Page 44 - 2022 Risk Basics - Anesthesiology

SVMIC Risk Basics: Anesthesiology

employment relationship or hospital privileges condition) to

supervise regardless of whether or not there is a statutory
requirement, the supervising physician will most likely be sued.

Hospital privileges contracts frequently contain provisions

requiring the surgeon to assume the role of CRNA supervisor
when an anesthesiologist is unavailable, and often, the

surgeon is unaware that such a contractual obligation exists. It
is important that the physician (anesthesiologist or surgeon)

and the CRNA be familiar with the laws and regulations in

the state in which they practice, as well as their contractual
obligations relative to the supervision requirements, as

these can vary from location-to-location and contract-to-
contract.

Moreover, Federal law states that for a hospital, a Critical

Access Hospital (CAH), or Ambulatory Surgical Center (ASC)
to participate in the Medicare program, that facility must

comply with requirements such as having a physician

supervise Certified Registered Nurse Anesthetists (CRNAs)
unless a state chooses to opt out of the supervision

requirement (42 CFR §§ 482.52; 485.639; 416.42). To date, 17
18
states have opted out. The ASA CMS Supervision Rules for
19
Nurse Anesthetists provide in pertinent part:

Ambulatory Surgical Centers

Surgical procedures must be performed in a safe manner by

qualified physicians who have been granted clinical

18 https://www.asahq.org/gather-content-articles/cms-supervision-rules-for-nurse-anesthetists
19 Alaska, California, Colorado, Idaho, Iowa, Kansas, Kentucky, Minnesota, Montana, Nebraska, New
Hampshire, New Mexico, North Dakota, Oregon, South Dakota, Washington, and Wisconsin have
opted out to date.

Page | 44