Physician-led anesthesia care has become a hot topic in many discussions and education sessions at ANESTHESIOLOGY 2019. By design, ASA is focusing attention on this important topic as a means to improve patient care. Donald E. Arnold, M.D., FASA, is ASA’s Assistant Treasurer and Chair of its Ad Hoc Committee on Payment and Care Delivery Models. He leads the discussion on the recent document “Physician-led Anesthesia Care,” created by the committee and released in August.

Donald E. Arnold, M.D., FASA

According to Dr. Arnold, the document provides more clarity and detail in how an anesthesiologist engages as the physician leader of the anesthesia care team. The document serves as a tool to help anesthesiologists think in more detail about comparisons and discussions regarding anesthesiology care delivery models.

“As our health care delivery system evolves, there has been greater adoption of physician-led, team-based patient care. ASA believes that whether care is personally performed by an anesthesiologist or provided through anesthesiologist-led, team-based care, physician leadership and direct clinical physician engagement in the care delivered are essential elements of physician-led care delivery models. This approach to team-based care provides the safest, best treatment,” Dr. Arnold said.

In the U.S., anesthesiology services are provided by qualified anesthesia professionals working within care delivery models that meet regulatory and statutory requirements. These care delivery models utilize differently comprised teams of qualified anesthesia professionals based on local resources, requirements and staffing decisions. ASA positions are reflected in the Statement on the Anesthesia Care Team. This approach is reinforced by the WFSA and WHO, organizations that have gone on record to say that wherever and whenever possible, anesthesia should be provided, led or overseen by a physician anesthesiologist.

The committee’s work began in 2018 when the Administrative Council, under the Economic Strategic Planning Initiative, commissioned an Ad Hoc Committee on Payment and Care Model Delivery to collect and review data and other information regarding the anesthesia care landscape. In particular, the committee studied current and developing roles of physician and non-physician anesthesia professionals and their prevalence; current ASA statements and standards, such as the Guidelines for the Ethical Practice of Anesthesiology; how current and developing models of care relate to existing billing and payment requirements; the workforce implications of current and developing models; and other items deemed relevant to the committee.

Among its findings and recommendations, the committee determined that the multi-jurisdiction health care delivery system and anesthesia care practice environment continue to require special consideration in care delivery and to preserve and protect patient safety. These requirements include CMS Conditions of Participation/Conditions for Coverage, CMS billing instructions, commercial payer requirements, state law and regulatory authority, and facility and practice level requirements and potentially other requirements.

Additionally, the committee recognized that some terms are used differently by these entities. Based on work by ASA and in alignment with other medical organizations  (e.g., AMA) the Ad Hoc Committee identified that currently available documents could be improved and supplemented by work that expands and provides more detailed guidance regarding physician-led anesthesia care. Following sunset of the Ad Hoc Committee, the standing Committee on the Anesthesia Care Team will continue work in this area, Dr. Arnold said.

“Every patient deserves physician-led anesthesia care, but exactly what physician-led anesthesia care means may need to be made more clear among our colleagues, hospital administrators, payers and government regulators,” Dr. Arnold said of the document. “Conversations surrounding physician-led anesthesia care are included in ANESTHESIOLOGY 2019 presentations, detailing the essential value that physicians bring to anesthesiology care.”

The full “Physician-led Anesthesia Care” document is available to ASA members by visiting the ASA website (you’ll need to be logged in to view the document).