Anesthesia Providers: The Author Replies
On behalf of my coauthor, Brian Dulisse (Aug 2010), I would like to respond to several of the criticisms raised by Rebecca J. Patchin and Alexander A. Hannenberg in their letters to the editor (Oct 2010).
First, Medicare hospital discharge abstracts are now routinely used in outcomes studies and by the Agency for Healthcare Research and Quality to measure hospital patient safety. Medicare is currently using the abstracts to penalize hospitals for hospital-acquired complications. Studies using Medicare abstracts have also been published in Anesthesiology, the journal of the American Society of Anesthesiologists.1
Anesthesia-related mortality rates are simply too low for both certified registered nurse anesthetists and anesthesiologists to permit meaningful tests of anesthesia-specific deaths and complications. Our goal was to determine whether the opt-out provision led to more inpatient surgical deaths or complications. It didnít.
Our analyses did adjust for patientsí age, sex, and race; the ten highest-mortality diagnosis-related groups (DRGs); andanesthesia procedure base units, critical in capturing the difficulty of the anesthesia procedure.
The Anesthesiology article by Jeffrey Silber and colleagues1 shows that unsupervised nurse anesthetists are more likely thananesthesiologists to treat heart failure and emergency room patients.
Nurse anesthetists and anesthesiologists receive essentially equivalent didactic and clinical training in administering anesthesia.And extra years of medical school do not automatically translate into superior anesthesia outcomes, as evidenced by uniformlylow mortality and complication rates for all providers of anesthesia services.
Nurse anesthetists working alone are more cost-effective even for Medicare because split billing allows supervising anesthesiologists to earn up to four times more per hour than nurse anesthetists. Such supervision is not cost-effective, as many studies over the past twenty years have shown.
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Research Triangle Institute