Under a federal regulation issued late last year, physicians must oversee all use of anesthesia in order for hospitals to receive Medicare reimbursement?.Citing a concern for rural hospitals, Governor Jeanne Shaheen joined governors from four other states in opting out of the new requirement?..That decision has prompted protest from the American society of anesthesiologists, but support from local hospital officials.
In a letter sent last month to federal Medicare administrator Thomas Scully, the Governor said exercising the new regulation?s opt out clause was in the best interest of state residents??But granite staters were not likely aware of either the policy or the Governor?s decision until the American society of anesthesiologists cried foul in newspaper ads claiming Shaheen is risking patients lives.?The ads urge citizens to call the governor in protest to ?Save a life. Maybe a loved one?s, Maybe your own.? Dr. Dan Laird, the Las Vegas-based spokesman of the American anesthesiologist?s society, acknowledged the ads would not have appeared if Shaheen weren?t in the midst of a US senate campaign. But he insists they speak the truth.
'The death rate and the failure to resuscitate rate were statistically significantly higher when an anestiasiologist were not involved in the care.'
Laird says a University of Pennsylvania study buttresses such claims. It asserts a lack of anesthesiologist oversight may have led to 2.5 deaths per thousand patients in 247 hospitals back in the 1990s??However, the conclusion comes with the caveat that it is based entirely on old medical bills submitted by caregivers?. Even so, Laird maintains the statistic is beyond reproach. He furthermore argues there is no evidence that requiring physician oversight of nurse anesthetists adversely affectes the availability of health care in rural areas.
'It?s never created a problem with access to care?..That is categorically and absolutely false.'
But Laird?s claims were roundly disputed yesterday by a procession of local doctors, nurse anesthetists and hospital admistrators, who participated in a pro-Shaheen news conference hosted by the NH Hospital association. Bob Langlais, President of Keene?s Cheshire medical Center opened the proceedings by pointing out that the governor?s decision respects not only the 1991 state statute governing nurse-practitioners, but also the way local hospitals have long operated.
'It is consistent with past practices; it is consistent with current practices?and constituent with NH statute. So what the governor did was continue the status quo. She didn?t make a change in how we deliver care she continued exactly what we?ve been doing for many many years.'
And According to Clem Barry Ceo of Colebrook?s Upper Connecticut valley hospital, replacing nurse anesthetists with anesthesiologists would make delivering a full range of care nearly impossible?..He says it would more than double his existing operating room labor costs.
'I would say this would put me out of business tomorrow but the future of my institution would be at jeopardy. This allows me to provide quality care, while at the same time allow me to be a financially viable business.
But as Dr. Paul Racicot, chief of emergency medicine at the Franklin and lakes region hospitals pointed out??much more than the bottom line may be at stake?..
'Without CRNA?s you would essentially not only not do surgery, you would not have an emergency room and people would suffer the consequences of not having access to care in these rural communities.'
Such arguments, however, Leave the American society of anesthesiologists? Dan Laird unmoved?..He maintains they are scare tactics designed to obscure the reality that the governor is simply dead set on giving consumers a raw deal.
'There is no cost savings whatsoever with anesthesia nurses?..Unfortunately what you get is less quality for the same price.'
And what do Nurse Anesthetists think? 20 year-practitioner, Jack Neary says the flap is simply the latest chapter in a turf war that?s been going on for a decades.
'We?ve been in existence for 100 years and there?s been a continual fight where there has been restriction or attempts at restrictions by anesthesiologists and you?re seeing it right here paid for by the American society of anesthesiologists.'
