Quite the interesting spin by the ASA found HERE
First it was funded by the ASA but more importantly we cannot see HOW they determined an Anesthesiologist was somehow involved in care. That is pretty important information. Some examples where they may find an Anesthesiologist on staff but which would not be valid for this conclusion would be:
- Hospitals happens to have an Anesthesiologist who performs PAIN only but has nothing to do with the CRNA cases.
- Anesthesiologist is employed by the facility as part of the administration yet again does not have anything to do with cases.
- Hospital where Anesthesiologists are still listed on the staff after years of not being at the facility.
- Anesthesiologist is doing their own cases when independent CRNA is performing their own. No different than if it were 2 rooms with just MDs.
- There are many urban facilities where Anesthesiologist is in house in an office from 7-3pm while CRNAs perform all the cases independently and then the MD goes home at 3 pm and the CRNAs cover 100% of the call independently as well.
Clearly none of these would validate what the ASA friends here are saying and these are all important parts of the puzzle.
In the statement by the ASA they do not define what "supervision" and in fact are assuming that just by proxy of being apart of the facility there is some form of supervision which is a stretch AT BEST. They emphasize this when they state:
"in situations when a nurse anesthetist is practicing and a physician anesthesiologist is also at the hospital, it is likely there is a formal working relationship that may include collaboration, consultation, rescue from critical events, or supervision."
This statement somehow makes the assumption that MDs who work with MDs never consult or collaborate or have a "formal working relationship" when that is patently untrue.
However, what is the most important take away here?
Only 47.5% of these hospitals HAD Anesthesiologists which is only 255 of the 538 facilities.
If we were to believe that the ASA did not use a loose determination of "supervision" and how they determined an Anesthesiologist was involved in care it does not impact the final truth which even they cannot escape.
Effectively, since these studies showed NO increase in morbidity and mortality in ANY of these facilities (including 282 of them where there were CERTAINLY no Anesthesiologists) the conclusion remains the same:
There is no difference in outcomes between Anesthesiologist only, Anesthesia Care Team and CRNA Only care except, of course, the significantly increased cost of the first two.
One last caveat: if the Authors of this study are arguing that billing code is not adequate to define actual CRNA-only cases they are also completely invalidating the sampling methodology in the Silber study...their favorite talking point.