The 2012 Legislative Session resulted in two significant wins for patients in Missouri and Tennessee.

The Missouri General Assembly passed legislation that prohibits non-physicians from performing fluoroscopic injections around the spinal cord.  SB 682 provides that only a licensed physician may perform certain techniques in the course of diagnosing or treating pain which is chronic, persistent, or intractable, or occurs outside of a surgical, obstetrical, or post-operative course of care.  Only licensed physicians are authorized to perform the following techniques: ablation of nerves, placement of drugs in the spinal column under fluoroscopic guidance, laser or endoscopic discectomy, and surgical placement of intrathecal infusion pumps or spinal cord stimulators.  The Act does not apply to inter-laminar lumbar epidural injections performed at a hospital or ambulatory surgery center under certain circumstances.  SB 682 does not apply to surgical or obstetrical anesthesia services or post-operative pain control by a nurse anesthetist or anesthesiologist assistant.  The bill is awaiting Governor Jay Nixon’s signature. 

Congratulations to the Missouri Society of Anesthesiologists for pushing this through the General Assembly in one legislative session!

Click here to review S.B. 682. 

In Tennessee, legislation was enacted that restricts who can perform or supervise interventional pain management in unlicensed facilities.  Effective July 1, 2013, the law prohibits the practice of steroidal spinal injections by an advanced practice nurse, including nurse anesthetists, and physician assistants in an unlicensed facility, unless under the direct supervision of a Tennessee physician.  Such a physician must be actively practicing spinal injections and hold current privileges to do so at a licensed facility.  Direct supervision is defined as being physically present in the same building as the APN or PA at the time the invasive procedure is performed.

Several efforts to exclude nurse anesthetists from the legislation failed.  From 2008-2010 Tennessee accounted for 58% of all Medicare billing nationally for such procedures done by nurses and physician assistants.

The legislation can be found here.  Congratulations to the Tennessee Society of Anesthesiologists!