It is impossible to argue the anesthesia services are necessary for all pain management procedures. Some pain management physicians ("PMPs") use monitored anesthesia care ("MAC") for almost every procedure, while other PMPs will not require MAC for even the most complex procedures.
There is a middle ground where the confluence of patient risk factors and procedural complexity meet and MAC becomes a viable consideration. In these situations readily available anesthesia professionals can be a valuable resource. All the above can be summarized as blah, blah, blah, results, blah, blah, blah, safety, blah, blah, blah.
What anesthesia professionals and facility administrators see, and what insurance administrators don’t see, is that given equal results, many patients prefer MAC during pain (or painful) procedures and would preferentially use PMPs and facilities that provide an anesthesia option, if they have a choice. If anesthesia professionals have a choice, most would prefer not to be involved in providing MAC for pain procedures because these patients:
- Require larger than normal doses of medication because of drug tolerance
- May have significant co-morbidities related to inactivity
- Have positioning and imaging requirements that make monitoring, airway management, and emergency responses difficult,
- Present with complex regimens of chronic ancillary medications making drug interactions more likely, and
- Pain procedures may be technically demanding for the PMP and the anesthesia professional.
And then there is the question...Who's going to pay for it? Rather than regurgitate the well-developed pro and con positions of various constituencies about MAC in pain management, what if:
- Insurers and PMPs work together to develop a list of patient risk factors and complex procedures for which MAC might be appropriate
- For the other patients and procedures, some, but not all, facilities would make MAC anesthesia available by including a discounted anesthesia charge in their facility charge for patients and cases not meeting the guidelines for MAC
As always, a PMP would use whatever sedation and technique they chose at any facility, but patients and PMPs who want MAC sedation would gravitate to those facilities with "Anesthesia Inside", just like the former branding of computers with "Intel inside." Let market forces determine who's right. Will facilities with higher facility charges because of the anesthesia component have increased net revenue because:
- case volume increases,
- decreased staffing costs, and
- improved efficiency?
The market will tell us.
Take Home Points:
- Anesthesia professionals may lust, but it is not to do unnecessary anesthesia for pain management cases
- Let market forces, not arbitrary decisions, allow patients, PMPs, and facilities determine their anesthesia options.