Patients

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.

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“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.

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Anesthesiologists

  • Administration of Narcotics in Daily Standard O.R. Use

    3/1/2017 We at PSA will be developing a stance on this on March 18.

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  • CME Important Notice

    10/10/2016 For licensed physicians in PA, a 3hr Child Abuse Reporting course counts only 2 hrs towards 100 total hrs for licensure renewal according to both State Boards of Medicine. CME deadline is 10/31/16 for DO physicians and 12/31/16 for MD physicians.

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  • #SportsPainChat on Youth Sports Injuries 9/27

    9/19/2016 Has your young athlete been sidelined by #sportsinjury pain for 3+ months? @American Society of Anesthesiologist’s pain medicine experts can help answer your questions about pain management. Join our Twitter #SportsPainChat on Sept. 27 at 1 p.m. ET / Noon CT. Sign up for reminders here: http://bit.ly/ASASportsPain

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  • Veterans' Lives at Risk - Letter to the Editor by Dr. Edward Dench

    6/21/2016 I am compelled to share a life-threatening risk to all of our veterans, and an opportunity for the public to be heroes for these uniformed men and women. Veterans Affairs is evaluating cost-saving measures that would elevate advanced practice registered nurses to the status of independent practice. Unfortunately, this is not a matter of a competitive sub-specialization, this is simply a capacity APRNs are not equipped to fill.

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  • Insurance Department Proposes Balance Billing Limits

    3/3/2016 On January 19, the Pennsylvania Insurance Commissioner released for comment draft legislation designed to "protect" consumers from "surprise balance billing”. This bill would limit out-of-network providers, including anesthesiologists, practicing in an in-network facility to billing patients only their co-pays and deductibles. Out-of-network physicians would then need to negotiate with the patient’s insurer to determine the remainder of their payment. This action follows a public hearing held last fall at which PSA and many others provided testimony.

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  • Generic Drugs: Low Supply and High Prices

    2/16/2016 It’s high time that policymakers stop playing politics with the lives of millions of patients who are no longer able to obtain affordable lifesaving drugs. Congress must restore free, fair and open competition to this broken marketplace by repealing the anti-kickback safe harbor. Drug shortage never had to happen and can be ended.

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  • ASA Is Now Accepting Nominations for 2017 Committee Membership

    11/23/2015 ASA is now accepting nominations for 2017 committee membership. The link to the nomination page is provided in the attached article.

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  • Please Participate in 2015 Survey of Commercial Payment Rates

    6/10/2015 6/10/2015: ASA requests your participation in the 13th survey of commercial payment rates. Results will be published in the ASA Newsletter later this year. In order to comply with Statement of Antitrust Enforcement Policy in Health Care, data must be at least three months old and only aggregate statistics may be published.

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  • PSA President to Discuss Medical Marijuana on CBS 21 Town Hall

    6/8/2015 6/8/2015: PSA President Robert Campbell, M.D., will participate in CBS 21 News' "Your Voice, Your Future" Town Hall on medical marijuana on June 11 from 7 to 8 p.m. The panel will also feature William Trescher, M.D., director of pediatric neurology at Penn State Hershey; Montel Williams, television personality; State Senator Mike Folmer; and Luan Speese, whose daughter suffers from seizures. A live broadcast will air on My Central PA 21.2 and stream on CBS21.com.

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  • ASA Legislative Conference

    5/15/2015 5/15/2015: The PA delegation to the 2015 ASA Legislative Conference in Washington, D.C., visited congressional offices on May 6. Pictured are Erin Sullivan, MD, Joshua Atkins, MD, PhD, Margaret Tarpey, MD, Shailesh Patel, MD, and Robert Campbell, MD.

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  • Learn About the Process for Obtaining Your Mcare Refund

    4/3/2015 4/3/2015: Last fall's Mcare settlement requires that $200 million be returned to physicians, hospitals, and other health care providers. This includes $139 million in refunds for prior assessment overpayments for 2009, 2010, 2011, 2012, and 2014. PAMED developed a website, the Mcare Refund Information Center, to help answer your questions. The website features a Quick Consult on legal issues impacting Mcare assignment and claim decisions as well as a webinar that provides a helpful overview of the refund process.

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  • National Doctor's Day

    3/30/2015 3/30/15: Mark National Doctor's Day by reading an excellent article on the history of anesthesiology practice from the Spring 2015 issue of The Sentinel. Authors Donald Martin, MD, and Robert Hoffman provide a compelling case for the importance of physician supervision. Turn to page 14.

