The U.S healthcare landscape has undergone significant change under the Affordable Care Act to provide care and expand coverage for the millions of Americans who have faced being uninsured. The result of an estimated 30 million Americans entering the healthcare system under Medicaid coverage is that cost efficiency has become one of the highest priorities for providers. With regard to the surgical suite, the supervision requirement for CRNAs continues to be an important topic of discussion.
The American Association of Nurse Anesthetists (AANA) has advocated for more than two decades to help educate states on the value CRNAs bring to patient care, and to allow them to administer anesthesia care without the supervision of a physician. As of this post, there are 17 states in the U.S that have opted out of the federal requirement for supervision (Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, Colorado, and Kentucky.)
Most anesthesia providers, if not all, would agree that access to quality anesthesia care is crucial. A new study published by Nurse Economic$, “Geographical Imbalance of Anesthesia Providers and its Impact on the Uninsured and Vulnerable Population,” illustrates that CRNAs bring anesthesia services to areas of the country that have statistically lower incomes, while anesthesiologists tend to aggregate near higher income populations. The study addresses changing state laws and removing barriers CRNAs face to practicing high-quality anesthesia care at a more reasonable cost. The study analyzed provider to population ratio (CRNAs or anesthesiologists per 10,000 people). “CRNAs correlated with lower income populations (r=-0.0839, p=0.0001) where anesthesiologists correlated with higher income populations (r=0.1831, p< 0.0001).”
This study demonstrates that areas of the country with vulnerable populations such as Medicaid eligible, uninsured, and unemployed populations have a higher correlation of CRNAs. Previous research has acknowledged the cost effectiveness and quality these nurse anesthetists bring to patients while providing the same quality of care at less expensive. The study “Cost Effectiveness Analysis of Anesthesia Providers,” published by Nursing Economic$ emphasized that CRNAs administer nearly 40 million anesthetics to patients each year while providing the same efficient care anesthesiologists would, at a significantly reduced cost. Anesthesiologists earn nearly twice the average CRNA salary, while Medicare pays the same fee for an anesthesia procedure.
In its Unite and Protect blog titled “What Opt Out Is and Is Not,” AANA highlights the Opt Out essentials and history. “There are those that would have facilities and others providers believe that the requirement for physician supervision is a practice requirement, but it is not a practice issue, it is a reimbursement issue for the facility to be reimbursed for those services rendered to Medicare patients.”
As the Affordable Care Act provides insurance to nearly 30 million new customers, providing populations with greater access to healthcare becomes a huge concern in today’s healthcare environment. Maximizing the value CRNAs bring to the OR and the overall practice would provide that access to these underrepresented healthcare communities via an available workforce of anesthesia professionals.
Fully utilizing all available anesthesia professionals (CRNAs and Anesthesiologists) is critical to surgical, anesthesia, and pain management services. Constructing barriers to CRNA can have costly and detrimental effects in communities that don’t have the appropriate access to these common healthcare services. A shortage of both types of anesthesia professionals could severely affect the health and financial well-being of individuals. Although the healthcare landscape is continually changing, and different points of view have emerged, all can agree ensuring quality and cost effective care to every American, no matter their geographic location or economic status, is a goal we should all share.
Do you think all states should opt out of the federal physician supervision requirement for CRNAs? Would the healthcare marketplace be better served? Let us know your opinion by adding a comment below.
Somnia believes CRNAs play an important role in the entire continuum of care. We are currently accepting nominations for our fifth annual CRNA of the Year Award. To submit a nomination, please click here.