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New Medicare Anesthesia Guidelines |
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Medicare Issues New Anesthesia Interpretive Guidelines for Hospitals
CMS No Longer Requires Physician Supervision of CRNAs Providing Labor Epidural Analgesia, Moderate Sedation, in Hospitals Participating in Medicare.
The Centers for Medicare & Medicaid Services issued new Medicare hospital conditions of participation interpretive guidelines for anesthesia services Dec. 11. Under the new guidelines, Medicare no longer requires physician supervision of labor and delivery epidural analgesia and moderate sedation services provided by CRNAs. In another change, Medicare now requires that deep sedation with propofol in the operative setting requires the involvement of an anesthesia professional such as a Certified Registered Nurse Anesthetist (CRNA).
With respect to labor and delivery epidural analgesia, the new guidelines state:“The administration of medication via an epidural or spinal route for the purpose of analgesia, during labor and delivery, is not considered anesthesia and therefore is not subject to the anesthesia supervision requirements at 42CFR 482.52(a).” Further, an illustration in the guidelines specifies that “analgesia via epidurals / spinals for Labor & Delivery is permitted to be administered by CRNAs without MD supervision.” In states that had not opted-out from the Medicare physician supervision mandate on CRNAs, the agency’s previous guidelines required operating practitioner supervision to be “immediately available … physically located … within the labor and delivery unit,” a requirement that burdened smaller hospitals in particular without increasing patient safety.
With respect to deep sedation using propofol, the new guidelines state:“An example of deep sedation would be a screening colonoscopy when there is a decision to use propofol, so as to decrease movement and improve visualization for this type of invasive procedure. Because of the potential for the inadvertent progression to general anesthesia in certain procedures, it is
necessary that the administration of deep sedation/analgesia be delivered orsupervised by a practitioner as specified in 42 CFR 482.52(a).” The agency’s previous guidelines did not make distinctions between general anesthesia,
moderate sedation, monitored anesthesia care (MAC), and analgesia, as the new guidelines do.
The new guidelines also state that “individual operating practitioners do not need to be granted
specific privileges to supervise a CRNA.”
The guidelines take effect immediately, Dec. 11, 2009, with Part B contractors and state survey agencies directed to
inform facilities and providers of the changes within 30 days.
The new guidelines speaking to aspects of operating practitioner supervision of nurse anesthetists do not
apply in the 15 states that have “opted out” from the Medicare physician supervision mandate. Nor did the previous guidelines apply in opt-out states.
For more information, read Medicare hospital interpretive guidelines for anesthesia services.
to these documents posted on www.aana.com will
be provided shortly.
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