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GAO: Medicare Pays Anesthesia Less Than Insurers
It doesn't pay to be an anesthesia provider where many Medicare beneficiaries live. A Government Accountability Office report has found that Medicare payments for anesthesia services during such procedures as hernia repairs and laparoscopy were 67 percent lower than private insurers' average payments in 41 Medicare payment localities in 2004.

"Medicare pays about 87 percent of market rates for most services, but about 34 percent for anesthesia services - a level even lower than another government report found just five years ago," says Wanda Wilson, CRNA, PhD, president of the American Association of Nurse Anesthetists. "While the cost-effective and high quality services of CRNAs have made it possible to meet the needs of seniors, such low reimbursements are not sustainable, nor are they good for the overall health of the Medicare program."

"Low anesthesia reimbursement leaves hospitals, ASCs and other surgical locations holding the bag as anesthesia groups shift costs to the facilities they serve," says Frank J. Purcell Sr., director of federal government affairs for the AANA. "To help address this issue, CRNAs and anesthesiologists are continuing to work with Congress and CMS to buck up Medicare anesthesia payments."

When the GAO used this information to look at the number of anesthesiologists and CRNAs in an area, they found a distinct correlation between the patient population and the type of provider serving it. Regions with many Medicare beneficiaries tended to have more CRNAs and fewer anesthesiologists, and as the ratio of patients with private payment services rose so did the number of anesthesiologists.
Arizona Examining Office-based Surgery Safety
The Arizona Medical Board has proposed new rules regulating office-based procedures that would require doctors who perform these types of surgeries to have specific monitoring and emergency equipment for all levels of anesthesia and sedation on hand. They'd also require specialized staff training and patient notification of the risks of undergoing surgery in an office setting.

This action comes in the wake of a lawsuit filed by the family of a woman who died following cosmetic surgery, says a recent news report. The death of Tucson, Ariz., attorney Kimberley A. Taylor, 53, was caused by a failed attempt to intubate her when she stopped breathing while undergoing surgery for liposuction and jaw line tightening, according to the suit filed against Ms. Taylor's office-based plastic surgeon and his nurse anesthetist.

When Ms. Taylor, who was under conscious sedation, stopped breathing, the surgeon and CRNA tried to revive her by intubating her, but they placed the breathing tube into the esophagus instead of the lungs, says the suit. Transported comatose to a hospital ER and placed on life support, she died 10 days later.
Improved Teamwork Needed in Hospital ORs
Anesthesiologists and nurses in public hospitals must improve their communication and collaboration skills, according to a study published in the August 2007 issue of the journal Acta Anaesthesiologica Scandinavica.

Head nurses and chief anesthesiologists disagree on who is responsible for the daily managing of the OR, say the researchers. Nearly two-thirds of polled doctors believe the anesthesiologist is responsible, but only 35 percent of nurses agree with that opinion.

The researchers note that the anesthesiologist's involvement in OR management has increased with the size of the surgical unit, while the nurse's role appeared to decrease in larger facilities. The study's authors believe the daily structure of hospital OR management must be redefined and believe that "better understanding of everyday operative management, interdisciplinary teamwork and leadership skills [is] warranted."

Jane Thilo, MD, MS, founder of Encompass Health, a healthcare leadership consulting company, says that in a large hospital operating rooms there are multiple shifts and teams convening and adjourning several times a day, making it more difficult for teamwork to gel. She adds that the smaller staffs of ambulatory surgery centers contribute to a greater familiarity between colleagues and, therefore, to more successful collaboration.

Dr. Thilo believes the importance of clearly defined roles in the OR is trumped only by the importance of choosing the right people, those who value collaboration without focusing on power struggles. "The OR is a dynamic environment and the people who are managing the OR must be flexible, must be trustworthy and trusting of their colleagues," she says, "and must stay focused on the overall goal of providing outstanding patient care."
News and Notes
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