The Medicare "opt-out" rule allows anesthesia to be administered without physician supervision, however it does not increase patient access to anesthesia care as has been thought, according to a study published in Anesthesia and Analgesia.
Here are five insights:
1. Since 2001, 17 state governors have exercised the Medicare "opt-out" rule.
2. Researchers included opt-out states organized into groups based on opt-out year.
• Group 1: Iowa (2001)
• Group 2: Idaho, Minnesota, Nebraska, New Hampshire and New Mexico (2002)
• Group 3: Alaska, Kansas, Oregon and Washington (2003)
• Group 5: Wisconsin and South Dakota (2005)
• Group 6: California (2009)
The analysis included 13 of the 17 opt-out states. The four states that would have made up group 4 were excluded for a number of reasons.
3. Researchers then calculated the anesthesia utilization rate for the three years before and three years after opt-out and compared it to the anesthesia utilization rate for non-opt-out states in the same time period.
4. For Group 1, the average anesthesia utilization rate for non-opt-out states increased 32 percent compared to a 16 percent increase in the opt-out state. Group 2 showed an increase of 26 percent for non-opt-out-states compared to the opt-out states' 18 percent increase.
5. Group 6 was the only group to show a slight increase in the opt-out state with an increase of 5 percent compared to the non-opt-out states' increase of 4 percent.
"The decision over whether to 'opt out' remains contentious in many states," said Eric Sun, MD, PhD. study author and instructor in the department of anesthesiology, perioperative and pain medicine at the Stanford (Calif.) School of Medicine. "Previous studies have attempted to examine patient outcomes in opt-out states, but none has investigated whether opting out of the federal rule improved access to care. This study shows that 'opt-out' alone is not the silver bullet to improving access."