Patients retain same access to care despite Medicare state's 'opting out' of physician supervision provision

A study published in Anesthesiology claims patient access to anesthesia care for common surgical procedures was similar in states that opted-out of a Medicare rule requiring physician supervision for anesthesia administration and those that didn't.

Eric Sun, MD, of Stanford (Calif.) University, led a team of researchers to examine Medicare claims data for approximately 1.1 million cases to determine distance traveled for total knee replacements, total hip replacements, cataract surgery, colonoscopy, esophagogastroduodenoscopy, appendectomies and hip fracture repairs between 1999 and 2011.

There was no reduction in the percentage of patients who traveled outside of their zip code in the opt-out states, except for total hip replacement patients; there were 2 percent fewer total hip replacement patients in the opt-out states.

In more than 80 percent of total hip replacement patients who traveled outside of their zip code, the effect "is of little practical significance."

None of the 17 "opt-out" states experienced a reduction in the distance patients traveled for their procedure.

Dr. Sun concluded, "“Patients in ‘opt-out’ states were no less likely to avoid traveling further distances to undergo these common procedures, than those in non-opt-out states. By looking at distance traveled as a measure of access, we’re adding to the body of literature that increasingly shows ‘opt-out’ is unlikely to be a silver bullet when it comes to improving access to care.”

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