Nav: Home

Neither increased access to surgery nor reduced costs achieved in states that 'opt-out' of requiring physician supervision for anesthesia

March 01, 2017

CHICAGO - "Opting-out" of the Medicare rule that requires anesthesia to be administered with physician supervision has little or no impact on access to either inpatient or outpatient surgery, according to a study published in Health Economics Review. Researchers also found the opt-out policy does not reduce costs, and in some cases may be associated with higher costs related to inpatient surgical care.

The study did not address why opting-out might increase costs. The researchers said several factors may contribute to this unexpected finding, including that nurse anesthetists may take longer to perform the same services, and working without physician supervision may lead to worse surgery outcomes, which requires additional treatment.

"The findings of this study underscore the point that before we make a policy or pass a new rule, we first need to rigorously study what the potential effects might be," said study lead author John Schneider, Ph.D., CEO of Avalon Health Economics. "A lot of states thought that by opting-out of the federal requirement, they would be increasing access to care. It turns out that simply opting-out is not a guarantee of increased access."

Since 2001, 17 state governors have exercised the option to opt-out of a federal rule that physicians supervise the administration of anesthesia by nurse anesthetists, most citing increased patient access to anesthesia care as the rationale for the decision.

The "opt out" provision was created due to a concern about a potential shortage of physician anesthesiologists, at least in some regions and states. The presumption was that allowing nurse anesthetists to practice without physician supervision would alleviate potential shortages, and enhance access to anesthesia care. Additionally, a lower professional service cost for nurse anesthetists practicing without physician supervision was presumed to lower anesthesia care costs.

This is the fourth study in just over a year that looked into whether the adoption of the opt-out rule impacted access to anesthesia care. All four studies found that opt-out does not increase access to anesthesia care. One study found that across urgent diagnoses, opt-out was not associated with increased access to anesthesia services. Another study found opt-out was associated with little or no increased access to anesthesia care for common procedures.

"The new study extends the literature on the impact of state opt-out policy by adding an assessment of its impact on costs of surgeries, and by assessing its impact on a wider variety of procedures requiring anesthesia services than in prior studies," the researchers wrote.

To analyze the effect of the opt-out rule on inpatient surgery, researchers used the largest publicly available all-payer (including all types of public and private insurance) health care database in the United States, which included many opt-out and non-opt-out states. For outpatient surgery, they used a database of outpatient surgery and services provided by hospital-owned and nonhospital-owned surgery facilities.

The outpatient analysis included three opt-out states (California, Colorado and Kentucky) and three non-opt-out states (Florida, Maryland and New Jersey). The analysis used data from multiple years of U.S. inpatient hospital discharges and outpatient surgeries. The outpatient database did not provide cost estimates for outpatient procedures, so the researchers were unable to evaluate the opt-out rule's effect on outpatient surgery costs.

"Unlike previous opt-out studies, the design of this study allowed us to better isolate the effect of the opt-out policy across states and over time," said Dr. Schneider.

"The primary intent of the opt-out rule was to improve access to anesthesia services by reducing barriers to utilize nurse anesthetists and increasing their scope of practice. In turn, the hypothesis is that the reduction in barriers will increase access to surgical care. In our study, we did not find evidence to support this belief," the researchers concluded.
-end-
The study, "Assessing the Impact of State 'Opt-Out' Policy on Access to and Costs of Surgeries and Other Procedures Requiring Anesthesia Services," was funded by the American Society of Anesthesiologists.

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring that physician anesthesiologists evaluate and supervise the medical care of patients before, during, and after surgery to provide the highest quality and safest care that every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount.

American Society of Anesthesiologists

Related Anesthesia Articles:

Coronavirus-infected patients needing emergency surgery: Anesthesia standards
Physicians describe the standardized procedure of surgical anesthesia for patients with COVID-19 infection requiring emergency surgery to minimize the risk of virus spread and reduce lung injury in a Letter to the Editor published in Surgical Infections, a peer-reviewed journal from Mary Ann Liebert, Inc. publishers.
Surgery with anesthesia not linked to indicator of Alzheimer's, Mayo study finds
Older adults who have surgery with general anesthesia may experience a modest acceleration of cognitive decline, even years later.
Choice of anesthesia may affect breast cancer metastases
A new study led by Stony Brook University Cancer Center researchers to be published in Nature Communications suggests that the choice of anesthesia may change the metastatic process of breast cancer by affecting the cytokine and microenvironment.
Is headache from anesthesia after childbirth associated with risk of bleeding around brain?
This study examined whether postpartum women with headache from anesthesia after neuraxial anesthesia (such as epidural) during childbirth had increased risk of being diagnosed with bleeding around the brain (intracranial subdural hematoma).
Music can be a viable alternative to medications in reducing anxiety before anesthesia
Music is a viable alternative to sedative medications in reducing patient anxiety prior to a peripheral nerve block procedure, according to a new Penn Medicine study.
In cases when patients under anesthesia experience anaphylaxis, hyperactive immune...
A study of 86 patients reveals how drugs used for anesthesia can induce life-threatening anaphylaxis (a dangerous type of allergic reaction) through an alternative immune pathway.
General anesthesia hijacks sleep circuitry to knock you out
In a study published online April 18 in Neuron, researchers found that general anesthesia induces unconsciousness by hijacking the neural circuitry that makes us fall sleep.
Anesthesia sends neurons down the wrong path in unborn rat babies
A study in Cerebral Cortex provides new insight into why -- and when -- anesthesia during pregnancy harms unborn brains.
Less anesthesia during surgery doesn't prevent post-op delirium
One in four older adults experiences delirium after surgery. Researchers at Washington University School of Medicine in St.
Focus on neuroscience, nociception to improve anesthesia, paper says
By focusing on nervous system circuits of nociception, the body's sensing of tissue damge, anesthesiologists can achieve unconsciousness in patients using less drug and manage post-operative pain better, leading to less need for opioids.
More Anesthesia News and Anesthesia Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Teaching For Better Humans 2.0
More than test scores or good grades–what do kids need for the future? This hour, TED speakers explore how to help children grow into better humans, both during and after this time of crisis. Guests include educators Richard Culatta and Liz Kleinrock, psychologist Thomas Curran, and writer Jacqueline Woodson.
Now Playing: Science for the People

#556 The Power of Friendship
It's 2020 and times are tough. Maybe some of us are learning about social distancing the hard way. Maybe we just are all a little anxious. No matter what, we could probably use a friend. But what is a friend, exactly? And why do we need them so much? This week host Bethany Brookshire speaks with Lydia Denworth, author of the new book "Friendship: The Evolution, Biology, and Extraordinary Power of Life's Fundamental Bond". This episode is hosted by Bethany Brookshire, science writer from Science News.
Now Playing: Radiolab

Space
One of the most consistent questions we get at the show is from parents who want to know which episodes are kid-friendly and which aren't. So today, we're releasing a separate feed, Radiolab for Kids. To kick it off, we're rerunning an all-time favorite episode: Space. In the 60's, space exploration was an American obsession. This hour, we chart the path from romance to increasing cynicism. We begin with Ann Druyan, widow of Carl Sagan, with a story about the Voyager expedition, true love, and a golden record that travels through space. And astrophysicist Neil de Grasse Tyson explains the Coepernican Principle, and just how insignificant we are. Support Radiolab today at Radiolab.org/donate.