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June 2002
Volume 66 |
Number 6
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RESIDENTS' REVIEW
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| Protecting Our
Nation's Seniors: Another Reason to Get Involved With Your
State Society |
James F. Weller, M.D., Secretary
ASA Resident Component Governing Council
Over the past three years, ASA has made great efforts to influence
the decision of the Centers for Medicare & Medicaid Services (CMS)
on physician supervision of nurse anesthetists. On November 13,
2001, CMS published its final ruling on this issue, leaving in
place the federal requirement for physician supervision of nurse
anesthetists participating in the care of Medicare patients. This
was a huge victory for ASA and for the safety of elderly patients
throughout the country. Unfortunately, the final rule allows the
governor of a state to opt out of the supervision clause after
consultation with the state medical and nursing boards if the
governor perceives that opting out is in the best interest of
his or her constituents.
Since November, the governors of four states have elected to
opt out of the physician supervision clause. On December 12, 2001,
less than a month after publication of the CMS final rule, Governor
Thomas Vilsack made Iowa the first state to opt out of physician
supervision. In February, Governor Mike Johanns of Nebraska became
the second governor to opt out. Idaho and Minnesota have since
followed suit. Component societies in several other largely rural
western states (Alaska, Kansas, Montana, North Dakota, Oregon,
Washington and Wyoming) are currently engaged in the ongoing debate
over opting out of the physician supervision clause of the CMS
rule.
Now that the focus has shifted from the federal to the state
level, what can we do as residents to continue the fight for the
safest possible perioperative care for our nation's seniors? First,
we must recognize that the arguments regarding patient safety
that ultimately convinced federal regulators to maintain the physician
supervision rule may be less cogent to state governors. Particularly
in rural states, governors may believe that supervision of a nurse
anesthetist by a physician (not necessarily an anesthesiologist)
somehow restricts access to care, which it does not. Furthermore,
our surgical colleagues, especially in rural areas, may see the
opportunity to opt out of physician supervision as absolving them
of responsibility for the medical management of their patients
while in the operating room. It is vital that we communicate to
them the indispensable role their medical training has prepared
them to play in assuring perioperative patient safety.
In order to best address the specific issues unique to each state,
it will be incumbent upon each state's anesthesiology society
to organize proactively and to educate its political leadership.
Many states already have laws mandating physician involvement
in anesthesia care. Fortunately, every ASA member also is a member
of his or her respective state society of anesthesiologists. It
is more important than ever, however, that members become actively
involved at the state level by attending state society meetings,
participating in organizational efforts and assisting in attempts
to educate state governors and legislatures about the importance
of physician involvement in anesthesia care.
The debate over physician supervision of nurse anesthetists is
a good reason for residents to get involved in their state component
societies, but it is not the only one. Activism at the state level
offers a unique opportunity for physicians to engage their communities
on a positive note as patient advocates. In a field that continues
to struggle for recognition, it is now more important than ever
that the future leaders of our specialty become leaders in their
communities.
While the political focus has shifted from the federal to state
government, residents should not abandon their national organization.
It is a testament to the tireless efforts of ASA and the ASA Political
Action Committee that we now have the opportunity to demonstrate
the importance of physician supervision of nurse anesthetists
at the state level. Now is not the time to abandon the national
leadership but rather to take on the new challenge of providing
leadership at the state level.
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James
F. Weller, M.D., is a CA-3 resident in the Department of Anesthesiology
and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore,
Maryland. |
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