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  • Register Now for Regional Anesthesia Workshop

    2/23/2015 2/23/15: Spaces are fillings quickly for the Fifth Annual Ultrasound-Guided/Cadaver Course in Regional Anesthesia and Central Vascular Access, sponsored by PSA and Penn State Hershey College of Medicine. This year's program, set for May 30-31 in Hershey, features an expanded format with basic and advanced tracks and increased education credit opportunities to include MOCA ® Part 2 Self-Assessment and Lifetime Learning Credits.

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  • New Child Abuse CE Requirements for State Licensure

    2/2/2015 2/2/2015: Effective January 1, 2015, the commonwealth of Pennsylvania implemented a mandate for all health-related licensees to obtain continuing education (CE) in child abuse recognition and reporting requirements. This applied to any licensee applying for license renewal (2 CE hours) and any initial applicants (3 CE hours). Any program offered to meet the CE requirement must be approved by the Department of State. The following links provide information about the child abuse laws and programs to meet this requirement.

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  • Breaking News! Governor Proclaims Physician Anesthesiologists Week 2015

    1/8/2015 1/8/15: January 11-17 is the inaugural celebration of "Physician Anesthesiologists Week." Gov. Tom Corbett has issued a proclamation setting the week aside in Pennsylvania; PSA has drafted a press release; and ASA has designed a poster. PSA members are encouraged to remind patients, colleagues, and policymakers of the importance of patient-centered, physician-led care.

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  • Breaking News! Read Pittsburgh Tribune-Review Article on Highmark Decision

    12/24/2014 12/24/14: The Pittsburgh Tribune-Review interviewed PSA President Robert Campbell, MD, for its article on Highmark's decision to back away from a proposal to stop paying for full anesthesia for some patients undergoing colonoscopies. Click on READ MORE below for the link to the article.

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  • Breaking News! 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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  • Breaking News! Highmark Delays Policy Change

    5/30/2014 5/30/14: Highmark announces that it is delaying implementation of changes in coverage for full anesthesia until the fall so officials can meet with medical specialty groups that expressed concern, including PSA. The changes were scheduled to take effect July 1.

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  • Executive Summary of Survey on Anesthesia Available

    5/27/2014 5/27/14: An Executive Summary of the PSA survey of 800 Pennsylvania voters, conducted April 26-30, 2014, provides more detail to support the survey's clear conclusion: Pennsylvania voters want a doctor in charge of administering anesthesia.

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  • Breaking News! Highmark Blue Shield Policy Change

    5/22/2014 5/22/14: A Highmark Blue Shield policy change, effective June 30, 2014, states that "monitored anesthesia care is not considered medically necessary for colonoscopies, bronchoscopes, or interventional pain procedures in patients at average risk related to use of anesthesia and sedation" (ASA PS 1 & 2 patients). If you haven't done so already, contact your billing service to determine whether, or to what extent, this affects your practice.

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  • Breaking News! Most Pennsylvanians Want a Doctor to Supervise Anesthesia

    5/12/2014 5/12/14: Nearly 90 percent of Pennsylvanians want a physician to administer anesthesia or respond to anesthesia emergencies during surgery, according to a PSA survey released today.

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  • PSA is on Facebook and Twitter!

    2/21/2014 2/21/14: The Pennsylvania Society of Anesthesiologists has created pages on Facebook and Twitter to keep you informed as fast-breaking events and news reports develop.

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  • House Prof. Licensure Comm. Votes Favorably on Physician Supervision

    11/12/2013 11/12/13: Log in and visit the "Current Issues" tab under "Insurance and Legislation" for a review of today's vote.

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  • Breaking News!

    8/29/2013 8/29/13: Be sure to log in and check the "Current Issues" tab under "Insurance and Legislation" for information on House Bill 1603 and for talking points on supervision of anesthesia care in hospitals.

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  • What Pain Medicine Policy for CRNAs Means for PA Anesthesiologists

    4/25/2013 Pain medicine is a recognized medical sub-specialty, and many of its practitioners are anesthesiologists. Is it, should it be, and/or will it become an equally accepted part of the scope of practice of nurse anesthetists?

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  • New web page allows you to connect with PA anesthesia practices

    4/15/2013 The PSA’s practice directory connects employers with those seeking anesthesiologist jobs in Pennsylvania. PSA members can search geographically to find potential employers in their area, as well as information about the type of employer (private practice, academic center, or hospital based) and type of anesthesia services (pain, cardiac, OB, etc.) that each employer provides.

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  • Lifebox Pulse Oximetry Project

    4/5/2013 Lifebox has now become a registered charity and its stated strategy is to first provide an actual pulse oximeter needs assessment in a particular country. The next step is to seek the necessary funding/donations for Lifeboxes to that country, to address the actual pulse oximeter gap.

