery, rather that including this payment in an all-inclusive PPS payment, gives neither the hospital nor the surgeon an incentive to use an assistant only when it is medically necessary. Last, there is no distinction to determine which assistants-at-surgery are eligible for payment under the physician fee schedule based on surgical education or past experience as an assistant. The GAO suggests that Congress consider consolidation of all Medicare payments for assistant-at-surgery services under the hospital impatient PPS system in order to fix the outlined problems.
The full text of the report is located at
http://www.gao.gov/cgi-bin/getrpt?GAO-04-97.
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