Anesthesia Care and the Law

As costs continue to rise, healthcare policymakers are balancing a mandate by their constituents to make the system more efficient and accessible, all while maintaining safe, high-quality service delivery. Research suggests a CRNA-based anesthesia care model moves lawmakers a step closer to meeting that challenge.

The practice of anesthesia has an exemplary safety record whether provided by a CRNA working alone, an anesthesiologist working alone, or a CRNA working with an anesthesiologist. In any of these scenarios, deaths attributed to anesthesia are extremely rare, occurring approximately once in every 250,000-300,000 anesthetics provided.

A 2010 study found the most cost-effective anesthesia delivery model is a CRNA working as the sole anesthesia provider. Another landmark study confirmed there are no measurable differences in the quality or safety of anesthesia services delivered by CRNAs, anesthesiologists, or CRNAs supervised by anesthesiologists. Long before either of these studies was published, a 2001 federal rule allowed states to opt out of (be exempt from) the Centers for Medicare & Medicaid Services (CMS) requirement that CRNAs must be supervised by a physician for their facility to be reimbursed. To date, 17 states have opted out. Whether or not a state has opted out, CRNAs are not required to be supervised by physician anesthesiologists.

To promote patient access to safe, high-quality, cost-effective healthcare, the American Association of Nurse Anesthetists (AANA) has called for Medicare to eliminate the unnecessary CRNA supervision requirement, and allow states and healthcare facilities to make their own decisions about how to best staff anesthesia departments based on state laws and patient needs. By making this change, Medicare can align national policy with states' scope of practice, promote healthcare delivery consistent with patient and community needs, and open the door for cost savings associated with delivery system innovation. This approach also is consistent with recent recommendations from the Institute of Medicine.

Given that CRNAs are highly educated, advanced practice registered nurses who consistently deliver anesthesia to patients using the same procedures as physician anesthesiologists, allowing these professionals to practice to their full scope of practice just makes sense.

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Scope of Practice Laws and Anesthesia Complications: No Measurable Impact of Certified Registered Nurse Anesthetist Expanded Scope of Practice on Anesthesia-related Complications
The research results suggest that there is strong evidence of differences in the likelihood of anesthesia complications by patient characteristics, patient comorbidities, and the procedures being administered, but virtually no evidence that complication rates differ based on anesthesia provider scope of practice or anesthesia delivery model.