Here in the Old North State, the potential to achieve greater cost-effectiveness within the health care sector has yet to be tapped.
One recurring issue that prevents such an outcome is the federal law by which all nurses, including certified registered nurse anesthetists (CRNAs), must provide anesthetic services under physician supervision. However, in 2001, the Center for Medicare and Medicaid Services (CMS) decentralized power giving states the choice to opt out of the oversight requirement and allowing advanced practitioner nurses to practice independently. North Carolina has not gone forth with this opt out.
Currently, House Bill 181 is making its way through the General Assembly. Simply reiterating North Carolina law, the bill is entitled "An act to confirm that North Carolina law requires physician supervision of all nurses providing anesthesia services."
Patient protection is critical, and teamwork amongst multiple medical providers is indeed vital. However, CRNAs’ autonomy should not be restricted. These respected providers should be able to care for patients to the fullest of their capabilities and be able to practice independently.
If CRNAs in North Carolina were able to practice solo, the provision of services would be able to expand geographically to rural areas. Patients would gain access to quality care at a much lower cost. Here’s why:
Credentials
CRNAs are advanced practice nurses who have earned a bachelor’s degree, practiced at least 1 year as an acute care nurse, and successfully completed a graduate-level nurse anesthetist program. These medical providers possess some of the same qualifications and educational training as anesthesiologists. The May-June 2010 issue of Nursing Economic$ states:
Anesthesiologists and CRNAs can perform the same set of anesthesia services, including relatively rare and difficult procedures such as open heart surgeries and organ transplants, pediatric procedures, and others.
Meanwhile, Health Affairs reports that, amongst anesthesiologists and certified registered nurse anesthetists, CRNAs have been the dominant providers of anesthetic services for over 150 years. It wasn’t until 1986 that the rapid influx of physicians specializing in anesthesiology yielded a greater number of anesthesiologists as solo practitioners or in a team environment with nurse anesthetists.
Show Me The Money
At times, the supervision requirement has patients suffering the burden of higher medical bills. When a CRNA works in tandem with an anesthesiologist, both providers are reimbursed for their services. However, anesthesiologists who oversee CRNAs are not always physically present throughout the entire procedure. In other words, both CRNAs and anesthesiologists receive payment, even if the physician is not present.
Because CRNAs’ salaries are significantly lower than anesthesiologists’, the services they administer to patients are less costly. This factor benefits not only patients, but also hospitals who employee CRNAs as well as insurance companies that pay reimbursement costs. Also, physicians will not have to undergo the stress of possible medical malpractice when deemed responsible for overseeing multiple CRNAs simultaneously.
Moving Forward
To date, 16 states have opted out, most of them rural. Multiple studies indicate that patient mortality and complexity trends have decreased in both opt out and non-opt out states since the legal turnover. Bloomberg Newsweek cited a 2009 report by Rand Corp. that found no evidence that nurses provide lower-quality care.
In the United States, CRNAs represent two-thirds of anesthetists in rural hospitals. In North Carolina, there are almost twice as many CRNAs as anesthesiologists.
Let’s rip off the government Band-Aid and breathe a bit.
