Effective November 1, 2012, 2011 Wisconsin Act 160 (the “Act”) creates a licensure process for anesthesiologist assistants practicing in Wisconsin who, since 1980, have practiced under delegated authority. A copy of the Act is available on the Wisconsin Legislature’s website.
Under the Act, licensed anesthesiologist assistants may assist in the delivery of care under the supervision of an anesthesiologist. They may not, however, be supervised by a surgeon or a certified registered nurse anesthetist. To provide the appropriate level of supervision, the Act requires that the supervising anesthesiologist be immediately available in the same physical location or facility and able to intervene if necessary.
The supervising anesthesiologist is responsible for being aware of and assigning appropriate tasks consistent with the anesthesiologist assistant’s education and training, the scope of practice of the supervising anesthesiologist(s) and the scope of practice limitations permitted by the Act. Under the Act, an anesthesiologist assistant may only assist and perform the following medical care tasks as assigned by the supervising anesthesiologist:
- Developing and implementing an anesthesia care plan for a patient;
- Obtaining a comprehensive patient history and performing relevant elements of a physical exam;
- Pretesting and calibrating anesthesia delivery systems and obtaining and interpreting information from the systems and from monitors;
- Implementing medically accepted monitoring techniques;
- Establishing basic and advanced airway interventions, including intubation of the trachea and performing ventilatory support;
- Administering intermittent vasoactive drugs and starting and adjusting vasoactive infusions;
- Administering anesthetic drugs, adjuvant drugs and accessory drugs;
- Implementing spinal, epidural and regional anesthetic procedures;
- Administering blood, blood products and supportive fluids;
- Assisting a cardiopulmonary resuscitation team in response to a life-threatening situation;
- Participating in administrative, research and clinical teaching activities specified in the supervision agreement; and
- Supervising student anesthesiologist assistants.
Anesthesiologist assistants must enter into a written supervision agreement with an anesthesiologist representing the anesthesiologist assistant’s employer. The supervision agreement must identify the supervising anesthesiologist(s) and define the practice of the anesthesiologist assistant consistent with the anesthesiologist assistant’s education and training, scope of practice limitations listed above and any other limitations determined by the anesthesiologist representing the anesthesiologist assistant’s employer. The supervision agreement must be reviewed on an annual basis and must be available for inspection at the location where the anesthesiologist assistant practices.
A supervising anesthesiologist may only supervise four anesthesiologist assistants at one time, pursuant to Medicare reimbursement standards. This does not prohibit a supervising anesthesiologist from acting as a supervising anesthesiologist for more than a total of four anesthesiologist assistants, as long as only four are providing patient care at any given time. In addition, anesthesiologist assistants may have more than one supervising anesthesiologist. For example, a group of six anesthesiologists may each work with an anesthesiologist assistant at different times and each of the six would be a supervising anesthesiologist.
Practical Takeaways
To ensure compliance with the Act, we recommend employers consider taking the following actions with regard to the practice of anesthesiologist assistants:
- Develop a template supervision agreement for use at the facility where the anesthesiologist assistant is practicing;
- Establish a process for the annual review of each supervision agreement;
- Develop a procedure to ensure that all supervising anesthesiologists are aware of the limitations of the anesthesiologist assistant’s practice, as set forth in the supervision agreement; and
- Review bylaws and billing and payment requirements to ensure the practice of anesthesiologist assistants is appropriately documented.
If you have any questions or would like assistance drafting a supervision agreement, please contact:
- Robin Sheridan at 414.721.0469 or rsheridan@wp.hallrender.com;
- Christina Severin at 414.721.0468 or cseverin@wp.hallrender.com;
- Anne Ruff at 414.721.0489 or aruff@wp.hallrender.com; or
- Your regular Hall Render attorney.
