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The Federal Trade Commission staff has submitted a comment to the Texas Medical Board raising concerns that the board’s Proposed Rule § 193.13 could harm competition by impeding access to surgical and other health care services that require anesthesia or related services.

The proposed rule would impose additional supervisory requirements on licensed, certified registered nurse anesthetists in administering anesthesia, and might expose Texas physicians who delegate the administration of anesthesia and related services to CRNAs to additional liability. The comment notes that while the particular supervisory requirements contemplated by the proposed rule are unclear, “any such requirements or increased liability may contract the supply, decrease the availability, or increase the cost of anesthesia services in Texas, without offering countervailing benefits to Texas health care consumers or third-party payors.” The comment explains that the risk of these effects may be higher in rural and other medically underserved areas of Texas. To illustrate the scope of the shortage areas, the comment observes that:

• 170 of 254 Texas counties are rural;
• 64 of 85 critical access hospitals in Texas are in counties where there are no anesthesiologists; and
• 33 of 85 critical access hospitals in Texas are in counties where CRNAs are the only licensed, specialized providers of anesthesia and anesthesia-related services.

The Commission vote approving the comment to the Texas Medical Board was 5-0. (The staff contact is Daniel Gilman, Office of Policy Planning, 202-326-3136.)

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