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New York’s 2018-2019 state fiscal year budget excluded a provision that would have undermined physician-led anesthesia care and was strongly opposed by both the New York State Society of Anesthesiologists (NYSSA) and the American Society of Anesthesiologists (ASA). The new fiscal year began April 1, 2018.
As originally proposed, Part H of the Governor’s health budget (A9507/S7507) would have eliminated physician supervision of nurse anesthetists and substituted a very weak collaboration arrangement. The collaboration relationship would not of required a physician to be at the same location. In fact, the collaborator did not have to be a physician, and could be a hospital administrator. Beyond significantly lowering the standard of anesthesia administration in the state, the bill would have also provided nurse anesthetists with unrestricted prescriptive authority, allowing more than 1,240 mid-level providers to prescribe narcotics at a time when the country is experiencing a critical opioid epidemic.
Claims in the bill language that there would be $10 million in savings were immediately refuted as under Medicare and Medicaid, reimbursement for anesthesia services is exactly the same whether it is administered by a physician anesthesiologist or by a nurse anesthetist who is medically directed by a physician anesthesiologist or supervised by a surgeon. Nurse anesthetists claims that they already provide the vast majority of rural and low income urban care were similarly shown to be inaccurate as there over three times as many practicing physician anesthesiologists in New York and most of the nurse anesthetists practice in and around New York City at the large hospitals. Many lawmakers also understood that if signed into law, Part H would have created a two-tier anesthesia delivery system in New York. Patients in more economically favorable positions would have continued to benefit from and have ready access to physician anesthesiologists while those of lesser means would be required to utilize nurse anesthetists.
For nearly two decades, the New York Legislature has rejected nurse anesthetists efforts to eliminate physician supervision safety requirements. ASA commends New York lawmakers for again putting patient safety first and removing this provision that would have undermined patient safety.
