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Office-Based Anesthesia

Each physician who provides anesthesia services or performs a procedure for which anesthesia services are provided in an outpatient setting, including the use of analgesics and anxiolytics, must register and pay a fee to the Texas Medical Board. The current fee for office-based anesthesia is a total of $210, per physician.

 

In addition, each physician who registers with the TMB for office-based anesthesia, or OBA, must identify what level of anesthesia services are provided at each practice site, with some exception for anesthesiologists.

 

Registration for OBA will be combined with the physician biennial registration. If you need to register to provide OBA services between registrations, please contact Pre-Licensure, Registration and Consumer Services at (512) 305-7030, for the proper forms.

 

Please visit Chapter 192 in the Board Rules for the complete regulations.

 

New:   Inspections of registered OBA locations in Texas to begin in 2014.

In order that we may ensure compliance with Board Rule 192 regarding the provision of anesthesia services in outpatient settings, the Board is implementing, starting January 2014, a program to inspect registered OBA locations in Texas.

The Board will provide at least 5 days’ notice prior to inspection.  At, or prior to, the time of inspection each physician who has registered an OBA location will be required to provide to the information requested by the Board.  Please do not submit any documentation at this time.

 

 

Who has to register for office-based anesthesia?

  1. A physician who provides level II-IV anesthesia services in an outpatient setting (including analgesics and anxiolytics).
  2. A physician who performs a procedure for which level II-IV anesthesia services are provided in an outpatient setting (including analgesics and anxiolytics).

What is the TMB definition of an analgesic and anxiolytics?

Board rule 192 defines analgesic and anxiolytics as shown below:

Analgesics--Dangerous or scheduled drugs that alleviate pain, but not including non-opioid based drugs such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs).

Anxiolytics--Dangerous or scheduled drugs used to provide sedation and/or to treat episodes of anxiety.

Who does not need to register for office-based anesthesia?

OBA registration does not apply to physicians who practice in the following settings:

  1. An outpatient setting in which only local anesthesia, peripheral nerve blocks, or both are used.
  2. Any setting physically located outside the State of Texas.
  3. A licensed hospital, including an outpatient facility of the hospital that is located apart from the hospital.
  4. A licensed ambulatory surgical center.
  5. A clinic located on land recognized as tribal land by the federal government and maintained or operated by a federally recognized Indian tribe or tribal organization as listed by the United States secretary of the interior under 25 U.S.C. (479-1) or as listed under a successor federal statute or regulation.
  6. A facility maintained or operated by a state or governmental entity.
  7. A clinic directly maintained or operated by the United States or by any of its departments, officers, or agencies.
  8. An outpatient setting accredited by:
    1. the Joint Commission on Accreditation of Healthcare Organizations relating to ambulatory surgical centers;
    2. the American Association for the Accreditation of Ambulatory Surgery Facilities; or
    3. the Accreditation Association for Ambulatory Health Care.
  9. Provide only level I services.

 

Note: physicians that provide only level I services, must still meet all other requirements under Chapter 192.

What are the standards for anesthesia services relating to OBA?

Physicians and anesthesiologists shall maintain current competency in ACLS, PALS, or a course approved by the board. In all settings under Chapter 192, at a minimum, at least two persons, including the surgeon or anesthesiologist, shall maintain current competency in basic life support.

 

Verifications of OBA registration are available on request. Please submit a written request by mail, fax or email to: Texas Medical Board P.O. Box 2029 MC 240 Austin, TX 78768 fax - (512) 463-9416 

 

The following standards are required for outpatient settings providing anesthesia services that are administered within two hours before an outpatient procedure. If personnel and equipment meet the requirements of a higher level, lower level anesthesia services may also be provided.

  • Level I services:

    1. at least two personnel must be present, including the physician who must be currently certified by AHA or ASHI, at a minimum, in BLS; and
    2. the following age-appropriate equipment must be present:
      1. bag mask valve; and
      2. oxygen.

