The most significant change for anesthesia and pain medicine practices in the proposed Medicare Fee Schedule rule for 2013 (NPRM), released on July 6, 2012, was the proposal to allow nurse anesthetists to perform chronic pain services without physician supervision in those states that include such services in the scope of practice of nurse anesthesia.  As noted in last week’s Alert, the 765-page NPRM contains many other potential changes.  Highlights appear below.1. Medicare Payment Rates in 2013It comes as no surprise that the 27 percent cut mandated by the Sustainable Growth Rate (SGR) formula remains in place for now and will take effect on January 1, 2013, if Congress fails to act.  Fear of the economic cliff that the entire country faces with mandatory spending reductions and the expiration of tax cuts early next year will undoubtedly affect how Congress deals with the SGR for 2013; what we cannot predict now...