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http://anesthesiologynews.com/index.asp?section_id=3&show=dept&issue_id=598&article_id=14572
[FONT=Verdana, Arial, Helvetica, sans-serif]CMS Issues New Interpretive Guidelines.
[FONT=Verdana, Arial, Helvetica, sans-serif]Ted Agres. Certified registered nurse anesthetists are specifically permitted to administer labor epidurals for analgesia and to perform minimal to moderate sedation for other purposes without physician supervision under new interpretive guidelines for hospital anesthesia recently issued by the Centers for Medicare & Medicaid Services.
According to Section 482.52 of the Revised Hospital Anesthesia Services Interpretive Guidelines issued by CMS on Dec. 11, 2009, the provision of acute analgesia through an epidural or spinal route during labor and delivery is not considered anesthesia, and a certified registered nurse anesthetist (CRNA) administering these forms of anesthesia does not require supervision by the operating practitioner or anesthesiologist.
Since local anesthetics, as well as minimal and moderate sedation, are not considered anesthesia per se, they are not subject to the CRNA supervision requirements, said Thomas E. Hamilton, director of the CMS Survey and Certification Group, in a summary of the revisions.
However, should the physician or operating practitioner decide that an anesthesia effect (defined as loss of voluntary and involuntary movement and total relief of pain) is necessary for the safe operative (cesarean) delivery of the infant, the CRNA supervision requirement would apply, Mr. Hamilton added.
Critical-access hospitals and ambulatory surgical centers are not required to follow the CMS revisions. Neither are hospitals located in any of the 15 states that have opted out of CRNA oversight requirements with CMS (see Anesthesiology News January 2010, page 1).
This is something we have been working with the Medicare agency for about five years so they could understand the implications of what they had previously published, said James R. Walker, CRNA, president of the American Association of Nurse Anesthetists (AANA). We were pleased and felt that we had been heard when they published the changes, he told Anesthesiology News.
Earlier CMS interpretive guidelines required a CRNA administering anesthesia to be supervised by an anesthesiologist or operating practitioner who is immediately availabledefined as being physically located within the operative suite or in the labor and delivery unit and prepared to immediately conduct hands-on intervention and who is not engaged in activities that could prevent him or her from doing so.
Whoever was the operative practitioner, it was putting them in the position to be present, and that was neither the customary practice nor the reality of the workplacenor was it necessary, Mr. Walker said. So, we worked with the agency, and the resolution they defined [was] the placement of the epidural as analgesia more so than anesthesia, which is correct. It does bring about reduction in pain, but [is] not anesthesia per se.
The American Society of Anesthesiologists (ASA) disagrees. The administration of neuraxial analgesia and anesthesia require medical direction by a qualified physician. Administration of a major conduction block via a labor epidural can result in potentially life-threatening complications for mother and baby, said Alexander A. Hannenberg, MD, ASA president. The physiological effects and complications of analgesic doses of anesthetics in labor and anesthetic doses have more in common than differences. Dr. Hannenberg told Anesthesiology News that As anesthesiologists, we are the most highly trained experts to manage these situations.
http://anesthesiologynews.com/index.asp?section_id=3&show=dept&issue_id=598&article_id=14572
[FONT=Verdana, Arial, Helvetica, sans-serif]CMS Issues New Interpretive Guidelines.
[FONT=Verdana, Arial, Helvetica, sans-serif]Ted Agres. Certified registered nurse anesthetists are specifically permitted to administer labor epidurals for analgesia and to perform minimal to moderate sedation for other purposes without physician supervision under new interpretive guidelines for hospital anesthesia recently issued by the Centers for Medicare & Medicaid Services.
According to Section 482.52 of the Revised Hospital Anesthesia Services Interpretive Guidelines issued by CMS on Dec. 11, 2009, the provision of acute analgesia through an epidural or spinal route during labor and delivery is not considered anesthesia, and a certified registered nurse anesthetist (CRNA) administering these forms of anesthesia does not require supervision by the operating practitioner or anesthesiologist.
Since local anesthetics, as well as minimal and moderate sedation, are not considered anesthesia per se, they are not subject to the CRNA supervision requirements, said Thomas E. Hamilton, director of the CMS Survey and Certification Group, in a summary of the revisions.
However, should the physician or operating practitioner decide that an anesthesia effect (defined as loss of voluntary and involuntary movement and total relief of pain) is necessary for the safe operative (cesarean) delivery of the infant, the CRNA supervision requirement would apply, Mr. Hamilton added.
Critical-access hospitals and ambulatory surgical centers are not required to follow the CMS revisions. Neither are hospitals located in any of the 15 states that have opted out of CRNA oversight requirements with CMS (see Anesthesiology News January 2010, page 1).
This is something we have been working with the Medicare agency for about five years so they could understand the implications of what they had previously published, said James R. Walker, CRNA, president of the American Association of Nurse Anesthetists (AANA). We were pleased and felt that we had been heard when they published the changes, he told Anesthesiology News.
Earlier CMS interpretive guidelines required a CRNA administering anesthesia to be supervised by an anesthesiologist or operating practitioner who is immediately availabledefined as being physically located within the operative suite or in the labor and delivery unit and prepared to immediately conduct hands-on intervention and who is not engaged in activities that could prevent him or her from doing so.
Whoever was the operative practitioner, it was putting them in the position to be present, and that was neither the customary practice nor the reality of the workplacenor was it necessary, Mr. Walker said. So, we worked with the agency, and the resolution they defined [was] the placement of the epidural as analgesia more so than anesthesia, which is correct. It does bring about reduction in pain, but [is] not anesthesia per se.
The American Society of Anesthesiologists (ASA) disagrees. The administration of neuraxial analgesia and anesthesia require medical direction by a qualified physician. Administration of a major conduction block via a labor epidural can result in potentially life-threatening complications for mother and baby, said Alexander A. Hannenberg, MD, ASA president. The physiological effects and complications of analgesic doses of anesthetics in labor and anesthetic doses have more in common than differences. Dr. Hannenberg told Anesthesiology News that As anesthesiologists, we are the most highly trained experts to manage these situations.
