CMS Relaxes Anesthesia Guidelines, Allows ED Exception

UPDATED Feb. 10, 2011 -- Please read this important letter from ACEP President Dr. Sandra Schneider regarding this win for emergency medicine and ACEP's crucial role. Also, read a letter from the President of the American Society of Anesthesiologists clarifying their position on emergency physicians and sedation.


Jan. 19, 2011 -- The Centers for Medicare & Medicaid Services (CMS) responded to ACEP’s concerns and now allows an exception for emergency departments in their interpretive guidelines on use of anesthesia services.

The updated guidelines, announced on Jan. 19, now state that hospitals can use different clinical guidelines in different areas of the hospital, specifically pointing out the unique environment of the emergency department and the specialized training of emergency physicians.

“For example, CMS now states that ACEP guidelines may be used in the emergency department and the American Society of Anesthesiologists’ guidelines for surgical services,” said Barbara Tomar, ACEP’s Federal Affairs Director. “This is the flexibility we’ve been asking for.”

In February 2010, CMS published interpretive guidelines on the use of anesthesia services.

Finding these guidelines to be restrictive, ACEP, the Emergency Nurses Association (ENA), and the American Association of Emergency Medicine (AAEM) sent a joint letter and shared ACEP’s clinical guidelines and recent literature. In April, the groups met with CMS Survey and Certification staff to request an exception for emergency departments.

The underlying Medicare condition of participation regulation -- that each hospital determines clinical privileges for anesthesia administration -- has not changed.

Last month, ACEP leaders had a productive meeting with ASA leaders to clarify the role of emergency physicians performing procedural sedation and the meeting should facilitate hospital-specific implementation of the revised CMS interpretive guidelines.

ACEP President Sandy Schneider, Past President Angela Gardner, President-elect David Seaberg, Vice President Andy Sama, and ACEP members Kevin Klauer and Allison Haddock, worked on this important and favorable change with the help of Ms. Tomar and others in ACEP’s DC office.

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