Page 44 - Part 1 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

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 states have opted out.
18
19
The ASA CMS Supervision Rules for 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

privileges by the governing body of the ASC in accordance
with approved policies and procedures of the ASC.

(a) Standard: Anesthetic risk and evaluation. (1) A physician

must examine the patient immediately before surgery to
evaluate the risk of anesthesia and of the procedure to be

performed. (2) Before discharge from the ASC, each patient
must be evaluated by a physician or by an anesthetist as

defined in this chapter, in accordance with applicable State
health and safety laws, standards of practice, and ASC

policy, for proper anesthesia recovery.

(b) Standard: Administration of anesthesia. Anesthetics must

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.

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