Article

As I See It

Another insurance carrier over-reach

Because who can’t perform surgery while simultaneously monitoring anesthesia?

In my last missive, I talked about how much more expensive eye surgery has become due to governmental regulations requiring and paying for pre-op evaluations and testing that have shown to be of little or no value (tinyurl.com/ViewpointMar18 ).

I want to do a 180 and discuss the opposite: a major payer refusing to pay for coverages that indeed are important and also standard of care. I’m talking about the recent decision by Anthem BlueCross Blue Shield to deny coverage to monitored anesthesia care for cataract surgery. Here’s the actual headline from none other than NPR: “Anthem says eye surgeons should monitor cataract anesthesia themselves.”

“ROUTINE” ≠ ONE-MAN SHOW

OK, you got me. Not only can I do all that, but sometimes I’ll prepare that evening’s seven-course meal while operating. Maybe walk the dog. Read over lecture evaluations. I mean, it’s “routine” surgery, so why can’t I multitask?

Anthem, I don’t mean to be disrespectful (maybe I’m way past that), but the whole reason these cataract surgeries are referred to by some as “routine” is because that have a very high success rate. And what in part is the reason for that success? It’s because surgeons like me have laser-like focus through our oculars during the procedure on what’s happening in the eye — nowhere else. Even when I sense something else is going wrong with the patient, I am so thankful I have an anesthetist there to deal with it.

I know the Medicare rates for anesthesia during cataract surgery are quite low, well under what’s being charged for those unneeded pre-op medical clearance evaluations. If insurance companies want to save money, surely there are other places to look besides taking away the only person in the room who is monitoring the overall health of my patient while he/she is having critical eye surgery.

THIS IS EVIDENCE?

Oddly, Anthem referred to only one scientific journal article in support of its decision. The paper’s senior author, friend and colleague Steven Rosenfeld, MD, wrote Anthem to express his dismay that it somehow took his findings and turned them on their head! Dr. Rosenfeld quoted his original publication, “In 1,006 consecutive cataract surgery cases, intervention by anesthesia personnel was required in 376 (37.4%) of cases. No preoperative characteristics were found to be reliable predictors of the need for intervention.”

He ended with the paper’s conclusions, “Because intervention is required in more than one-third of cataract surgery cases and the authors cannot reliably predict those patients at risk, monitored anesthesia care seems justified in cataract surgery with the patient under local anesthesia.”

This issue may be resolved by publication date (See tinyurl.com/y847jnjj ), but we must remain vigilant. Many ways exist to cut excessive costs in our health-care system. Eliminating anesthesia services is not one of them. OM