Education and Practice Barriers for CRNAs
Education and Practice Barriers for CRNAs
CRNAs have had their ability to practice independently challenged. During the last decade, nurse anesthetists' skills have been publicly brought into question by physicians who have attempted to block efforts aimed at independent CRNA practice. Efforts include pressuring state governors from opting out of the federal Medicare Part A physician supervision requirement for facility reimbursement of CRNA services, particularly when there is no state law or regulation requiring nurse anesthetists to be supervised by a physician. In a press release targeting members of Congress, anesthesiologists declared, "seniors will die" if CRNAs are not supervised by anesthesiologists (ASA, 2000), despite the fact that no state mandates CRNA supervision by an anesthesiologist. The anesthesiologist lobbyists stated the reason for the supervision stems from lack of sufficient (medical school) training (ASA, 2000). However, some small successes have worked towards the favor of the CRNAs, and to date, seventeen state governors have opted out of this unnecessary federal requirement in order to provide flexible staffing models that work for the delivery of safe anesthesia services in their respective states (AANA, 2013a).
More recently, insurers have sought to deny CRNA reimbursement for chronic pain management services based on private corporate analysis that nurse anesthesia education and training is inadequate for them to be paid for those services. Fortunately, the Centers for Medicare & Medicaid Services (CMS) ruled in November 2013 that Medicare administrators should reimburse CRNAs for chronic pain management services as long as they are within the CRNA scope of practice for the state in which the services are rendered (AANA, 2013c)
Outcomes data supports the safety and cost-effectiveness of the delivery of anesthesia care by CRNAs. After analysis of seven years of Medicare data, Dulisse and Cromwell (2010) found the change in CMS policy allowing states to opt out of the physician supervision requirement for CRNA reimbursement was not associated with increased risk to patients. Other research suggests that CRNAS are less costly to train than anesthesiologists and have the potential for providing anesthesia care efficiently and competently (Hogan, Seifert, Moore & Simonson, 2010). Anesthesiologists and CRNAs can perform the same set of anesthesia services, including relatively rare and difficult procedures such as open-heart surgeries and organ transplantations, pediatric procedures, and others. CRNAs are generally salaried employees; however, compensation lags behind anesthesiologists. As the demand for health care continues to grow, increasing the number of CRNAs, and permitting them to practice in the most efficient delivery models, will be a key to containing costs while maintaining quality care (Hogan et. al, 2010)
Challenges Associated With Autonomous CRNA Practice
CRNAs have had their ability to practice independently challenged. During the last decade, nurse anesthetists' skills have been publicly brought into question by physicians who have attempted to block efforts aimed at independent CRNA practice. Efforts include pressuring state governors from opting out of the federal Medicare Part A physician supervision requirement for facility reimbursement of CRNA services, particularly when there is no state law or regulation requiring nurse anesthetists to be supervised by a physician. In a press release targeting members of Congress, anesthesiologists declared, "seniors will die" if CRNAs are not supervised by anesthesiologists (ASA, 2000), despite the fact that no state mandates CRNA supervision by an anesthesiologist. The anesthesiologist lobbyists stated the reason for the supervision stems from lack of sufficient (medical school) training (ASA, 2000). However, some small successes have worked towards the favor of the CRNAs, and to date, seventeen state governors have opted out of this unnecessary federal requirement in order to provide flexible staffing models that work for the delivery of safe anesthesia services in their respective states (AANA, 2013a).
More recently, insurers have sought to deny CRNA reimbursement for chronic pain management services based on private corporate analysis that nurse anesthesia education and training is inadequate for them to be paid for those services. Fortunately, the Centers for Medicare & Medicaid Services (CMS) ruled in November 2013 that Medicare administrators should reimburse CRNAs for chronic pain management services as long as they are within the CRNA scope of practice for the state in which the services are rendered (AANA, 2013c)
Outcomes data supports the safety and cost-effectiveness of the delivery of anesthesia care by CRNAs. After analysis of seven years of Medicare data, Dulisse and Cromwell (2010) found the change in CMS policy allowing states to opt out of the physician supervision requirement for CRNA reimbursement was not associated with increased risk to patients. Other research suggests that CRNAS are less costly to train than anesthesiologists and have the potential for providing anesthesia care efficiently and competently (Hogan, Seifert, Moore & Simonson, 2010). Anesthesiologists and CRNAs can perform the same set of anesthesia services, including relatively rare and difficult procedures such as open-heart surgeries and organ transplantations, pediatric procedures, and others. CRNAs are generally salaried employees; however, compensation lags behind anesthesiologists. As the demand for health care continues to grow, increasing the number of CRNAs, and permitting them to practice in the most efficient delivery models, will be a key to containing costs while maintaining quality care (Hogan et. al, 2010)
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