Any thoughts on new CMS rules?

[Mman]

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Link from ASA describing new CMS guidelines

I'd particularly like thoughts on this section...

Immediately Available Specifically Defined - guidelines now define “immediately available” (pg. 11, 12) to mean that the anesthesiologist must be: Physically located within the same area as the CRNA or AA
o E.g., in the same operative suite, same labor and delivery unit, or same procedure room Not otherwise occupied in a way that prevents the anesthesiologist from immediately conducting hands-on intervention, if needed



Apparently I am not allowed to supervise cases in more than 1 physical location at a time anymore??? C-section going in the OB suite 50 yards from the main ORs? No can do anymore according to this. 2 offsite cases that are not in the same physical location? Gotta have one anesthesiologist for each and they can't be supervising anything else.

 

[countingdays]

Link from ASA describing new CMS guidelines

I'd particularly like thoughts on this section...

Immediately Available Specifically Defined - guidelines now define “immediately available” (pg. 11, 12) to mean that the anesthesiologist must be: Physically located within the same area as the CRNA or AA
o E.g., in the same operative suite, same labor and delivery unit, or same procedure room Not otherwise occupied in a way that prevents the anesthesiologist from immediately conducting hands-on intervention, if needed



Apparently I am not allowed to supervise cases in more than 1 physical location at a time anymore??? C-section going in the OB suite 50 yards from the main ORs? No can do anymore according to this. 2 offsite cases that are not in the same physical location? Gotta have one anesthesiologist for each and they can't be supervising anything else.

They really need to start beta testing bureaucrat's policies to correct obvious flaws before unleashing them.

 

[deleted126335]

Link from ASA describing new CMS guidelines

I'd particularly like thoughts on this section...

Immediately Available Specifically Defined - guidelines now define “immediately available” (pg. 11, 12) to mean that the anesthesiologist must be: Physically located within the same area as the CRNA or AA
o E.g., in the same operative suite, same labor and delivery unit, or same procedure room Not otherwise occupied in a way that prevents the anesthesiologist from immediately conducting hands-on intervention, if needed



Apparently I am not allowed to supervise cases in more than 1 physical location at a time anymore??? C-section going in the OB suite 50 yards from the main ORs? No can do anymore according to this. 2 offsite cases that are not in the same physical location? Gotta have one anesthesiologist for each and they can't be supervising anything else.

e.g.: exempli gratia. Which means "for example" It does not not mean limited to.

 

[Mman]

I'm aware of what e.g. means. They have essentially stated that an anesthesiologist must be in the same physical unit as any case that they are supervising.

What percentage of c-sections in this country do you think have an anesthesiologist physically on the OB unit the entire duration of the case? What percentage of offsite cases physically have an anesthesiologist at the location the entire duration of the case?

If you really want to get picky, forget ever going to the cafeteria to get lunch if you have a case going on.

 

[Sandman2009]

Is this not the stance that anesthesiologists want? To have more supervision on other providers?

 

[Mman]

Is this not the stance that anesthesiologists want? To have more supervision on other providers?

Supervising and directing the care of a patient is a good thing. It's good for the patients.

Having a rule that states where you must stand while you do that is a bad thing. I'll wager a guess that >90% of the hospitals in the country do not have enough anesthesiologists to meet this criteria 24/7 as they are currently staffed. Of the 10-15 I've worked at or rotated through as a medical student or resident or attending, I can't think of a single one that could meet the standard at all times. ICU's have 10 or 20 or even 40 beds with a single physician supervising and they may or may not be physically present in the unit at any given time. I think it's a little outrageous for CMS to suggest that an anesthesiologist cannot supervise a c-section on an OB suite and a lap chole in the OR 50 yards away at the same time.

A simple solution becomes just having anesthesiologists do their own cases for all cases out of the main OR because it is a waste of money to pay a CRNA to do a case with an MD. That's not good for efficiency, but it's cheaper than trying to require 1:1 supervision.

 

[Sandman2009]

Thanks for a real answer. 'preciated.

 

[N-Surge]

How far does this stuff go? Will I now need an anesthesiologist in the room for local, when I am removing a mole? 🙄

Being more serious, how does this affect the role of the CRNA with respect to that of the Anesthesiologist?