ANESTHESIA: Doctors and Nurses Spar Over HCFA Rules
Doctors and nurses continue their six-year battle over a HCFA proposal that removes doctor oversight of nurses administering anesthesia, the Washington Post reports. The American Society of Anesthesiologists and the American Association of Nurse Anesthetists are at odds over a recent HCFA announcement that, beginning this month, nurses may administer anesthesia for hospitals and ambulatory surgery centers without a doctor present. The agency would give states the option of retaining supervision regulations. Backed by the American Medical Society, state medical societies and specialist groups, anesthesiologists are hoping to attach a rider to unrelated legislation that would delay the rule's implementation. Sen. Mike DeWine (R-Ohio), chair of the Judiciary Committee's antitrust subcommittee, called for a hearing tomorrow to discuss the issue. He also urged HHS to conduct a comprehensive study of anesthesia results for Medicare patients prior to changing the guidelines.
The controversy is generating election year cash for some politicians and features an "all-star cast of recently hired lobbyists," including former Senate majority leader Bob Dole, who is going to bat for the doctors, and Bob Livingston (R-La.), a former House Appropriations Committee chair, fighting for the nurses. Dewine, who is up for reelection, received $20,000 from anesthesiologists and he's not alone: a political action committee for the doctors donated more than $1.1 million so far in this election. The nurses are spending money too, but much less. The nurse PAC spent under $400,000 from January 1999 through March. Anesthesiologists gave Rep. Bill Thomas (R-Calif.), chair of the House health subcommittee of Ways and Means, $5,000 and ran an ad campaign in his home town about patient safety. Nurses also wooed Thomas with a fundraiser.
Safety or Cash?
The nurse anesthetists claim that they handle roughly two-thirds of the estimated 26 million anesthesias each year, many in rural areas, with "generally excellent results." According to the Institute of Medicine, anesthesia safety has made "dramatic gains" in the past two years, but doctors argue the improvement is "largely a result of their oversight." They contend that if HCFA's regulations go into effect, patients' safety will be in jeopardy. But the main point of contention is the reimbursement fee: when nurses are supervised by doctors -- even if the doctor is only present for a few minutes -- they split the fees. Under the new rule, when nurses work alone, they will receive the entire fee (Morgan, 6/3).