using CRNAs to provide anesthesia," says
Mr. Simonson. Wellpoint and Humana soon
followed Noridian's lead. A few years later,
Aetna tried to introduce a similar guide-
line, but it was rescinded after GI doctors
and their societies spoke out against it.
Anthem revised its guideline after its
release to be specific to anesthesia care
and removed mention of moderate seda-
tion, according to an ASA press release.
But the "revision does not address the fun-
damental flaw of the guideline," the ASA
says in its letter to Anthem that highlights
a few of the ways this guideline disrupts
patient care. For example, most patients
wouldn't be able to tolerate the placement
of a needle for a retrobulbar block without
anesthesia care.
"The block takes 8 seconds, but they're a
crucial 8 seconds," says James D. Grant,
MD, president of the American Society of Anesthesiologists. "If some-
one jerks the wrong way during the block, the eyeball could get dam-
aged."
Many are hoping the epic team-up between nurse anesthetists,
physician anesthetists and ophthalmology organizations convinced
Anthem to put the guideline in an indefinite holding pattern.
"You know, nurse and physician anesthetists are rarely on the same
side — except when it comes to patient safety. So you know this
[guideline] is not a good idea," says Jay Horowitz, BSN, CRNA, ARNP,
of Sarasota, Fla.
OSM
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 9
According to a nationwide
cost comparison study
conducted for the
American Association of
Nurse Anesthetists in
2016, the average costs
for anesthesia services in
a cataract operation are:
$194.66 for CRNA
$400.76 for
anesthesiologist
Costs for Cataract
Sedation
