In the ongoing debate about the increased scope of practice of Certified Registered Nurse Anesthetists (CRNAs), more fuel has been added to fire concerning pain management practices.
On November 1st, the Centers for Medicare and Medicaid Services (CMS), will decide whether nurse anesthetists are able to bill Medicare at rates on par with anesthesiologists when treating chronic pain. Additionally, the ruling could also allow CRNAs to write prescriptions for patients suffering from chronic pain.
The potential ruling has been faced with much opposition. In a grassroots effort to sway decision-makers, the American Society of Anesthesiologists (ASA) has urged CMS and Congressional lawmakers to reconsider, insisting that CRNAs do not have the proper training or education to practice chronic pain management independently.
“The common ground here is that whoever is diagnosing or treating patients should have the requisite experience, education and skill,” says Marc Koch, MD, MBA, president and CEO of Somnia Anesthesia. “Whether they are an MD, DO, CRNA or NP is less important. Obamacare predicts to feed more than 30 million new patients into the healthcare system; without commensurate increases in provider census figures. The medical landscape will have no choice but to react with an all hands on deck approach in order to attenuate the adverse impact to access that the general public will face.”
This conflict is another in a long line of contentious issues that have arose as the scope of practice of CRNAs has expanded in many areas of the United States. Seventeen states nationwide have opted out of the federal physician supervision requirement, with Kentucky the most recent.
“The various stakeholders in the pain management space—anesthesiologists, neurologists, orthopedists, family practice and other specialties that provide pain services—should create suggested Minimum Level of Qualifications [MLOQ] predicated on a variety of factors, rather than solely completion of a fellowship, and quality outcome data should be the factor modulating the forward- looking MLOQ requirements.”
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