Why you should worry about Anthem’s new anesthesia policy

March 19, 2018

Is this new policy in the patient's best interest?

According to a recent article, Anthem has issued a new policy in which ophthalmologists now must monitor their patients’ anesthesia while performing routine cataract surgeries.  This has drawn skepticism from ophthalmologists and anesthesiologists alike, who are concerned this policy jeopardizes patient safety.

The policy states anesthesia is only medically necessary if the patient is under the age of 18, cannot cooperate due to medical issues or cannot lie flat, or if the procedure is complex in nature, among other things.

Read the full policy here

This has the ophthalmic community worried, as pulling double-duty could mean patient safety is at risk.

“An ophthalmologist cannot administer conscious sedation, monitor the patient and do cataract surgery, all at the same time,” said David Glasser, MD, clinical spokesperson for the American Academy of Ophthalmology (AAO). The academy believes that the insurance company’s new policy is not in patients’ best interest.

During cataract surgery, patients are sedated but still conscious during the procedure. They are monitored by the anesthesiologist to ensure they are kept relaxed and calm. This policy was issued online, and ophthalmologists are awaiting clarification on its official implementation.

“Having anesthesia personnel in the room is one of the key ingredients in the safety and effectiveness of cataract surgery today,” Dr. Glasser said.

The decision to have an anesthesiologist or nurse anesthetist in the room during cataract surgery with sedation is best made between the ophthalmologist and the patient, he said. 

"While cataract surgeries are generally routine,” said Bruce Weiner, DNP, MSNA, CRNA, president of the AANA, “any 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.”

Weiner says that seniors are also at greatest risk for complications due to an increase in 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.”

Anthem doesn’t seem to necessarily think so, however.

According to an Anthem spokesperson, there is no one definitive approach regarding anesthesia use in cataract surgery, and patients’ specific needs should be taken into consideration as well as potential risk of harm to individuals who are sedated during surgical procedures.

“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,” said the spokesperson.

Anthem is open to discussing the policy update with those who are concerned, said the spokesperson. “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.”

This article has been updated.