What was the effect of Prospective Payment Legislation in 1983 on CRNA use in hospitals?

• A. Increased reimbursement for CRNAs in hospitals.
• B. Eliminated reimbursements for CRNAs entirely.
• C. Had no effect on reimbursement.
• D. Inadvertently created a disincentive to use CRNAs in hospitals, as hospitals were not reimbursed fully for CRNA services.

Answer: (D)

Prospective payment fixed payments per hospital admission mean the hospital’s revenue is set by the diagnosis-related group regardless of the actual care costs. If anesthesia services, including CRNAs, aren’t reimbursed separately beyond that fixed amount, hospitals absorb the cost of CRNA services within the flat payment. That creates a financial risk: adding or employing CRNAs may not raise reimbursement, so hospitals have a disincentive to use CRNAs as much as possible. The result is reduced use of CRNAs in hospitals under this system, rather than increased reimbursement or no change.