Archive April 2018 XIX, No. 4

Anesthesia Alert: Cataract Surgeons Giving Anesthesia?

Insurer says anesthetists aren't needed for most cataract cases.

JoEllen McBride

JoEllen McBride, PhD

BIO

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A major health insurer wants to deny coverage of anesthesiology services during cataract surgery, saying the surgeon can handle sedation and emulsification on his own.

Think your eye docs would mind much if they had to administer IV sedatives and look up from the microscope during the case to monitor vital signs? Of course they would (as would your patients!), but they might have to if Anthem delivers on its promise to eliminate coverage for an anesthesiologist or a nurse anesthetist during what it calls "routine" cataract surgeries. "You want your ophthalmologist focusing only on the surgery at hand and not the patient's anesthesia issues," says Steven Gayer, MD, MBA, chief of surgery and anesthesia at Bascom Palmer Eye Institute in Miami, Fla. "I would hate to be the surgeon who has a case of a vocal local: trying to talk a patient down with no one in the room to help."

In a clinical guideline (osmag.net/fR2uCB) released in February, Anthem states that ophthalmologists can administer and monitor sedation without jeopardizing patient safety. The guideline also says that monitored anesthesia care is medically necessary only under certain circumstances: if the patient is younger than 18 years old, or is unable to cooperate or communicate because of dementia or other medical conditions, can't lie flat, has not tolerated conscious sedation, or if a complex surgery is anticipated. For all other cases, Anthem considers MAC or general anesthesia not medically necessary.

Organized opposition

As you might imagine, the cataract and anesthesia communities are up in arms, calling on Anthem to rescind the policy before it's enacted (no date has been set and Anthem did not respond to a call for comment). All the major medical societies in ophthalmology and anesthesia have sent letters of protest to Anthem's medical director.

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