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In 2001, a final rule was adopted which amended the Medicare and Medicaid anesthesia Conditions of Participation (COPs) for hospitals, critical access hospitals (CAHs) and ambulatory surgical centers (ASCs). The final rule continued the requirement for physician supervision of nurse anesthetists but allowed state governors to “opt-out” of this requirement under certain circumstances. Since amending the Medicare safety rule, governors in 17 states have opted-out.  

Since becoming law in 1966, Medicare has supported a team approach to anesthesia care, requiring that it be performed by a physician or a physician-supervised nurse anesthetist or physician anesthesiologist-supervised anesthesiologist assistant. The role of the physician anesthesiologist is to medically evaluate the patient’s fitness for surgery and anesthesia, determine potential risk, manage the patient’s medical condition during surgery, treat any medical complications and supervise post-operative care. In the absence of a physician anesthesiologist, there is only one other medical professional in the operating room with the education and training to perform these services: the surgeon.  

Nurse anesthetists are a valued member of the anesthesia team, but their nurse education and limited clinical training does not equal the medical education and training of a physician. Nurse anesthetists are not trained in medical decision making, differential diagnoses, medical diagnostic interpretations or medical interventions. Removing physician supervision of anesthesia care makes no more sense than removing it from any other critical care location.

The 17 states that have opted-out are:

• Iowa (December 2001)    
• Nebraska (February 2002)   
• Idaho (March 2002) 
• Minnesota (April 2002) 
• New Hampshire (June 2002) 
• New Mexico (November 2002) 
• Kansas (March 2003)
• North Dakota (October 2003) 
• Washington (October 2003)
• Alaska (October 2003) 
• Oregon (December 2003) 
• Montana (January 2004) 
• South Dakota (March 2005) 
• Wisconsin (June 2005) 
• California (July 2009) 
• Colorado (September 2010:
• Critical Access Hospitals and specified rural hospitals)
• Kentucky (April 2012)

To learn more about the importance of the patient centered, physician-led anesthesia care team, visit www.asahq.org/WhenSecondsCount

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