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Anthem's Anesthesia Policy Draws Fire

By John Commins  
   March 20, 2018

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."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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