Over half of American hospitals are located in rural areas, yet the vast majority of them are not given the same resources as institutions located in urban areas. Rural hospitals typically face problems with outdated medical equipment and reduced staff numbers coupled with low patient volumes. Since 2016, over 80 rural hospitals have closed their operations. To combat this disparity, several programs were unveiled to increase the health services offered in rural areas. One such program, is the “Anesthesia Rural Pass-Through” mechanism, which was created as a way to incentivize anesthesia providers to operate in small rural hospitals. Through this program, hospitals are able to address the shortage of healthcare providers by boosting the recruitment and subsequent retainment of anesthesia providers in rural areas.
Under the “pass-through” program, Medicare pays for services offered by anesthesia providers using Medicare Part A, which allows for more generous payments than Medicare Part B. Low Part B payments as well as low patient volume are among the biggest hindrances to maintaining anesthesia services in rural areas. Low payments are a major financial burden on hospitals and can lead to a reduction or even a termination of anesthesia services.
Nationwide, there are an estimated 650 hospitals that currently provide services through the “pass-through” program. To be eligible for the program, hospitals must be located in a rural area. Additionally, the volume of anesthesia cases at these hospitals may not exceed 800 cases per year. Currently, the Center for Medicare and Medicaid Services (CMS) only allows nurse anesthetists (NA) and anesthesiologist assistants (AA) to participate in the “pass-through” program in certain rural hospitals, barring actual anesthesiologists from participating.
In 2017, H.R.2881 was introduced by representative Lynn Jenkins (R-KS). This bill proposed to provide Medicare Part A payments on a reasonable-cost basis for anesthesia services carried out by anesthesiologists in rural hospitals. This initiative would do for anesthesiologist what the “pass-through” program did for NAs and AAs in rural settings. Proponents of H.R.2881 hope that the bill will help combat the shortage of anesthesiologists in approximately 50% of the country, with shortages predominantly effecting rural America.
Given the scarcity of anesthesiologists in rural areas, certified registered nurse anesthetists (CRNAs) have increased in number to fill the void. CRNAs tend to work shorter hours than anesthesiologists and provide more monitored anesthesia care. There are some obvious shortcomings since general anesthesia and regional anesthesia must be performed by anesthesiologists, not CRNAs. Despite these limitations, CRNAs are the only providers of anesthesia services in many areas.
Anesthesia is an essential component of surgical operations as it allows patients to undergo procedures safely and with minimal pain. Studies have shown that the number of anesthesiologists would have to increase greatly to meet future demand. Although legislation to incentivize anesthesiologists to provide services in rural areas has been proposed, CRNAs may be the answer to increasing demand for anesthesia services in the meantime. In the long run, however, anesthesiologists still need to be incentivized to practice in remote areas so that rural inhabitants have access to the same quality of care as their urban counterparts
“Protect Access to Rural Anesthesia Services.” American Association of Nurse Anesthetists. https://www.aana.com/docs/default-source/fga-aana-com-web-documents-(all)/mya2017-0 5–1pager-rural-anesthesia-030717.pdf?sfvrsn=275c49b1_4.
“Anesthesia Shortage.” OR Manager 26, no. 7 (2010). https://www.ormanager.com/wp-content/uploads/pdfx/ORMVol26No7AnesthesiaShortageDepends.pdf.
“H.R.2881 – 115th Congress (2017-2018): Medicare Access to Rural Anesthesiology Act of 2017.” United States Congress. June 21, 2017. Accessed November 05, 2018. https://www.congress.gov/bill/115th-congress/house-bill/2881.
“Important Role of Anaesthesia in Surgery.” HKU Li Ka Shing Faculty of Medicine. https://www.med.hku.hk/healthedu/issue216/e-issue216.pdf.
“Rural Hospital Programs.” Health Resources & Services Administration. October 01, 2018. Accessed November 05, 2018. https://www.hrsa.gov/rural-health/rural-hospitals/index.html.
” Rural Pass Through Legislation.” American Society of Anesthesiologists (ASA). Accessed November 05, 2018. https://www.asahq.org/advocacy-and-asapac/advocacy-topics/rural-pass-through-legislation.