Clincians raise patient safety concerns about a policy that foists onto ophthalmologists the responsibility for anesthesia monitoring during cataract surgery. Anthem says the policy is consistent with its commitment to providing high-quality, affordable care.
An Anthem Inc. policy under which ophthalmologists assume responsibility for anesthesia and patient monitoring during cataract surgeries is not sitting well with the clinicians who conduct the procedures.
American Association of Nurse Anesthetists President Bruce Weiner, CRNA, this week called it a "dangerous and reckless policy that jeopardizes the safety and well-being of millions of patients, all in an effort to cut costs and increase profits."
"While cataract surgeries are generally routine surgical procedures that require anesthesia, especially those involving hypersensitive areas like the eyes, call for highly educated anesthesia professionals like CRNAs to administer medication and monitor patients properly without distraction," he said.
David Glasser, MD, clinical spokesperson for the American Academy of Ophthalmology, said the academy "feels strongly that Anthem’s new policy is not in the patient's best interest."
"An ophthalmologist cannot administer conscious sedation, monitor the patient and do cataract surgery, all at the same time. Having anesthesia personnel in the room is one of the key ingredients in the safety and effectiveness of cataract surgery today," Glasser said.
"The decision to have an anesthesiologist or nurse anesthetist in the room during cataract surgery with sedation is best made by the ophthalmologist and the patient. And that decision should place the patient’s well-being first, above all other considerations," he said.
Anthem defended the policy and said it was consistent with the insurer's commitment "to providing consumers with access to high quality, affordable healthcare, including safe and effective medical technologies."
"One of the ways we work to meet this commitment is to ensure consumers receive the right care, at the right time, in the most appropriate clinical setting," Anthem said.
Weiner says most cataract patients are older and at greater risk for complications due to comorbidities such as respiratory and cardiovascular disease.
"For this reason the AANA is gravely concerned about not having an anesthesia professional such as a CRNA providing anesthesia care during cataracts surgery," Weiner said. "It is neither practical nor safe for ophthalmologists to simultaneously perform surgery, administer anesthesia and monitor patient conditions."
Weiner said that cataract surgery is safe and complication free for the approximately 3.6 million people who undergo the procedure each year, in large part because proper patient care teams are in place.
"Anthem’s new policy, however, puts millions of people at risk for serious eye injury or worse by asking ophthalmologists to manage two very intricate procedures at the same time," he said.
Anthem said the policy has been vetted by its physician-led Medical Policy & Technology Assessment Committee.
"According to the literature reviewed, there is no one definitive approach regarding the use of anesthesia for cataract surgery and patient specific needs should be taken into consideration as well as potential risk of harm to individuals who are sedated during surgical procedures," Anthem said.
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"Anthem’s guideline allows for general anesthesia and monitored anesthesia care for cataract surgery when clinical indications support that they are medically necessary and provides coverage for other forms of anesthesia, including intravenous moderate sedation, without the need for review.
"We value our relationships with providers. We have been and will continue to have a dialog with our providers and medical societies regarding their concerns," Anthem said.
"Anthem is committed to providing consumers with access to high quality, affordable healthcare, including safe and effective medical technologies. One of the ways we work to meet this commitment is to ensure consumers receive the right care, at the right time, in the most appropriate clinical setting."
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John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.