PAYMENT FOR PHYSICIAN ANESTHESIA SERVICES.

SEC. 4048. PAYMENT FOR PHYSICIAN ANESTHESIA SERVICES. (a) In General.— Section 1842(b) of the Social Security Act (42 U.S.C. 1395u(b)) is further amended by adding at the end the following new paragraph: “(14) (A) In determining the reasonable charge under paragraph (3) of a physician for medical direction of two or more nurse anesthetists performing, on or after April 1, 1988, and before January 1, 1991, anesthesia services in whole or in part concurrently, the number of base units which may be recognized with respect to such medical direction for each concurrent procedure (other than cataract surgery or an iridectomy) shall be reduced by— “(i) 10 percent, in the case of medical direction of 2 nurse anesthetists concurrently, “(ii) 25 percent, in the case of medical direction of 3 nurse anesthetists concurrently, and “(iii) 40 percent, in the case of medical direction of 4 nurse anesthetists concurrently. “(B) In determining the reasonable charge under paragraph (3) of a physician for medical direction of two or more nurse anesthetists performing, on or after January 1, 1989, and before January 1, 1991, anesthesia services in whole or in part concurrently, the number of base units which may be recognized with respect to such medical101 STAT. 1330–90 direction for each concurrent cataract surgery or iridectomy procedure shall be reduced by 10 percent. “(C) The Secretary shall require claims for physicians’ services for medical direction of nurse anesthetists during the periods in which the provisions of subparagraph (A) or (B) apply to indicate the number of such anesthetists being medically directed concurrently at any time during the procedure, the name of each nurse anesthetist being directed, and the type of procedure for which the services are provided.”. (b) Development of Uniform Relative Value Guide.— The Secretary of Health and Human Services, in consultation with groups representing physicians who furnish anesthesia services, shall establish by regulation a relative value guide for use in all carrier localities in making payment for physician anesthesia services furnished under part B of title XVIII of the Social Security Act on and after January 1, 1989. Such guide shall be designed so as to result in expenditures under such title for such services in an amount that would not exceed the amount of such expenditures which would otherwise occur. (c) Study of Prevailing Charges for Anesthesia Services.— The Secretary of Health and Human Services shall conduct a study of the variations in conversion factors used by carriers under section 1842(b) of the Social Security Act to determine the prevailing charge for anesthesia services and shall report the results of the study and make recommendations for appropriate adjustments in such factors not later than January 1, 1989. (d) GAO Studies.— (1) The Comptroller General shall conduct a study— (A) to determine the average anesthesia times reported for medicare reimbursement purposes, (B) to verify those times from patient medical records, (C) to compare anesthesia times to average surgical times, and (D) to determine whether the current payments for physician supervision of nurse anesthetists are excessive. The Comptroller General shall report to Congress, by not later than January 1, 1989, on such study and in the report include recommendations regarding the appropriateness of the anesthesia times recognized by medicare for reimbursement purposes and recommendations regarding adjustments of payments for physician supervision of nurse anesthetists. (2) The Comptroller General shall conduct a study on the impact of the amendment made by subsection (a), and shall report to Congress on the results of such study by April 1, 1990.