CMS has issued revised Interpretive Guidelines for the Hospital Conditions of Participation. The revised Interpretive Guidelines, which are effective immediately, contain significant changes affecting anesthesia providers, including the following:
• Labor Epidurals. CMS removed language exempting labor epidurals from the physician supervision requirements. The revised Interpretive Guidelines note that, "there is often no bright line, i.e., no clear boundary, between anesthesia and analgesia. This is particularly the case... with respect to labor epidurals." The revised Interpretive Guidelines require hospitals to "establish policies and procedures, based on nationally recognized guidelines, that address whether specific clinical situations involve anesthesia versus analgesia... [H]ospital anesthesia services policies and procedures are expected to also address the minimum qualifications and supervision requirements for each category of practitioner who is permitted to provide analgesia services."
• Pre-Anesthesia Evaluation. CMS relaxed timeframes associated with the completion of certain elements of the pre-anesthesia evaluation. Within 48 hours immediately prior to surgery or other procedure requiring anesthesia services, the following must be documented:
o Review of the patient's medical history, including anesthesia, drug and allergy history; and
o Interview, if possible given the patient's condition, and examination of the patient.
The remaining elements, listed below, must be reviewed and updated as necessary within 48 hours, but "may also have been performed during or within 30 days prior to the 48-hour time period, in preparation for the procedure":
o Notation of anesthesia risk
o Identification of potential anesthesia problems
o Additional pre-anesthesia data or information (e.g., diagnostic tests, consultations)
o Development of the plan for the patient's anesthesia care
• Post-Anesthesia Evaluation. Federal regulations require that a post-anesthesia evaluation be completed and documented no later than 48 hours after surgery or other procedure requiring anesthesia services. The revised Interpretive Guidelines clarify that, "While the evaluation should begin in the PACU/ICU or other designated recovery location, it may be completed after the patient is moved to another inpatient location or, for same day surgeries, if State law and hospital policy permits, after the patient is discharged, so long as it is completed within 48 hours." If a patient is unable to participate in the post-anesthesia evaluation, the post-anesthesia evaluation still should occur within 48 hours, and the reason for the patient's inability to participate should be documented (e.g., post-operative sedation, mechanical ventilation, etc.).