Dear MSA Membership,


There has been considerable activity over the past few weeks culminating in several very important notifications from the Center for Medicare & Medicaid Services and the Department of Health & Human Services.   You know doubt received an earlier update on the release of the Accountable Care Organization (ACO) final regulations. In that regard, the ASA Ad Hoc ACO Taskforce along with ASA staff are working to analyze the 696 page document, and as soon as there is any information on its impact on the profession and our patients, I will let you know in a follow-up message.


In the meantime, I have included the release of two additional proposed rules...


New CMS Rules Include No Changes to Supervision Requirement


This week, the Centers for Medicare & Medicaid Services (CMS) released two proposed rules aimed at reforming existing Medicare and Medicaid regulations.  At the urging of ASA, the rules, which propose changes to a number of areas of patient care under the federal health programs, include no changes to the long-standing physician supervision patient safety standard. 


The two proposed rules, "Regulatory Revision to Promote Program Efficiency, Transparency and Burden Reduction" and "Reform of Hospital and Critical Access Hospital (CAH) Conditions of Participation (CoP)" are the result of an Obama-Administration initiative aimed at reviewing and reforming existing federal regulations.  A January 18, 2011, a Presidential Executive Order directed federal agencies, including the U.S. Department of Health and Human Services and CMS, to analyze rules that may be "outmoded, ineffective, insufficient or excessively burdensome, and to modify, streamline, expand or repeal them in accordance with what has been learned." 


In response to the order, CMS proposes changes to existing rules governing ambulatory surgical centers, hospital medical staff, CAH services and other areas of patient care.  In the hospital and CAH rule, CMS specifically proposes changes to the existing CoP, a broad set of rules for hospital and CAH operations of which the physician supervision standard is a part. However, no changes are proposed to the actual supervision portions of the CoP.


As part of the process leading up to the release of the proposed rules this week, the Department of Health and Human Services reported that they were asked to eliminate the supervision requirement. Commenters were referenced as suggesting that requiring a physician to supervise care was unnecessary because "the work can be done just as easily by Certified Registered Nurse Anesthetists (CRNAs)..." 


A commenter is also reported to have stated that the supervision standard requires "unnecessary supervision by an operating practitioner or an anesthesiologist upping costs by increasing staff members but not safety"  and to have urged "that all regulations and interpretive guidelines issued by CMS be reviewed with the intent of removing restrictions concerning anesthesia services provided by nurse anesthetists."


The two proposed rules are expected to be formally published next week in the October 24 Federal Register, the daily compendium of federal regulations. The rules will be the subject of public comment until December 17.  ASA will provide additional information to members about the proposed rule and commenting opportunities in coming days.  ASA plans to submit formal comments in response to both of these proposed rules.


ASA's August 26 post regarding the Administration's efforts is linked here... 

HHS to Undertake Significant Regulatory Review and Effort Could Impact Anesthesia Related Rules


The two CMS proposed rules are linked here...

Regulatory Revision to Promote Program Efficiency, Transparency and Burden Reduction

Reform of Hospital and Critical Access Hospital (CAH) Conditions of Participation (CoP)


As you can imagine, there was a considerable amount of effort put forth by the ASA. This task did not move forward without considerable opposition. ASA, joined by a number of lawmakers, urged CMS to maintain the supervision standard. ASA believes physician supervision ensures patient access to the safest, cost-efficient anesthesia care.  Accordingly, the Society remains strongly committed to maintaining the physician supervision standard on behalf of patients requiring anesthesia services. 

Best Regards,


Kenneth Elmassian, D.O., Director 
American Society of Anesthesiologists 
President, Michigan Society of Anesthesiologists


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