Provider turf wars and Medicare payment rules

• 成果类型: Article
• 署名作者: Chen, Alice J.; Munnich, Elizabeth L.; Parente, Stephen T.; Richards, Michael R.
• 署名单位: University of Southern California; University of Louisville; University of Minnesota System; University of Minnesota Twin Cities; Baylor University; University of Southern California
• 刊物名称: JOURNAL OF PUBLIC ECONOMICS
• ISSN/ISSBN: 0047-2727
• DOI: 10.1016/j.jpubeco.2022.104812
• 发表日期: 2023
• 关键词: Anesthesia; physicians; Certified registered nurse anesthetists; Provider regulation; Scope of practice; medicare; quality of care

摘要

Barriers to entry and scope of work restrictions are common features of US labor markets, especially within healthcare industries. However, concerns over access and costs of care have encouraged some deregulation. We empirically explore relaxed occupational rules of anesthesia care whereby physician -trained anesthesiologists and certified registered nurse anesthetists (CRNAs) perform overlapping ser-vices but often engage in joint production. After CRNAs were granted practice independence, we find only modest (3%) reductions in anesthesiologist billing for CRNA supervision and no evidence of greater use of CRNAs. Our results caution policymakers against overestimating the downstream impact resulting from removing these provider regulations.(c) 2022 Elsevier B.V. All rights reserved.