Category Archives: Sedation Practice

CMS Guidelines: Threat or Opportunity?

New guidelines have been released from Centers for Medicare & Medicaid Services related to “Anesthesia” services.  These guidelines have set off a firestorm of emails, letters, questions, and overall confusion to what they truly mean, what is their intention and how should these “interpretive” guidelines be interpreted.

The Society for Pediatric Sedation was one of many organizations that wrote to CMS, and expressed our opinion about the positives and negatives of these guidelines.  Our letter can be found here.

How has your institution approached these guidelines?

Has it been used as a threat to change your entire bylaws, sedation structure and deem “one physician” as the “controller” of  Anesthesia/Sedation? Has it been seen as “much ado about nothing” with no significant change seen based on your current structure? Has it brought specialties together or separated them further on this very important issue?

Overall, how do you feel it has or will impact patient care in your institution?

In my institution, it is yet to be determined.  Early on, I would readily admit that the confusion and difference of opinion led to some “tension” and mildly heated discourse.  Time will tell as the administration seeks to find clarity and answers to this dilemma.

The Opportunity

Overall, however, I see this as a great opportunity for improved sedation care.  Of course, this opportunity can only be seized if the anesthesia department and sedation service both feel that collaboration is truly what these guidelines are promoting.  The opportunity for anesthesia to provide oversight, input and collaboration is far different than an effort to take “control” or take back sedation care that they could not or did not want to provide many years ago thus allowing skilled expert sedation providers to fill this niche.

On the other hand, sedation services have an opportunity to promote very important dialogue with their anesthesia colleagues.  They should work to integrate care and not seen as a competitive services but rather a complementary one.

Our Hope

My feeling is that these guidelines can be interpreted very differently and “bias” clearly affects one’s vision.  However, if we are truly focused on “what is best for the patient” we can only hope that visions will clear, weapons will be dropped, and we will look back at these guidelines as an opportunity to promote multidisciplinary collaboration and improve sedation care.

High hopes perhaps, but perhaps a lofty goal that we as a society should strive for.

The SPS would appreciate your thoughts, opinions and experiences on this matter.  Please share via this Blog.  As a society we will continue to work to dialogue with Joint Commission, CMS and other agencies to meet our goals of improving sedation quality and safety.

Mick Connors MD

SPS and Sir William Osler

As the inaugural blog posting of the Society for Pediatric Sedation, I felt it only appropriate that we understand the historic significance of this development in modern medicine. Modern medicine continues to evolve and specialism is alive and well in America as suggested and discussed by Sir William Osler in his address to the emerging Pediatric Society in 1892.

If you have not read this address, I would highly recommend taking the time to do so, it can be found at http://mcgovern.library.tmc.edu/data/www/html/people/osler/index.htm . It was published in the Boston Medical and Surgical Journal Vol 126:19, 457-459. I will utilize this blog to highlight some of the remarkable similarities of Sir Willam Osler’s address and the development of this Society for Pediatric Sedation some 120 years later. Continue reading