Ask Yourself These Questions Before Offering In-office Anesthesia

The requirements for offering in-office anesthesia services vary widely by state. Review these key questions to help your practice avoid costly penalties for noncompliance.

Q. Do you have the authority to hire or supervise an anesthesiology provider? Are you sufficiently experienced to meet the standard of care?

In Illinois, the Ambulatory Surgical Treatment Center Act provides that anesthesia services may be performed by or under the direction of a licensed physician who has specialized anesthesiology experience or completed a residency in anesthesiology. The Act even recommends that this physician be a board-certified or board-eligible anesthesiologist. In other words, only these professionals are qualified to order anesthesia services. 

Illinois law, however, is slightly more inclusive about who may administer anesthesia services under physician supervision. Certified Registered Nurse Anesthetists (CRNA), for example, are among the medical professionals with clinical privileges at an ASTC who are allowed to select, order, and administer anesthesia under supervision by a qualified physician. 

Q. Can a Nurse Practitioner hire or supervise a Certified Registered Nurse Anesthetist? Can a general Medical Doctor supervise a CRNA?

A Nurse Practitioner (NP) may hire a Certified Registered Nurse Anesthetist (CRNA) but cannot supervise a CRNA providing anesthesia services. As mentioned above, anesthesia services may be provided by a qualified Medical Doctor (MD) or otherwise by a qualified CRNA acting under a qualified MD’s direction. To that end, an NP may not supervise a CRNA for the purpose of providing anesthesia services. 

Additionally, as discussed above, not just any MD may supervise a CRNA. An MD may only supervise a CRNA if the MD has “specialized preparation or experience” in anesthesiology or otherwise completed an anesthesiology residency. 

Q. If you offer in-office anesthesia or sedation, do you need to apply for a new type of facility classification? 

Another threshold question for many healthcare professionals contemplating offering in-office anesthesia is whether they have a proper, legally compliant facility. 

In Illinois, qualified staff may provide anesthesia services in either a licensed hospital or a licensed ASTC. ASTC’s are not required to offer in-office anesthesia services. Still, those that choose to do so are subject to various equipment, staffing, sanitation, and building requirements provided by the code.

As such, if you want to offer anesthesia services and your facility is not already a licensed ASTC or hospital, you must apply for new licensure accordingly. If your business is already a licensed ASTC or hospital, you do not need to apply for a new type of facility classification. However, your already-licensed facility must comply with the code’s anesthesia requirements. Failure to do so can result in license revocation or failed license renewal.

Does your facility meet requirements for offering in-office anesthesia services?

Among other clinical space requirements, the code requires a licensed ASTC to provide different types of rooms for post-anesthesia recovery for surgical patients. Each recovery room must contain:

• a drug distribution station
• handwashing facility
• charting facilities
• nurses’ station
• storage space
• a toilet accessible to the patient without leaving the room

Among other support service area requirements, the code requires a licensed ASTC to provide storage facilities for anesthesia equipment. The code also prohibits the use of flammable anesthetics. The equipment requirements include creating and following written procedures for the safe storage and use of inhalation anesthetics and other medical gases. Moreover, the code requires that those procedures be written in accordance with the latest guidelines from the National Fire Protection Association.

Q. Do you need a transfer agreement with a hospital in case a medical emergency arises?

Not necessarily. In Illinois, the Code requires that a licensed ASTC maintain written documentation of one of three things to ensure availability of follow-up care at a hospital when needed:

• A transfer agreement with a hospital within approximately 15-30 minutes travel time of the facility; 
• A statement that the medical director of the facility has full admitting privileges at a hospital within approximately 15-30 minutes of travel time. In the statement, the medical director must assume responsibility for all facility patients requiring follow-up care; or 
• A statement that each staff physician, dentist, or podiatrist has admitting privileges in a hospital within 15-30 minutes of travel time of the facility.

Q. Can your anesthesia professional work as an independent contractor, or should they be an employee?

There are three common types of employment relationships that a practice may have with an anesthesia professional.

First, consider hiring an MD or a CRNA as an employee if your practice uses anesthesia often. Practices that employee anesthesia professionals pay them a salary in exchange for their services. If your practice uses anesthesia often, it can benefit from this type of arrangement because you would always have a qualified staff member available. This arrangement can help eliminate stressors associated with independent contractors or continually looking for new hires. 

Second, consider establishing a non-exclusive contract with an outside anesthesia group. In this arrangement, your practice can contract with multiple anesthesia groups or qualified individuals to provide anesthesia services. Many practices enjoy this arrangement because of the potential for increased flexibility, availability, and types of anesthesia services that come with having a large pool of qualified staff at their disposal. However, unlike with employee arrangements, your practice has relatively less control over personnel’s immediate availability— an obstacle for healthcare practices that provide emergency or urgent procedures.

Third, consider an exclusive contract with an outside anesthesia group. Regardless of the frequency with which your practice uses anesthesia, this type of arrangement may be more appealing than its non-exclusive counterpart. An exclusive contract with an outside anesthesia group can improve your practice, similar to that of a non-exclusive contract. However, exclusive contracts also allow medical practices to better coordinate staffing schedules and provide more consistent care to patients. 

Conclusion

Each states’ requirements for anesthesia services, staffing, and facilities vary, making them extremely difficult to navigate. Moreover, the best anesthesia solutions for one medical practice may not fit another. If you or your medical practice are thinking about offering in-office anesthesia, consider contacting the experienced attorneys of Jackson LLP Healthcare Lawyers to help lift the burden of this arduous process.

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.