For Policy Makers

The TSA Governmental Affairs team works with Texas legislative and regulatory bodies on behalf of all Texans to ensure the continued safe and effective medical practice of anesthesiology in Texas.

Importance of Physician-Led Anesthesia Care

Anesthesiologists’ extensive education up to 16,000 hours of clinical training have prepared them to make the crucial decisions that can mean the difference between life and death. Experience in the operating room matters. In fact, a peer-reviewed study of nearly 200,000 surgeries found that the presence of an anesthesiologist prevented deaths; 6.9 per 1,000 cases in which complications occurred.

  • Anesthesiologists are highly trained medical doctors who ensure the safest outcomes for their patients.
  • Most states and policies of the nation’s top hospitals require physician-led anesthesia care.
  • Removing anesthesiologists from care increases risk for patients without expanding healthcare access or reducing costs.

Texas Law Requires Physician Supervision of CRNAs

Attorney General Paxton issued an opinion, KP-0353, specific to the supervision and delegation requirements of physician anesthesiologists to nurse anesthetists. KP-0353 concludes that under state and federal law, CRNAs are required to be delegated to and supervised by a physician.
The Texas Medical board maintains FAQs which detail the delegation and supervision requirements of mid-level providers in the state.

Anesthesiologists Reduce Costs and Increase Quality of Care

Anesthesiologists’ services are reimbursed by Medicare, Medicaid, and most third-party insurers at the same rate as services provided by nurse anesthetists. Actually, anesthesiologists play a critical role in controlling health care costs before, during and after surgery by:

  • Reducing unnecessary testing, same-day cancellations, operating room emergencies, and surgical complications.
  • Decreasing the need for additional consults from other specialty physicians for services that could be provided by an anesthesiologist.
  • Reducing the risk of costly hospitalization following outpatient surgery.

Independent Practice Does NOT Increase Access to Care

States that have granted independent practice to nurse anesthetists in Medicare did not result in increased access to surgical care. In fact, it may even reduce access to outpatient surgical care.

  • Texas has the second highest number of physician anesthesiologists and the highest number of CRNAs.
  • The only way to increase access to anesthesia surgical care in Texas is to increase the number of operating rooms!

Granting independent practice to nurse anesthetists has not been shown to increase access to pain management care either. Our recent evidence debunk more incorrect assertions.

Meet the Anesthesia Care Team

Anesthesiology is a medical practice specialty in which controlled substances are used to depress conscious awareness. Under general anesthesia, a patient’s cardiac and respiratory functions are completely controlled using medications and machines. Anesthesia has been referred to by some as a “controlled death” or a “controlled coma”.
In anesthesia, we commonly utilize a care team model to include the following:

  • Physician Anesthesiologist – MD or DO
  • Certified Registered Nurse Anesthetist – CRNA
  • Certified Anesthesiology Assistant – CAA

Nurse anesthetists and anesthesiologist assistants practice interchangeably at the delegatory authority of a physician anesthesiologist. The physician remains responsible for the medical management of the patient and for all delegated acts within the physician-led care team.

  • A 2022 study found care provided by non-physicians working independently was more expensive than care provided by physicians.
  • A CRNA may be supervised by any physician or dentist, but a CAA must work only under the delegation of a physician anesthesiologist.
  • A 2018 study found no difference in mortality, length of stay, or inpatient spending when a care team model included a CAA versus a CRNA.

Surprise Medical Billing

TSA was an integral part of negotiating the prohibition on surprise medical billing laws at the state and federal level. Patients should not be caught in the middle of payment disputes between providers and carriers.
Texas and the federal government passed very similar laws on the topic, but implementation in each jurisdiction has been very different. TSA dives more into the details on the differences and ongoing challenges and opportunities to protect patients HERE.

The Texas Way. Senate Bill 1264 (SB 1264 86R) protects patients from surprise medical bills. The law has since been recognized across the country as a success and model for other states.

  • SB 1264 holds the patient harmless for out-of-network bills under state regulated plans.
  • SB 1264 removes patients from the middle of provider and insurance carrier payment disputes.
  • SB 1264 creates a dispute resolution process between an insurance carrier and the provider or facility, in which an arbitrator ultimately decides the payment amount.
  • The latest Texas Department of Insurance Balance Billing Biennial Report released November 2022.

The Federal Way. The No Surprises Act passed in 2020 and was intended to afford patients the same protections as the Texas independent resolution process using a similar arbitration process.

  • The federal agencies charged with implementing the law botched the rulemaking process and tipped the arbitration process heavily in favor of insurance carriers.
  • TMA has now sued the federal agencies three separate times claiming they deviated from the intent of the law as written, created law through rulemaking and other items.
  • TSA continues to support TMA and the ASA in the fight to ensure providers are fairly represented in the federal independent resolution process.
  • ASA No Surprises Act resources.

If you are struggling with the IDR website and process please email: IDRhelp@tsa.org for assistance. The TSA Practice Management Committee members can help!

Anesthesiologists and Pain Medicine

While our members who provide pain management are represented by the Texas Pain Society, pain management is at the heart of our medical specialty; anesthesiologists can specialize in both acute and chronic pain management. As such we support strategies to address the Opioid Crisis. While opioids may be necessary in managing pain, many times multimodal non opioid methods are adequate and have fewer risks.

  • Four of the top 25 U.S. cities for opioid abuse are in TEXAS.
  • In 2020, there were more than 142 million opioid prescriptions in the United States.
  • The overall opioid dispensing rate in 2020 was 43.3 prescriptions per 100 people, some counties had rates that were nine times higher.
  • The drug overdose fatality rate in Texas is 14.1; 14 of 100,000 deaths in Texas are a result of overdose.
  • Anesthesiologists are experts in utilizing regional anesthesia or nerve blocks to reduce the use of opioids during and following surgery.

Anesthesiologists and Maternal Health Care

Anesthesiologists work collaboratively with their obstetric colleagues to ensure the health and safety of the mother and child throughout. Expecting moms should meet with their anesthesiologist prior to delivery to work out a pain- management plan that works for them. Anesthesiologists should be part of the local leadership teams involved with quality management, case reviews, and other programming regarding pregnancy hypertensive disorders and postpartum hemorrhage management.

Anesthesiologists take on leadership roles to reduce maternal mortality and gaps in mortality rates by:

  • Participating in state-level maternal mortality review committees and the Alliance for Innovation on Maternal Health (AIM).
  • Working closely with obstetricians to identify pregnant patients at increased risk for complications and to ensure that an anesthesiologist is involved in planning their care.
  • Leading efforts to make doctors and nurses aware of the early warning signs of a problem and the need to seek immediate help from an anesthesiologist.

Governmental Affairs Team

We are here to help and answer questions, please reach out to us.

Richard Evans

Director, Governmental Affairs

richard@tsa.org

Natalia Ovcharenko

Governmental Affairs Assistant

natalia@tsa.org

Amr E. Abouleish, MD, FASA

President, Texas Society of Anesthesiologists

Lisa E. Weiss, MD, FASA

Chair of Governmental Affairs Committee

lisaweissmd@gmail.com

Kenisha W. Muse, MD

Vice-Chair of Governmental Affairs

kenisha.muse@gmail.com

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