Debates concerning the scope of practice of Certified Registered Nurse Anesthetists (CRNAs) have been prevalent in the anesthesia services industry for years. The stance on both sides of the aisle has, not surprisingly, been historically dictated by the perceived benefits or consequences from proposed laws. On one side are those who oppose legislation that expand CRNA duties (typically anesthesiologists), arguing that they are not qualified to perform certain procedures. The other side consists of CRNAs who support the proposed scope of practice changes and believe that they are qualified and capable of performing the additional duties outlined.
Wherever you may fall on the spectrum of this debate, it is difficult to argue that the rulings have typically favored the expanded role of CRNAs in the surgical setting, resulting in an increase in the utilization of CRNAs in a care team model. Since 2001, for exemption from federal regulation for physician supervision of CRNAs. Now, if a proposed Medicare rule becomes law, nurse anesthetists would also enjoy a major change in the scope of practice in pain management. In April 2011, Noridian, the Medicare contractor for the most of the western United States, imposed a rule that CRNAs would not be reimbursed for pain management service.
The proposed ruling introduced by the Centers for Medicare and Medicaid Services (CMS) allows CRNAs to request independence and receive 100% reimbursement when diagnosing and treating pain management patients as long as it’s within the scope of practice in their particular state.
If the CMS ruling is enacted into law, it will be seen as another major victory for CRNAs, as well as a frustrating development for anesthesiologists who staunchly oppose expanded scope of practice legislation.