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Rural Pass-Through Legislation and Anesthesia

rural pass-through

Rural Pass-Through is a crucial initiative to help bridge the healthcare gap between urban and rural areas. These programs aim to improve healthcare access in underserved rural regions of the U.S. by addressing financial challenges that may deter healthcare providers from moving to and establishing practices in these areas. Administered through Medicare, rural hospitals may pay for the costs of nurse anesthetists and anesthesiologist assistants (“Improve Rural Health Care Access: Strengthen the Anesthesia Rural Pass-through Frequently Asked Questions”). These rural hospitals can pay for the services of anesthesia providers through Medicare Part A, which is considered a “pass-through” approach. Traditionally, Medicare Part B is used as payment for anesthesia services (“Improve Rural Health Care Access: Strengthen the Anesthesia Rural Pass-through Frequently Asked Questions”).

The Rural Pass-Through was initially to be a temporary solution to ensure access to anesthesia health professionals in rural areas. This program was created in the 1980s (“Rural Pass-through Provision Included in Newly Introduced Senate Legislation”, 2011). However, this program is pivotal to healthcare delivery in rural areas and was made permanent for this reason. Rural hospitals with financial constraints and low patient volumes can pay for anesthesia providers through Medicare Part A (“Rural Pass-through Provision Included in Newly Introduced Senate Legislation”, 2011). However, there are specific criteria rural hospitals must meet to qualify for the rural pass-through including: employing no more than one full-time equivalent of an anesthesia provider and having the provider to agree not to bill under Medicare Part B for services. Lastly, hospitals cannot complete more than 800 anesthesia procedures a year (“Improve Rural Health Care Access: Strengthen the Anesthesia Rural Pass-through Frequently Asked Questions”). However, Medicare Part A can only be used to fund nurse anesthetists and anesthesiologist assistants, not physicians.

Now that rural pass-through is permanent, more associations, specifically the American Society of Anesthesiologists, are advocating for this program to include physician anesthesiologists given that there is also a large shortage of physician anesthesiologist providers in rural areas. Physician anesthesiologists can offer a unique skill set and range to help augment the services provided by hospitals. Incorporating physician providers into this plan would not exclude other anesthesia providers from participating in the pass-through mechanism (“Improve Rural Health Care Access: Strengthen the Anesthesia Rural Pass-through Frequently Asked Questions”). This is especially beneficial given the unique patient needs in rural areas.

Ultimately, the rural pass-through program has significantly enhanced healthcare access in rural areas and has the potential to impact care delivery even more. By extending the scope of the now permanent rural pass-through legislation to include physician anesthesiologists, states can further address healthcare provider shortages and health disparities unique to rural areas, benefitting patient care (“Improve Rural Health Care Access: Strengthen the Anesthesia Rural Pass-through Frequently Asked Questions”). The American Society of Anesthesiologists is currently advocating for H.R. 5256, known as the Medicare Access to Rural Anesthesiology Act, to advocate for this very concept (“ASA Applauds Introduction of Medicare Access to Rural Anesthesiology Act; Legislation Will Increase Rural Patients’ Access to Physician Anesthesia Care”, 2023).

References

“ASA Applauds Introduction of Medicare Access to Rural Anesthesiology Act; Legislation Will Increase Rural Patients’ Access to Physician Anesthesia Care.” American Society of Anesthesiologists (ASA), American Society of Anesthesiologists, 23 Aug. 2023, https://www.asahq.org/about-asa/newsroom/news-releases/2023/08/asa-applauds-introduction-of-medicare-access-to-rural-anesthesiology-act.

“Improve Rural Health Care Access: Strengthen the Anesthesia Rural Pass-through Frequently Asked Questions.” American Society of Anesthesiologists (ASA), American Society of Anesthesiologists, https://www.asahq.org/advocating-for-you/rural-pass-through.

“Rural Pass-through Provision Included in Newly Introduced Senate Legislation.” American Society of Anesthesiologists (ASA), American Society of Anesthesiologists (ASA), 13 Oct. 2011, https://www.asahq.org/advocacy-and-asapac/fda-and-washington-alerts/washington-alerts/2011/10/rural-pass-through-provision-included-in-newly-introduced-senate-legislation.

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