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ASA Policy
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 24 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 valued members 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 24 states that have opted-out are:
To learn more about the importance of the patient centered, physician-led anesthesia care team, visit Made for This Moment or email [email protected].
Additional Resources
Date of last update: August 3, 2023
