Medicare

Pursuant to a congressional request, GAO provided information on: (1) Medicare reimbursements for radiologists, anesthesiologists, and pathologists (RAP); and (2) the market structure for RAP services.

GAO found that Medicare generally pays RAP on the same basis as other physicians, but limits reimbursement for: (1) inpatient radiology services because radiologists' capital costs for such services are lower; and (2) anesthesiology support services. GAO also found that: (1) many RAP have written or verbal agreements with their hospitals that grant them exclusive rights to perform RAP services; (2) hospitals have little incentive to control costs in contracting for RAP services, and the market is not affected by competition; (3) RAP are among the physicians with the highest net income and the highest return on medical education costs; (4) Medicare has no special requirements for prepayment review of RAP claims; and (5) there was considerable variation in Medicare payments for RAP services among the geographic areas that it examined.