Anesthesia Business Consultants President and CEO Tony Mira summarized efforts to repeal Anthem's clinical guideline related to anesthesia services during cataract surgery.
Here's what you should know.
1. Anthem issued a clinical guideline stating anesthesia services were medically unnecessary during cataract surgeries for a majority of patients.
2. The guideline instead puts the responsibility of topical, local or regional anesthesia as well as conscious sedation into the hands of ophthalmologists. Anthem listed few exceptions to the guideline. Those exceptions include pediatric cases, patients requiring complex surgeries, patients who are unable to communicate or those with histories of anesthesia problems.
3. Several professional societies, including the American Academy of Ophthalmology, have issued statements criticizing the measure, while asking Anthem to reconsider.
4. The California Academy of Eye Physicians and Surgeons and California Society of Anesthesiologists each sent letters to Anthem asking for the policy's immediate recension. The California Medical Association issued a complaint to the California Department of Managed Health Care and California Department of Insurance.
5. Mr. Mira said policy opponents "fear the Anthem policy could signal a 'slippery slope' of removing coverage for other vital healthcare services that would jeopardize the quality and safety of care."