    Level II services:

    1. at least two personnel must be present, including the physician who must be currently certified by AHA or ASHI, at a minimum, in ACLS or PALS, as appropriate;
      1. another person must be currently certified by AHA or ASHI, at a minimum, in BLS; and
      2. a licensed health care provider, who may be one of the two required personnel, must attend the patient, until the patient is ready for discharge; and
    2. a crash cart must be present containing drugs and equipment necessary to carry out ACLS protocols, including, but not limited to, the following age-appropriate equipment:
      1. bag mask valve and appropriate airway maintenance devices;
      2. oxygen;
      3. AED or other defibrillator;
      4. pre-measured doses of first line cardiac medications, including epinephrine, atropine, adreno-corticoids, and antihistamines;
      5. IV equipment;
      6. pulse oximeter;
      7. EKG Monitor;
      8. benzodiazepines for intravenous or intramuscular administration and lipid emulsion for treating local anesthetic systemic toxicity; and
      9. specific reversal agents, flumazenil and nalaxone, if benzodiazepines or narcotics are used for sedation.

    Level III services:

    1. at least two personnel must be present, including the physician who must be currently certified by AHA or ASHI, at a minimum, in ACLS or PALS, as appropriate;
      1. another person must be currently certified by AHA or ASHI, at a minimum, in BLS;
      2. a licensed health care provider, which may be either of the two required personnel, must attend the patient, until the patient is ready for discharge; and
      3. a person, who may be either of the two required personnel, must be responsible for monitoring the patient during the procedure; and
    2. the same equipment required for Level II;
    3. establishment of a working intravenous feed;
    4. the presence of appropriate antagonists (i.e. Naloxone and Flumazenil); and
    5. adherence to ASA Standards for Postanesthesia Care.

    Level IV services:

    Physicians who practice medicine in Texas and who administer anesthesia or perform a procedure for which anesthesia services are provided in outpatient settings at Level IV shall follow current, applicable standards and guidelines as put forth by the American Society of Anesthesiologists (ASA) including, but not limited to, the following:

    1. Basic Standards for Pre-anesthesia Care;
    2. Standards for Basic Anesthetic Monitoring;
    3. Standards for Post-anesthesia Care;
    4. Position on Monitored Anesthesia Care;
    5. The ASA Physical Status Classification System;
    6. Guidelines for Non-operating Room Anesthetizing Locations;
    7. Guidelines for Ambulatory Anesthesia and Surgery; and
    8. Guidelines for Office-Based Anesthesia.
  • OBA - Unanticipated Transfer/Hospitalization or Death

    Physicians or surgeons must notify the board in writing within 15 days if a procedure performed in any of the settings under these rules resulted in an unanticipated and unplanned transport of the patient to a hospital for observation or treatment for a period in excess of 24 hours, or a patient's death intraoperatively or within the immediate postoperative period. Immediate postoperative period is defined as 72 hours.  Please use the form below for notification of unanticipated transfer/hospitalization or death.

     

    Unanticipated Transfer/Hospitalization or Death

     

    Please contact Pre-Licensure, Registration and Consumer Services at (512) 305-7030 if you have any additional questions.

  • How much does OBA registration cost?

    The biennial registration fee for office-based anesthesia is a total of $210, per physician.

    I am an anesthesiologist. I contract out my services to other physicians to provide anesthesia for procedures in their offices. Since the anesthesia is not done in my office and I am only a contractor, do I need to register for Office Based Anesthesia (OBA)?

    Yes, both the anesthesiologist and the physician performing the procedure should be registered for OBA. Statute states that each physician who administers anesthesia or performs a procedure for which anesthesia services are performed in an outpatient setting shall register for OBA and comply with current OBA regulations. Please note, an anesthesiologist who contracts out their services to multiple physicians is not required to register each location where they perform OBA, but only the highest level of OBA services that they provide.

    How do I verify what level of OBA services an individual is registered for?

    Verifications of OBA registration are available on request. Please submit a written request by mail, fax or email to: Texas Medical Board P.O. Box 2029 MC 240 Austin, TX 78768 fax - (512) 463-9416