Comments
It is clear that CMS and its office bearers seem to have little idea what surgical care is all about. One mistake or lack of timely intervention and the patient could be dead. There is a reason a why specialist anesthesiologist physician whose training spans over close to 12 to 15 years and costs close to a million dollars is delegated with the primary responsibility of surgical care of patients. The nurse is trained to work under the supervision of an anesthesiologist who evaluates a patient, understands the associated anesthetic and surgical risk and above all proposes a plan that either he/she or one of his or her designee executes . Remember 100% of the rescues in the operating rooms are performed by physician anesthesiologist in united states. And 100% of the sickest patients undergoing high risk procedures are performed by Physician anesthesiologists. They catch the problems before, during and after surgery. Todays patients coming to ASE are sicker, older, have multiple co-morbid conditions that only a seasoned physician anesthesiologist can evaluate and treat. Almost 100% of the medicare patients that CMS is responsible for will be placed in great peril, and by the time data becomes available a number of patients would have suffered serious damage or death due to this policy change. And frankly, I can't understand one setting where, why sickest of the sick should not get the benefit of a Physician Anesthesiologist. It clearly appears to be about money or a clear attempt to discriminate against the under privileged patients who are frail, sicker and poor and live in rural or underserved areas. This does little to improve access, however, it surely creates a double standard, a double whammy, because with this ruling and similar rulings in the past sicker, poorer, rural and above all medicare beneficiaries ( over 67 years, the sickest population) now will be offered cheap and substandard care.
As a physician anesthesiologist, I am deeply concerned that in the Medicare Physician Fee Schedule proposed rule, CMS is proposing to allow nurse anesthetists to perform the preoperative assessment of anesthetic risk and presurgical evaluation in an ASC setting. This is a deeply troubling proposal that will have a negative impact on patient safety.
I oppose this proposed change because it would jeopardize the safety of patients. Physicians have the medical background necessary to assess the patient’s underlying condition in an objective, evidence-based and patient-centric way. As a physician anesthesiologist, I have the necessary knowledge and skills to assess the patient with respect to anesthetic risk, and also to assess whether each patient’s preoperative management has been optimized prior to undergoing surgery. Nurse anesthetists do not have the same clinical background or depth of training in clinical issues. Nurse anesthetist training is limited to anesthesia care delivery, not risk assessment, diagnosis or medical decision making outside the scope of an anesthetic.
Thank you,
Dr. Govind Rajan M.B.,B.S., FAACD, FASA
