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US eye doctors push back against insurer

US eye surgeons are fighting back against a new policy from a leading health insurer that would make ophthalmologists responsible for anaesthetising and monitoring patients during cataract operations.

Health insurer Anthem has asserted ophthalmologists are able to perform the extra duties without compromising patient safety, and plans to implement the policy nationwide soon.

According to Newsday, Anthem stated its decision was developed by a panel of medical experts and based on providing patients with “high quality, affordable healthcare, including safe and effective medical technologies.”

However, the American Academy of Ophthalmology, the American Society of Anesthesiologists and the American Association of Nurse Anesthetists have questioned the safety of the policy and are pressuring Anthem to rescind the policy. The groups have said the policy sends the wrong message, could harm patients, and may lead to other health insurance companies adopting similar plans.

"The literature does not support the concept that monitored anaesthesia care is unnecessary for routine cataract surgery."
Amjad Hammad, Nysos

Standard operating procedure for cataracts is to have an anaesthetist administer the sedating medication and remain in the room to monitor and re administer as needed. Ophthalmologists have said it is not possible to predict when a patient may have an unexpected heart rhythm disturbance, respiratory problem or complication arising from the anaesthesia.

“Ophthalmologists are not trained in anaesthesiology and when we are doing surgery we are entirely focused on the eye. There is a unanimous voice in ophthalmology that this is not the right thing to do for the patient,” interim chairman of ophthalmology for the Northwell Health network in Long Island Dr Richard Braunstein said.

“I think in large part much of the safety that we associate with cataract surgery is the security of having an anaesthesiologist to appropriately anaesthetise the patient and monitor the patient to keep them safe during surgery.”

New York State Ophthalmological Society president Dr Amjad Hammad also pointed out that Anthem has not provided any evidence to support its claims.

“The literature does not support the concept that monitored anaesthesia care is unnecessary for routine cataract surgery. The highest standard of care and the level of sedation most commonly used include the presence of a certified registered nurse anaesthetist or an anaesthesiologist,” Hammad said.

Costs for anaesthesiology services range from around US$200–400 (AU$256 –513).per procedure, based on a 2016 survey conducted by the American Association of Nurse Anaesthetists.

With the proposed policy, the costs will no longer be covered by insurance under Anthem.

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