ANESTHESIA: ‘Turf War’ Rages Pending OMB Decision
Anesthesiologists and nurse anesthetists remain "at each other's throats" in a political " turf war" over rules for administering anesthesia to Medicare patients, the New York Times reports. In 1997, HCFA proposed lifting a federal rule that required doctors to supervise nurse anesthetists -- a plan that now awaits final approval from the Office of Management and Budget. While nurses support dropping the supervision requirement, doctors have raised doubts about its effects on the quality of patient care. The move, designed to lower health care costs, has "inflamed" the conflict between doctors and nurses (New York Times, 10/8).
Patient Safety or Greedy 'Big Boys?'
For example, anesthesiologists question whether unsupervised nurses have the "fortitude to challenge a doctor and halt surgery" if necessary. Although Dr. Jim DeFontes, anesthesia coordinating chief for the Southern California Kaiser Permanente Medical Group, respects nurses, he warns that "we need to be careful how far we expand scopes of practice and allow people to practice unsupervised. There's a lot of financial pressure to do that" (Allen, Los Angeles Times, 10/9). Dr. Ann Still, professor of anesthesiology at the University of Alabama-Birmingham, agreed. "There's no comparison [between anesthesiologists and nurse anesthetists]. [T]he physician takes control; they're the most qualified person in that operating room," she said, adding that leaving a nurse unsupervised "definitely could jeopardize a nurse's career while jeopardizing a patient's safety." She noted that anesthesiologists have eight years of education -- four years of medical school and four years of specialized training -- while nurse anesthetists receive a four-year nursing degree and two years of training. Still, nurse anesthetists called the quality of care argument a "smoke screen." Kathy D'Andrea Knipe, president of the North Carolina chapter of the American Association of Nurse Anesthetists, said, "This is a game that's been going on for years. The bottom line is money, and we're talking big bucks. The big boys are afraid of losing their cut of the pie." The New York Times reports that hospitals and outpatient clinics could "save substantially" if HCFA drops the supervision requirement. Anesthesiologists earn an average of $240,000 annually, while nurse anesthetists earn about $94,000 per year.
In Congress, however, many lawmakers remain "unpersuaded" by nurses' arguments. Both Sens. Jesse Helms (R-N.C.) and Daniel Patrick Moynihan (D-N.Y.) back the supervision rule, although Sen. Arlen Specter (R-Pa.) has sided with nurses. Both sides have used "intense" lobbying campaigns to sway legislators -- with the doctors group pouring $1 million into political campaigns and the nurses group contributing $400,000 -- resulting in a political "stalemate." According Robert Reischauer, president of the Urban Institute, "[T]his is really an argument over whether the shift would affect quality; everyone knows it would affect costs. This is a battle in a larger war -- and a war that could go on for decades" (New York Times, 10/8).