to intervene because the patient was having an adverse event. Since
there wasn't a reliable way to predict which patients were at risk for
these events, "monitored anesthesia care seems justified in cataract
surgery with the patient under local anesthesia."
"It's remarkable that they misinterpreted the results of that paper,"
says David B. Glasser, MD, secretary for federal affairs of the
American Academy of Ophthalmology. He points out that even a
minor intervention could turn into a major one if the surgeon has to
spend time finding the proper person to handle it. "While there are
things the surgeons may do by themselves," adds Dr. Glasser, "that's
not something an ophthalmologist can do while also working on a
patient's eye."
Ophthalmologist Hunter Newsom, MD, agrees. "Just last week, I
had 40 cases in one day, 30 another. I know a certain percentage of
patients are going to need something beyond the normal. If some-
thing starts to go wrong and I don't have an anesthetist there to han-
dle it, it would mean I went in knowingly unprepared," says Dr.
Newsom, who owns 3 Florida eye surgery centers. "I have zero inter-
est in not having anesthesia present during my cataract surgeries."
A dangerous precedent
This policy would only affect patients and providers in the 14 states
where Anthem provides services — for now. "If Anthem implements
this guideline, it could pave the way for other third-party providers to
do the same," says Bruce Weiner, DNP, CRNA, president of the
American Association of Nurse Anesthetists.
And he's justified in pointing this out, according to Mr. Simonson.
Back when Noridian tried this for cataract surgery, they also introduced
a guideline that said they wouldn't pay for MAC for colonoscopies.
"The endoscopists didn't fight them because many of them weren't
Anesthesia Alert
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