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
"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