Anesthesiologists, Certified Registered Nurse Anesthetists and Anesthesiology Assistants: Overvaluation By Providers Or Undervaluation By Payers

BackgroundConsidering that National Health Expenditures (NHE) in the United States (U.S.) have mounted to 4,124 billion dollars with 593.1 billion dollars (14.4%) spent on physician services in 2020, it will be interesting to see how specialties fared in terms of percentage of billed dollars approved to reflect on how NHE would have been faring if 100% billed dollars were approved. ObjectivesWhether (and by how much), as compared to other healthcare providers in the U.S., anesthesia providers (anesthesiologists, certified registered nurse anesthetists (CRNAs) and anesthesiology assistants) are being differently reimbursed in terms of approved dollars by Centers for Medicare & Medicaid Services (CMS) as percentages of dollars billed by providers. Materials and Methods: The source of data about approved dollars by CMS as percentages of dollars billed by providers is Denniston Data Inc. at Provider Ranking System (PRS) which provided deidentified cumulative tabulated data sourced from CMS public access reimbursement data for the years 2012-2020 to the author who, as a private citizen, had enrolled for annually renewed subscription to PRS. ResultsAmong the 73 specialties whose data was complete for all the nine years (2012-2020), the top three specialties with highest percentages of billed dollars which were approved (56% to 76%) were almost consistently chiropractic, optometry and clinical psychologist respectively and anesthesiology assistants, CRNAs and anesthesiologists respectively were consistently the bottom three specialties with lowest percentages of billed dollars which were approved (11% to 18%). ConclusionDuring 2012-2020, anesthesia providers got 11%-18% of their billed dollars approved by CMS and yet anesthesiologists averaging almost top 1% wages (99th percentile) nationally with CRNAs averaging top 5% wages (95th percentile) nationally pose the question what their wages would have been if their billed dollars were 100% approved by CMS.