DENVER, Co (February 27, 2018) – The Outpatient Ophthalmic Surgery Society (OOSS) lends its voice to efforts to rescind a new clinical guideline released this February by managed healthcare organization Anthem that states anesthesia services for cataract surgery are not medically necessary for the majority of patients.
The updated Clinical UM Guideline CG-MED-60 requires eye surgeons to assume responsibility for topical, local, or regional anesthesia or conscious sedation for all cataract patients with very limited exceptions. These exceptions include pediatric cases, patients requiring an anticipated complex or long surgery, patients unable to communicate or cooperate, or those with histories of problems with anesthesia.
As the only organization dedicated exclusively to advocating and supporting the medical practice of outpatient ophthalmic surgery, OOSS assigns high priority to any policy or regulation that threatens patient care, health, or safety. OOSS agrees with other ophthalmology organizations, including the American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS), in recommending that the Guideline be rescinded.
OOSS President Jeffrey Whitman, MD, expressed his organization’s concerns in a letter directed to Anthem. In it he states, “The Guideline reflects a misguided view of the complexity of cataract surgery, the relative training and skill sets of the ophthalmic surgeon and anesthesia provider, and the unique characteristics and health status of the typical cataract patient.”
Anthem has stated that, notwithstanding its Guideline, it will not deny coverage for cataract anesthesia. OOSS will continue to collaborate with opposing voices to rescind Anthem’s update and asks OOSS members to keep OOSS apprised of Anthem claims issues in member localities. Share your claims issues at OOSS Talk
Continue to check OOSS Washington Updates and join the conversation at OOSS Talk for more on this Guideline’s status and related OOSS advocacy efforts.
The updated Clinical UM Guideline CG-MED-60 may be viewed at: https://www11.anthem.com/ca/medicalpolicies/guidelines/gl_pw_d056667.htm.
OOSS’ letter to Anthem may be viewed at: Final Anthem Letter – Anesthesia Services WORD- 2-21-18.
Should you have any questions or comments regarding the Anthem anesthesia services guideline, please contact OOSS’ Washington Counsel, Michael Romansky, JD, at mromansky@OOSS.org.