American Society of Anesthesiologists Endorses New Medicare Rule: Doctors Will Stay Involved in Anesthesia Care

    PARK RIDGE, Ill., Nov. 13 /PRNewswire/ -- Action today by the Bush
 administration brings to a close a nearly four-year battle to keep anesthesia
 safe for all patients.
     The Centers for Medicare & Medicaid Services (CMS), formerly the Health
 Care Financing Administration, released its final regulatory rule mandating
 that physicians supervise patients' anesthesia care in all Medicare- and
 Medicaid-approved hospitals and ambulatory surgical centers.
     According to American Society of Anesthesiologists (ASA) President Barry
 M. Glazer, M.D., "The Bush administration has preserved an important patient
 safety measure that had been protecting patients for more than 35 years before
 it was discarded by the Clinton administration."
     Last January, two days before leaving office, President Clinton put
 through a change to the Medicare anesthesia supervision rule that would have
 allowed anesthesia nurses to give anesthetics to patients without a doctor
 being involved in that care before, during and after surgery.  The rule change
 was first proposed in December 1997.
     The new rule as published reflects for the most part what ASA, the medical
 community, patient advocates, members of Congress and thousands of senior
 citizens have been supporting -- that the safest possible anesthesia care a
 patient can receive occurs when a physician is involved in that care.
     "We are cautiously optimistic about this rule," Dr. Glazer said.  "While
 the new rule preserves the much-needed physician-supervision requirement,
 there are some portions that could be exploited and abused by those opposed to
 having a physician involved in every anesthetic."
     The newly rewritten Conditions of Participation, which every Medicare- and
 Medicaid-approved health care facility must follow, will continue to require
 physician supervision of anesthesia nurses in hospitals and ambulatory
 surgical centers.  State governors, however, could opt to have one or more
 facilities in the state excluded from this requirement after meeting certain
 loosely defined criteria established by the Department of Health and Human
 Services (HHS).  A governor would have to:
 
      -- Consult with the state boards of medicine and nursing;
      -- Demonstrate that the change is consistent with state law; and
      -- Attest that the requested change is in the best interest of the
         citizens of that state.
 
     Should some states decide to drop physician supervision for its Medicare-
 Medicaid population, HHS' Agency for Healthcare Research and Quality would
 conduct a prospective patient safety study to assess patient outcomes relating
 to the work of unsupervised anesthesia nurses in those states versus states
 where they continue to be supervised by a physician.
     Dr. Glazer said that patient safety advocates remain wary of the state
 opt-out provision of the new rule because, according to HHS, the criteria was
 left vague so as not to infringe on states' rights to regulate the health care
 professions in that state.
     "HHS' opt-out criteria fails to adequately define what specific procedures
 and protocols a state governor would have to follow to opt out of, or back
 into, the supervision rule," he said.  "We expect that any governor
 considering this option will want to do what is best for the citizens of that
 state and will base such a decision on sound science, not political pressure."
     Yet retention of the national standard for continued physician supervision
 of anesthesia care -- a standard that has been in effect consistently since
 the Medicare program was created in the mid-1960s -- is a victory for many
 people, young and old, who will have surgery in the coming months or years,
 Dr. Glazer said.
     "We are pleased that the Bush administration chose to listen to the
 hundreds of thousands of medical professionals, senior citizens, patient
 advocates, members of Congress and civic leaders who voiced their support for
 continuing to require that a physician be involved in every patient's
 anesthesia care.
     "It was the right thing to do," Dr. Glazer said.
 
     The American Society of Anesthesiologists (ASA) represents more than
 36,000 physicians dedicated to patient safety and quality medical care.
 Founded in 1905, ASA is a scientific and educational association of
 anesthesiologists that was organized to advance the practice of anesthesiology
 and to improve the quality of care of the anesthetized patient.  It is the
 largest organization of anesthesiologists in the world.
 
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SOURCE American Society of Anesthesiologists

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