Your anesthesiologist takes several factors into account when recommending the type of anesthesia. Some of those factors include the type of surgery or non-operative procedure being performed and your medical history. These types of anesthesia are not always clearly defined, and patients may progress from one level of sedation/anesthesia to a lighter or deeper level during the procedure. For this reason, the American Society of Anesthesiologists (ASA) considers anesthesia a continuum, from light sedation to general anesthesia.


“Anesthesia Care Team”
Most anesthetics administered in Pennsylvania are provided using an “Anesthesia Care Team” model, with the anesthesiologist serving as the “director” of the anesthesia care team. Prior to surgery the anesthesiologist evaluates the patients’ current state of health and is responsible for designing the anesthesia plan taking into account the patient’s condition and the nature of the surgery.



  • Highmark Shelves Controversial Proposed MAC Policy

    12/22/2014 12/22/14: Highmark recently notified PSA that it will abandon its controversial proposed monitored anesthesia care (MAC) policy. Instead it will align its MAC policy with Medicare, which will implement a national policy change effective January 1, 2015. (See page 3 of the Winter 2014 Sentinel for details on the CMS change.) CMS has recognized that the prevailing practice for endoscopies in general and screening colonoscopies in particular is undergoing a transition, and that anesthesia separately provided by an anesthesia professional is becoming the prevalent practice. We understand that physician advocacy to keep the current policy in place was a big part of Highmark’s decision – thanks to PSA, PAMED, the Hospital Association of Pennsylvania, the Pennsylvania Ambulatory Surgery Association, and the Pennsylvania Society of Gastroenterologists. This is a big win for patient safety and public health.

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  • PSA Members: Please Review Reports Before 10/11 Annual Business Meeting

    9/5/2014 UPDATED 9/23/14: Bylaws changes and election of leadership positions will be voted on at the PSA's Annual Business Meeting in New Orleans on October 11. Please review the proposed bylaws changes and Nominating Committee report as well as minutes from the 2013 Annual Business Meeting in advance of the 2014 Annual Business Meeting on October 11. The meeting will be in the Melrose Room of the Hilton Riverside Hotel from noon to 1:15 p.m.

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  • Free CME Course on ER/LA Opiod Analgesics REMS

    8/21/2014 8/21/14: The Pennsylvania Board of Medicine is presenting a free CME course on Extended-Release and Long- Acting (ER/LA) Opioid Analgesics Risk Evaluation and Mitigation Strategy (REMS) on September 16 from 9 a.m. to 12 p.m. at the Pennsylvania Convention Center in Philadelphia. This course qualifies as FDA REMS-compliant training. The Board of Medicine strongly encourages all licensees who prescribe ER/LA Opioids to attend this course.

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  • Breaking News! Support CMS Position on Anesthesia for Colonoscopy

    8/21/2014 8/21/14: The Proposed Medicare Physician Fee Schedule for 2015 includes a position statement important to all anesthesiologists, and especially those providing anesthesia for colonoscopy. This position statement supports the value of anesthesia for colonoscopy and paves the way for continued reimbursement for our services, not only colonoscopy but also for the increasing number of similar minimally invasive procedures for which anesthesia is becoming standard practice.

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The choice of anesthetic or sedation is made by a physician taking into account various factors, including but not limited to the procedure being performed and the general medical condition of the patient. General anesthesia may be administered by an anesthesiologist, a nurse anesthetist under the direct supervision of a physician, preferably an anesthesiologist, or in some states by an anesthesiologist’s assistant under the direct supervision of an anesthesiologist. 

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The Anesthesiologist’s Expanding Role
The Centers for Medicare and Medicaid Services (CMS) released a January 2011 update to their Interpretive Guidelines for the Anesthesia Services Condition of Participation for Hospitals. As a result anesthesiologists have assumed a leadership role in developing and implementing medical staff rules and regulations (bylaws) that define the qualifications and supervision requirements for many “categories of practitioners”, such as those providers performing “Moderate Sedation”, “Deep Sedation” or obstetrical “analgesia” services. 

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