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  • Submit an article for 'My Mentor' series

    3/18/2013 Who influenced you in your career and what lessons did you learn? Submit an article for our next PSA newsletter. Here is our first article by Dr. Roman Y. de Jesus.

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  • Meningitis Outbreak: Confirmed cases increase

    1/25/2013 The national meningitis outbreak has impacted 75 facilities in 23 states, including two facilities in Pennsylvania. Read how this developed and learn the best course of action for patients exposed to suspect lots.

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  • Drug Shortages: Learn the Latest, See Where to Report Shortages

    12/7/2012 PSA's drug shortages resource page outlines why the problem is growing, which drugs are in short supply, and who is addressing the issue.

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  • New: CME Journal Articles Available for PSA Members

    8/30/2012 This is a physician licensing year. PSA members can earn Category I CME credits toward relicensing by logging into this section and reading these journal articles. Recent topics include methods for detection of intraoperative awareness and management of postoperative nausea and vomiting.

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  • The History of Modern Anesthesia

    5/7/2012 As anesthesiologists, CRNAs, hospital administrators, and health policy experts debate and consider scope of practice and supervision issues for non-physician anesthetists, those supporting a broad scope of practice often point out that nurses, not anesthesiologists, were the first modern anesthesia providers. Most of these historical references are accurate. The question is, what is the significance of this history?

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  • Strategies to Detect Drug- Induced Respiratory Depression

    3/6/2012 APSF believes that clinically significant drug-induced respiratory depression (oxygenation and/or ventilation) in the postoperative period remains a serious patient safety risk that continues to be associated with significant morbidity and mortality since it was first addressed by APSF in 2006.

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  • PSA Member Advocates for Controlled Substances Database

    6/16/2011 Michael Ashburn, MD, MPH, a PSA member, provided information to the Pennsylvania House Human Services Committee on June 16 regarding the possible creation of a controlled substances database.

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  • Court Decision Affirms Colorado’s Opt-Out From Medicare’s CRNA Rule

    4/21/2011 Most recently, Colorado’s Governor requested an “opt-out” and the Colorado Society of Anesthesiology (CSA) filed a lawsuit challenging that decision. A Colorado Court has now decided that case, in favor of the opt-out and against the CSA. The court found that both Colorado statutes and regulations authorized the delivery of anesthesia by a CRNA without physician supervision. The important point for PSA members is that the decision is based on several parts of Colorado law that differ substantially from Pennsylvania law.

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  • FTC contests Alabama’s restrictions on CRNAs

    11/19/2010 The proposed rule (rightly) restricts the “interventional treatment of pain to qualified, licensed medical doctors and doctors of osteopathy, who may not delegate to non-physician personnel the authority to utilize such procedures to diagnosis, manage or treat chronic pain patients.” See why the FTC opposes it and why we should care in Pennsylvania.

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  • Don’t Let Half-Truths Determine Patient Care!

    10/8/2010 The motto of the PSA is “Physicians Protecting Patients.” In addition to the clinical care that anesthesiologists provide daily in the OR, the ICU and the Pain Clinic, we must advocate and provide for patient protection in the legislative arena.

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  • Alert: Epinephrine pre-filled syringe shortage

    6/21/2010 Epinephrine emergency syringes 1 mg/10 mL (0.1 mg/mL) are currently on backorder from the sole manufacturer of this product. Although the shortage is expected to resolve later this summer, practitioners should be aware of risk for error created by the shortage.

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  • Explaining the locked cart rule

    5/20/2010 Pennsylvania facilities are again reporting citations from inspectors for unlocked anesthesia carts between cases. Targeting this issue in Pennsylvania hospitals is contradictory to CMS regulation and Joint Commission standards. PSA is currently exploring and addressing this issue.

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  • Physicians receive big court wins in Mcare litigation

    4/16/2010 Pennsylvania's Commonwealth Court ruled on April 15 in favor of physicians/hospitals in the two lawsuits that said funds were incorrectly taken from state-run liability insurance programs for physicians and hospitals.

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  • Check Out Our Clinical Section

    3/26/2009 This new web site, created by the Pennsylvania Society of Anesthesiologists (PSA), offers useful information for a number of audiences – from doctors fresh out of medical school to patients awaiting surgery to the legislators who make important decisions about the health regulations that affect all Pennsylvanians. If you’re an experienced anesthesiologist, we hope you can take advantage of our clinical section, which provides updates on current clinical topics as well as standards, practice parameters and recommendations for the latest intraoperative, preoperative, postoperative and pain management techniques.

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Physicians

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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