Background: Interstate variations among anesthesia providers in terms of their submitted charge amounts with corresponding Medicare allowed amounts have not been recently explored. Objective: To quantify interstate variations in submitted charge amounts in relation to corresponding Medicare allowed amounts for the services provided by anesthesia providers during 2013-2021 for Medicare beneficiaries in the United States (U.S.). Materials and Methods: Public Use Files for 2013-2021 period from Centers for Medicare & Medicaid Services were accessed to generate cumulative excel sheets of de-identified anesthesia providers data according to anesthesia providers stated location in fifty U.S. states and the District of Columbia. Thereafter, total number of providers, total number of services, total submitted charge amounts and total Medicare allowed amounts were finally tabulated according to the year of billed anesthesia service as well as according to anesthesia providers state. Results: The submitted charge amount to Medicare allowed amount ratios varied from 4-9 across the states in 2013 for anesthesiologists as well as certified registered nurse anesthetists (CRNAs). These ratios worsened to 5-13 across the states for anesthesiologists in 2021 while these ratios worsened to 5-12 across the states for CRNAs in 2021. The greatest number of anesthesiologists serving Medicare beneficiaries have been located in California across the years while the greatest number of CRNAs serving Medicare beneficiaries have been located in Florida across the years. Overall, some states have more anesthesiologists per 100,000 population serving Medicare beneficiaries with District of Columbia having the maximum (28 anesthesiologists per 100,000 population) while some states have more CRNAs per 100,000 population serving Medicare beneficiaries with North Dakota having the maximum (38 CRNAs per 100,000 population). Conclusion: Over the years (2013-2021), ratios of submitted charge amounts to Medicare allowed amounts have variably worsened for anesthesiologists and CRNAs serving Medicare beneficiaries across U.S. irrespective of the state stated by anesthesiologists and CRNAs as their primary location per National Plan and Provider Enumeration System.
Competing Interest StatementThe authors have declared no competing interest.
Funding StatementThis study did not receive any funding
Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
Wayne State University: IRB Administration Office determined that this project did not meet the definition of Human Participant Research subject to IRB oversight and review because of public use files from CMS
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
Data AvailabilityAll data produced in the present work are contained in the manuscript with links how to access raw data at public use files from CMS contained in the supplementary files
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