Outpatient Surgery Magazine

Almost Left Behind - Subscribe to Outpatient Surgery Magazine - April 2018

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://magazine.outpatientsurgery.net/i/964269

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Page 26 of 108

to cooperate or communicate because of dementia or other medical conditions, can't lie flat, has not tolerated conscious sedation, or if a complex surgery is anticipated. For all other cases, Anthem considers MAC or general anesthesia not medically necessary. Organized opposition As you might imagine, the cataract and anesthesia communities are up in arms, calling on Anthem to rescind the policy before it's enacted (no date has been set and Anthem did not respond to a call for com- ment). All the major medical societies in ophthalmology and anesthe- sia have sent letters of protest to Anthem's medical director. This is not the first time an insurer has tried to deny coverage of anesthesiology services during cataract surgery. Noridian introduced a similar guideline in 2002. "We fought it and kicked their you-know-whats," says Dan Simonson, CRNA, the former manager and chief CRNA of an eye cen- ter in Spokane, Wash. How did they do it? By presenting evidence-based objections to the carrier's medical director — the person responsible for making these guidelines. "When we showed him an article that stated that 1 out of every 100 patients getting cataract surgery would experience an adverse event that needed intervention by an anesthetist, he backed off," says Mr. Simonson. And that's just what the organizations that represent anesthetists and ophthalmologists are hoping happens this time. But what evidence are they citing now? Anthem listed some peer- reviewed articles at the end of the guideline that they say supports their policy. One of those papers, however, seems to argue against their guideline. The paper looked at more than 1,000 cataract surger- ies and found that in more than one-third of them, the anesthetist had A P R I L 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 2 7

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