Statement on ​Definition of ʺImmediately Availableʺ When Medically Directing

Developed By: Committee on Economics
Reaffirmed: October 23, 2019 (original approval: October 17, 2012)

Definition:
An anesthesiologist who is personally performing an anesthetic is exclusively and completely dedicated to that case. A medically directing anesthesiologist is immediately available if s/he is in physical proximity that allows the anesthesiologist to re-establish direct contact with the patient to meet medical needs and any urgent or emergent clinical problems. These responsibilities may also be met through coordination among anesthesiologists of the same group or department.

Guidelines for Developing Policy Regarding Immediate Availability:
Differences in the design and size of various facilities make it impossible to define a universally applicable specific time or distance for physical proximity. The physical layout of the operating room and other anesthetizing locations are important in determining how medically directing anesthesiologists can fulfill the requirement to be immediately available.

Individual anesthesia groups and/or departments should establish objective and specific written policies regarding immediate availability that consider objective elements such as distance, a map or time that recognizes the specific local environment, and factors that should be taken into account so that a medically directing anesthesiologist is available to immediately conduct hands-on intervention for each patient. The demands of particular surgical and other diagnostic or therapeutic procedures and the clinical needs of patients may further restrict what constitutes immediate availability under specific circumstances.

The medically directing anesthesiologist may perform other services as allowed by Medicare or local Contractor instructions. The activity should be interruptible and allow the anesthesiologist to re-establish direct contact with the patient to address urgent or emergent clinical situations. An anesthesiologist maintains medical direction and is immediately available when providing a personal break of short duration to a staff member under circumstances to be described in the written policies established by the department or practice.

There are other activities that are not appropriate for the medically directing anesthesiologist. Examples of such activities include, but are not limited to (1) personally performing another anesthetic, (2) performing other elective procedures on patients not undergoing a surgical procedure (such as chronic pain blocks) or (3) engaging in any other activity that would prevent a timely return to establish direct contact with the patient to meet medical needs or treat emergencies.