Impact of Legislation on Scope of Practice Among CRNAs
Impact of Legislation on Scope of Practice Among CRNAs
In 2010, the RAND Corporation analyzed the labor markets for anesthesia. They predicted a continuing shortage of anesthesia providers ranging from a 5.2% vacancy rate in the South to a 10% vacancy rate in the Northeast. The study also revealed a maldistribution of anesthesia providers across the country, with only 5% of anesthesiologists practicing in rural areas and 45% of rural hospitals exclusively using the services of CRNAs for anesthesia delivery. As concerning as these shortages are, these predictions do not take into account the ramifications of the ACA and providing insurance coverage to an additional 30 million Americans. Access to anesthesia care outside of urban areas is heavily dependent on the services of CRNAs and is expected to increase.
In response to the shortage of anesthesia providers and established quality of care shown by CRNAs, states were given the opportunity to "opt out" of physician supervision of CRNAs in 2001 according to the Centers for Medicare and Medicaid Services. To date, 17 states have exercised the opt-out clause and allow CRNAs to practice without medical direction by an anesthesiologist and without supervision from the operating physician and receive full reimbursement from Medicare. Removal of the burdensome supervision rule has allowed continued access to anesthesia services in underserved areas and critical access hospitals throughout the United States by enabling hospitals who struggle to recruit adequate numbers of anesthesia providers the flexibility to use CRNAs to their full SOP. In 2010, a study was conducted to compare anesthesia-related mortality and complication rates over a 6-year period among Medicare patients in opt-out and non–opt-out states, which found that the removal of physician supervision of nurse anesthetists did not result in an increased risk to patients. The impact of the removal of physician supervision is not limited to rural areas. Hospitals and ambulatory surgery centers in these states now have the flexibility to determine what type of anesthesia model best serves the needs of their patients while meeting cost restraints.
Geographic Distribution of Anesthesia Providers
In 2010, the RAND Corporation analyzed the labor markets for anesthesia. They predicted a continuing shortage of anesthesia providers ranging from a 5.2% vacancy rate in the South to a 10% vacancy rate in the Northeast. The study also revealed a maldistribution of anesthesia providers across the country, with only 5% of anesthesiologists practicing in rural areas and 45% of rural hospitals exclusively using the services of CRNAs for anesthesia delivery. As concerning as these shortages are, these predictions do not take into account the ramifications of the ACA and providing insurance coverage to an additional 30 million Americans. Access to anesthesia care outside of urban areas is heavily dependent on the services of CRNAs and is expected to increase.
In response to the shortage of anesthesia providers and established quality of care shown by CRNAs, states were given the opportunity to "opt out" of physician supervision of CRNAs in 2001 according to the Centers for Medicare and Medicaid Services. To date, 17 states have exercised the opt-out clause and allow CRNAs to practice without medical direction by an anesthesiologist and without supervision from the operating physician and receive full reimbursement from Medicare. Removal of the burdensome supervision rule has allowed continued access to anesthesia services in underserved areas and critical access hospitals throughout the United States by enabling hospitals who struggle to recruit adequate numbers of anesthesia providers the flexibility to use CRNAs to their full SOP. In 2010, a study was conducted to compare anesthesia-related mortality and complication rates over a 6-year period among Medicare patients in opt-out and non–opt-out states, which found that the removal of physician supervision of nurse anesthetists did not result in an increased risk to patients. The impact of the removal of physician supervision is not limited to rural areas. Hospitals and ambulatory surgery centers in these states now have the flexibility to determine what type of anesthesia model best serves the needs of their patients while meeting cost restraints.
