In the interests of patient safety and quality of care, we believe that all patients in Illinois deserve the involvement of an anesthesiologist when they are most vulnerable.

Current laws in 45 states all require physician some level of involvement for anesthesia care. They may define collaboration, direction, and consultation differently, but nurse anesthetists in these 45 states are required to have a physician involved when they deliver anesthesia services.

Anesthesia is unlike primary or preventative health care. It is a complex, high-risk care setting where complications can present quickly that require immediate medical attention to prevent serious injury or death.

The Role of a Physician Anesthesiologist

With 12 to 14 years of education and 14,000 to 16,000 hours of clinical training, physician anesthesiologists serve a critical role in providing safe anesthesia care. For patients who have poorer health status, the involvement of a physician anesthesiologist in their care is an imperative. Without physician involvement, Illinois would be lowering the standard of care for our citizens and potentially putting their lives at risk for no reason.

In 2018, the World Health Organization (WHO) published “International Standards for a Safe Practice of Anesthesia.” It highly recommends: “Wherever and whenever possible, anesthesia should be provided, led or overseen by a physician anesthesiologist.”

Rural Access

In order to deliver anesthesia, both nurse anesthetists and physician anesthesiologists rely completely upon the presence of a surgeon or other doctor requesting anesthesia services. Recent research also shows that removing physician supervision does not increase patient access to surgery procedures or anesthesia care.

According to the 2019 data from the U.S. Bureau on Labor Statistics, Illinois has the fourth highest employment levels for anesthesiologists. States with more anesthesiologists are: New York, Texas and California. The metropolitan area encompassing Chicago, Naperville and Elgin has the seventh highest employment levels for nurse anesthetists in the country.

To address shortages and access, we should look at the Illinois Rural Health Summit Planning Committee report from October 2018. That report recommends: “Create public-private partnerships to recruit and retain a health care and behavioral health workforce, including physicians, nurse practitioners, physician assistants, social workers and behavioral therapists.”

Cost of Care

Medicare, Medicaid and commercial insurance carriers reimburse anesthesia based on a consumption basis. That is, the cost of the anesthesia is an algorithm which takes a base unit of the type of procedure, the age and health of the patient and multiplies that by a time unit for the length of time the patient is under anesthesia. The cost of the anesthesia does not change depending on the provider. Therefore, independent practice of the nurse anesthetist provides no cost saving to the patient.

Payment is made based on a billing code and blind to who provides the anesthesia service. For anesthesia services, nurses and physicians are reimbursed by insurance carriers at the same rate.

If SB 2566 can’t reduce state healthcare costs and it doesn’t increase access to care, what does it do? On behalf of the members of the Illinois Society of Anesthesiologists, I suggest that it only decreases patient safety throughout the state. Please consider maintaining the current safety standards in our state by preserving the physician-led model and voting against Senate Bill 2566.