Practice Model Trends in Medicare Payments Across States and Regions

Additionally, AAs practice under physician delegation in two states. Because AAs cannot practice independently, if an AA is involved in a case, the care team model must be utilized to comply with state laws and most reimbursement regulations. Facilities also implement their own policies through bylaws and management decisions. * Other Influences. Because CRNAs practice under various team-oriented arrangements but can also work independently, the mere presence of CRNAs does not clearly drive either the use of team-based or undirected CRNA models. Attitudinal or cultural traits that drive organizational policies among facilities and payors are difficult to quantitatively measure at a state level. [...]the more abstract impact of these factors is illustrated in the diagram as diffuse external influences instead of explicit arrows among measurable terms. A measure for the share of payments in a state attributed to AAs was calculated by summarizing the total payments associated with AAs for those states and the years where they were authorized to create a measure of the percent of total payments associated with AAs. Because of potential inaccuracies related to administrative data, some states without AA authorization exhibited small amounts of payments for AA services, which were zeroed out.