Take a Deep Breath: New CMS Anesthesia Regulations

Part II: Anesthesia Administration and Privileging Practitioners

Though Centers for Medicare and Medicaid Services (CMS) expectations for Anesthesia Services have changed little over the years, these Conditions of Participation (CoPs) were recently revised and published in Transmittal 59 dated May 21, 2010. This four-part series outlines compliance challenges associated with the new CoPs and solutions to help hospitals assess vulnerabilities in anesthesia and sedation activities.

According to the regulations, only the following practitioners can administer anesthesia:

• A qualified anesthesiologist
• A doctor of medicine or osteopathy (other than an anesthesiologist)
• A dentist, oral surgeon, or podiatrist who is qualified to administer anesthesia under State law
• A certified registered nurse anesthetist (CRNA), under the supervision of the operating practitioner or of an anesthesiologist who is immediately available if needed, unless in an opt-out state (As of July, 2009, opt-out states include CA, IA, NE, ID, MN, NH, NM, KS, ND, WA, AK, OR, SD, WI, MT.)
• An anesthesiologist’s assistant, who is under the supervision of an anesthesiologist who is immediately available if needed

The Medical Staff bylaws or rules and regulations must include criteria for determining the anesthesia service privileges to be granted to an individual practitioner and a procedure for applying the criteria to individuals requesting privileges for any type of anesthesia services, including those not subject to the anesthesia administration requirements (sedation). The hospital’s Governing Body must approve the specific anesthesia service privileges for each practitioner who furnishes anesthesia services, addressing the type of supervision required, if any. The privileges granted must be in accordance with state law and hospital policy.

The type and complexity of procedures for which the practitioner may administer anesthesia must be specified in the privileges granted to the individual practitioner. When a hospital permits operating practitioners to supervise a CRNA administering anesthesia, the Medical Staff bylaws or rules and regulations must specify for each category of operating practitioner, the type and complexity of procedures that category of practitioner may supervise. However, individual operating practitioners do not need to be granted specific privileges to supervise a CRNA.

To comply with this section of the regulations, changes in policies and practices may be necessary. Assuring that all areas have been addressed is the only reliable way of avoiding violations on survey. Begin by assuring the following has been established in policy or practice:

• Define what privileges are required for each level of anesthesia services, including sedation and monitored anesthesia care.
• Align policy and practice regarding the appropriate level of supervision for non-physicians permitted to administer anesthesia under supervised situations.
• Define criteria for determining the anesthesia services privileges for individual practitioners, including those that may administer only sedation.

If the hospital will permit operating practitioners to supervise a CRNA administering anesthesia, specify in the Medical Staff bylaws or rules and regulations, for each category of operating practitioner, the type and complexity of procedures that category of practitioner may supervise.

• On an ongoing basis, assure that the following occurs as designed:
• The Governing Body shows approval of the specific anesthesia privileges granted to individual practitioners and any type of supervision required.
• If operating practitioners are allowed to supervise CRNAs, then define the privileges required to permit this supervision and the type and complexity of procedures where allowed.

This series of articles provides a guide to the most important aspects of the new regulations. When modifying your current practice, please refer to the full text of the regulations.

The next article in this series, “Take a Deep Breath: New CMS Anesthesia Regulations,” will tackle Responsibilities of the Anesthesia Services Department.

If you have questions about this series or any CMS regulation, please contact Kate Fenner, Managing Director of Compass Clinical Consulting, or Cary D. Gutbezahl, MD, President, at 513-241-0142.