On November 29, 2012, the Wisconsin Division of Quality Assurance published a new memorandum (DQA Memo 12-018) that provides information to health care providers regarding Wisconsin Act 160. Act 160 created new licensing requirements for anesthesiology assistants. Act 160 (the “AA Licensure Act”) was signed into law by Governor Walker in March and went into effect on November 1, 2012.
The AA Licensure Act added a new category of licensed health care providers in the state known as “anesthesiologist assistants” and created an infrastructure to create requirements to promote the safe and competent practice of individuals who attain this new licensure status.
The passage of the AA Licensure Act is but the latest development in the legal dynamics between Anesthesiologists and Certified Registered Nurse Anesthetists that began when Wisconsin opted to permit CRNAs to independently bill for their services which was affirmed in 2007. The AA Licensure Act creates a separate class of licensed professional that can only operate under supervision from a physician anesthesiologist.
For a full summary of the AA Licensure Act and the recently released DQA Memo, visit our web site.
Council On Anesthesiologist Assistants
The AA Licensure Act created a new council on anesthesiologist assistants within the Department of Safety And Professional Services by adding section 15.407(7) to the Wisconsin Statutes. The council is created to make recommendations to the medical examining board regarding the scope of practice of anesthesiologist assistants. The membership of the counsel is to be selected from a list of recommended appointees to be submitted by the president of the Wisconsin Society of Anesthesiologists after considering the recommendations of the Wisconsin Academy of Anesthesiologist Assistants.
The members of the council are subject to final approval by the medical examining board and hold three-year terms. Members on the council must include a member from the medical examining board, a licensed anesthesiologist assistant, and two physician anesthesiologists.
Practice Locations and Temporary Licensure
Licensed anesthesiologist assistants may practice in Wisconsin hospitals, critical access hospitals and ambulatory surgical center in the state of Wisconsin. Section 448.04(1)(g) that was created by the new law permits a temporary license to be issued to individuals who meet certain requirements and who are eligible for but have not yet passed the certification examination to become and anesthesiologist assistant. The temporary license may only be issued for up to 18 months.
Supervision and Supervision Agreement
An anesthesiologist assistant is only permitted by the scope of licensure to assist an anesthesiologist and must practice under the supervision of an anesthesiologist. The statute specifies details that must be maintained by the supervising anesthesiologist in order to meet the definition of “supervision.” The supervising anesthesiologist must at all times be immediately available in the same location or facility and must be able to intervene in the procedure if required. Supervision requirements should be reviewed in detail and incorporated into specific protocols that are applicable to the provision of anesthesia services in a facility.
The statute requires an anesthesiologist assistant to be employed by a hospital, ambulatory surgery center or an affiliate of a hospital. Anesthesiologist assistants can only practice under a supervision agreement with a physician anesthesiologist who represents the employer of the anesthesiologists assistant. The statutes defined specific provisions that must be included within the supervision agreement between the anesthesiologist and the anesthesiologists assistant.
Limited Permitted Activities
The statute defined a limited scope of practice for an anesthesiologist assistant who is only authorized to perform the following types of tasks:
(a) Developing and implementing an anesthesia care plan for a patient;
(b) Obtaining a comprehensive patient history and performing relevant elements of a physical exam;
(c) Pretesting and calibrating anesthesia delivery systems and obtaining and interpreting information from the systems and from monitors;
(d) Implementing medically accepted monitoring techniques;
(e) stablishing basic and advanced airway interventions, including intubation of the trachea and performing ventilatory support;
(f) Administering intermittent vasoactive drugs and starting and adjusting vasoactive infusions;
(g) Administering anesthetic drugs, adjuvant drugs, and accessory drugs;
(h) Implementing spinal, epidural, and regional anesthetic procedures;
(i) Administering blood, blood products, and supportive fluids;
(j) Assisting a cardiopulmonary resuscitation team in response to a life threatening situation; and
(k) Participating in administrative, research, and clinical teaching activities specified in the supervision agreement.
The new category of provider will require hospitals and other facilities to take a look at their credentialing policies, anesthesia policies, procedures and protocols, and their compliance program risk areas. The new supervision requirements need to be closely examined and integrated into procedure. Credentialing implications of the temporary and permanent licensure categories should also be considered. Facilities should also look at their applicable conditions of participation and/or accreditations agency policies to determine whether any issues are raised.
Medicare generally permits reimbursement to be received for the services of appropriately supervised anesthesia assistants. However, the supervision requirements for anesthesiologist assistants is generally more stringent than for Certified Registered Nurse Anesthetists who, depending on state law, may be permitted to independently bill for their services without supervision.
A good place to start on reimbursement issues is the Medicare MLN Matters Article found at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Medicare_Information_for_APNs_and_PAs_Booklet_ICN901623.pdf
You can access the DQA Memo at the following link: DQA Memo 12-018 – http://www.dhs.wisconsin.gov/rl_DSL/Publications/12-018.htm
You can directly access Act 160 that created the new category of provider at the following link: Wisconsin Act 160 – https://docs.legis.wisconsin.gov/2011/related/acts/160.pdf
For more information on the requirements of the new anesthesiologist assistant law and its implications, please feel free to contact John H. Fisher, CHC, CCEP, a health care law and compliance attorney in our law firm.