TSA Advocacy

The Texas Society of Anesthesiologists is a state component of the American Society of Anesthesiologists representing over 3,700 physician anesthesiologists, residents, medical students and anesthesiologist assistants in Texas practicing the medical specialty of anesthesiology. Our physicians have a minimum of 8 years of medical education and many continue to a 1-2-year post-residency fellowship to specialize in pediatrics, cardiac anesthesia, critical care or pain medicine. They have over 15,000 hours of clinical training and are your critical care physician during the entire surgical or procedural event, responsible for all aspects of your care, pain management and your safety and survival.

Note: All documents are pdf files

EXPERIENCE MATTERS IN THE OPERATING ROOM

Anesthesiologists have twice the education levels and five times the clinical experience of nurse anesthetists. As physicians they are able to treat the whole body and are able to respond and rescue patients in the operating room and throughout hospitals. In a statewide survey, 82% of respondents said they want an anesthesiologist in charge of their anesthesia – not a nurse. Why many nurse anesthetists are getting Doctorate of Nurse Practice degrees, this in no way makes them comparable to physicians. In fact, 85% of the Doctoral programs created between 2015 and 2018 had no clinical experience included and many are online only. This lack of education is recognized by the federal Medicaid program which specifically requires anesthesia in participating hospitals to be performed only at the delegation and supervision of a physician if performed by a nurse. Anesthesiology is the practice of medicine. Independent practice of nurse anesthetists provides no greater access to anesthesia surgical care, no cost savings for patients and increases costs and safety concerns.

PAPERS ON WHY MAINTAINING PHYSICIAN LED ANESTHESIA CARE IS IMPORTANT:

DO YOU KNOW WHO IS TREATING YOU? DETAILS ON THE ANESTHESIA CARE TEAM.

There are physicians, doctors, and mid-level providers who assist with your anesthesia care. In Texas, a non-physician must practice under the delegation and supervision of a physician. If you're confused by the mix of initials after a health care provider's name, what their training is and who regulates them, you can view this paper which we've created as a general guide. In anesthesia, there are three providers – physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants. Nurse anesthetists and anesthesiologist assistants practice interchangeably at the delegatory authority of a physician anesthesiologist and while nurse aestheticists may practice under the delegatory authority of another physician, the physician remains responsible for the medical management of the patient and for all delegated acts within the physician-led care team.

PAPERS ON ANESTHESIA CARE TEAM AND ITS MEMBERS:

WE'RE HOSPITAL BASED PROVIDERS AND CONTRACT WITH INSURANCE CARRIERS SEPARATELY.

Physician anesthesiologists work in hospitals but are not employees of the hospital as that would be a violation of Texas' Corporate Practice of Medicine law which protects patients from having a corporate board room dictate our medical decisions for better profits. Our clinical groups contract with hospitals to provide coverage (sometimes with one group providing exclusive coverage and other times with multiple groups in one hospital) and the anesthesia groups contract with insurance carriers separately from the hospital for payment rates and in-network status. If an insurance carrier does not have an adequate network of physicians in their in-network hospital (so called 'narrow' networks or no network due to poor payment or no negotiation), a coverage gap may result in a remaining balance. The TSA lead the effort in 2019 to pass SB 1264, the balance billing legislation for state regulated insurance. This bill holds insured patients harmless for this remaining balance and requires facilities, physicians and providers to go into a process to settle the outstanding debt with the carrier. Carriers and the healthcare providers must attempt to settle in an informal conference call. If that does not work, facilities may request a mediation and physicians and other providers may request arbitration to resolve the dispute. Below is a summary of SB 1264, a chart explaining the different paths for facilities and physicians or providers, as well as the latest report on claims that have been mediated or arbitrated through this process. This process only applies to state regulated insurance, ERS and TRS claims. Any claims from an ERISA plan are federally regulated and there is a federal process to resolve balance billing claims starting in January 2023.

PAPERS ON BALANCE BILLING:

PHYSICIAN ANESTHESIOLOGISTS ARE SPECIALISTS IN PAIN MANAGEMENT

While our members who provide pain management are represented by the Texas Pain Society, pain management is at the heart of our medical specialty. As such we support strategies to address the Opioid Crisis and believe government should be careful of unintended consequences on legitimate chronic pain patients when crafting legislation to address abuse of prescription medications. We further believe that pharmacists who play an important role in denying suspicious prescriptions, are illegally practicing medicine.

 

Legislative Scorecard

 

Texas Legislative Scorecard

 

Are you a TSA Member?

 

On our Member Advocacy Page you can find information about legislation, elected officials, and our Legislative Action Alerts!

 

Levels of Anesthesia

 

Local Anesthesia prevents pain by inducing the loss of sensation in a localized area of the body while the patient remains awake.

Regional Anesthesia blocks the electrical nerve impulses in a nerve or group of nerves to the site of the surgical procedure, including spinal, epidural and nerves to the arms, chest or stomach  

Minimal Sedation relieves anxiety but pre-serves consciousness. The patient is typically relaxed but readily responds to verbal commands. Blood pressure, heart rate and respiratory function are generally unaffected.

Moderate Sedation depresses consciousness and relieves anxiety and pain. Purposeful response to verbal command or light tactile stimulation is maintained. Blood pressure, heart rate and respiratory function are minimally affected.

Deep Sedation leaves the patient not easily arousable but able to responds to repeated or painful stimulation. Blood pressure and heart rate are generally maintained, but intervention may be required to maintain respiratory function.

General Anesthesia means that the patient is completely unconscious, and not responsive to painful stimuli. Blood pressure, heart rate and respiratory function is compromised.