cleansocks

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If an office wants to hire an anesthesiologist to do moderate-deep sedation for minor procedures below the neck:

1. what kind of regulatory requirements does the office have to satisfy before they can hire anesthesiologist to do this?

2. how should the anesthesiologist go about billing - by 15min increments? by case? how do they choose how much to charge?
a. if procedures covered by insurance
b. if procedures entirely "fee for service" (out of pocket - no insurance company involvement)

3. the office is willing to purchase necessary equipment and drugs (monitors including CO2, infusion pump, whatever airway stuff needed, IV stuff, etc)
a. OPA/NPA, laryngoscope, LMAs in case of emergency; ambu bag for ventilation good enough in case ventilation needed?
b. what anesthetics and emergent drugs would you have them stock? prop, midaz, fent, ketamine, phenylephrine, epi... vaso feels like definitely overkill but would make me feel safer somehow. would office have to get MH cart if they carry succ? or is that just an ASC rule? roc?
c. stock kits for emergency aline/central line?

4. does anesthesiologist have to let their insurance carrier know they'd be doing anesthesia at this location?

5. should anesthesiologist keep their own records (H&P, consent, intraop) or let the office hold onto these?

what other considerations are important?
 

sleepallday

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May 21, 2010
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If an office wants to hire an anesthesiologist to do moderate-deep sedation for minor procedures below the neck:

1. what kind of regulatory requirements does the office have to satisfy before they can hire anesthesiologist to do this?

2. how should the anesthesiologist go about billing - by 15min increments? by case? how do they choose how much to charge?
a. if procedures covered by insurance
b. if procedures entirely "fee for service" (out of pocket - no insurance company involvement)

3. the office is willing to purchase necessary equipment and drugs (monitors including CO2, infusion pump, whatever airway stuff needed, IV stuff, etc)
a. OPA/NPA, laryngoscope, LMAs in case of emergency; ambu bag for ventilation good enough in case ventilation needed?
b. what anesthetics and emergent drugs would you have them stock? prop, midaz, fent, ketamine, phenylephrine, epi... vaso feels like definitely overkill but would make me feel safer somehow. would office have to get MH cart if they carry succ? or is that just an ASC rule? roc?
c. stock kits for emergency aline/central line?

4. does anesthesiologist have to let their insurance carrier know they'd be doing anesthesia at this location?

5. should anesthesiologist keep their own records (H&P, consent, intraop) or let the office hold onto these?

what other considerations are important?

you probably shouldn't be doing it if you don't know what drugs and equipment you need...
 

AdmiralChz

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ASA has educational materials and guidelines on these subjects on their webpage, available for free if you're a member and even then probably still free if you're not.
 
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cleansocks

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ASA has educational materials and guidelines on these subjects on their webpage, available for free if you're a member and even then probably still free if you're not.

Oh okay I'll see if I can find it on the site
 

cleansocks

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ASC accreditation

We are looking into this. Our practice manager suggests that it is very labor intensive to get accredited......

Yah it is a long and expensive process, especially for Medicare.

But I wonder if that's the only regulatory body capable of accrediting an office for anesthesia. Seems like overkill if the procedures a very minor/non-invasive but transiently painful.
 
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