Park Ridge, Ill. - Governor Judy Martz has informed the Centers for Medicare & Medicaid Services (CMS) in Washington, D.C., that Montana is opting out of the federal physician supervision requirement for nurse anesthetists because it "is in the best interest of Montana’s citizens." The opt-out, which was supported by both the state Board of Medical Examiners and Board of Nursing, is effective immediately.
Montana becomes the 12th state to take advantage of an anesthesia care rule published by CMS in the Federal Register [66 FR 56762-56769] on Nov. 13, 2001, following Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, and Oregon. The rule allows a governor to notify CMS in writing of the state’s desire to opt out of (be exempt from) the supervision requirement for Certified Registered Nurse Anesthetists (CRNAs) after the governor meets the following prerequisites: consults with the state’s boards of medicine and nursing, determines that opting out of the requirement is consistent with state law, and decides that it is in the best interests of the state’s citizens.
In the two years that states have been opting out of the supervision requirement, there have not been any reports of anesthesia patient deaths or injuries related to the removal of physician supervision of CRNAs.
In her letter to CMS, Gov. Martz stated that, "The Board of Medical Examiners, the Board of Nursing, and other interested and affected parties have been consulted in this matter. This exemption is in the best interest of Montana’s citizens and is consistent with state law." In addition to nurse anesthetists and hospital administrators, nearly 50 physicians from across the state wrote letters to the governor in support of the opt-out.
"I am very pleased that the governor has decided to exercise the opt-out," said Jim Ahrens, president of the Montana Hospital Association. "CRNAs are an integral part of Montana’s healthcare delivery system. In most rural communities, they are the only providers of anesthesia services; without their services, access to surgical care would be severely restricted."
Almost 80 percent of Montana’s hospitals depend solely on nurse anesthetists to provide anesthesia care for their surgical, obstetrical, and trauma patients.
"Montana’s CRNAs have a long and impressive track record of service," said Ahrens. "This decision will enable them to continue to provide these very valuable services."
Montana Nurses’ Association (MNA) President Kate Steenberg echoed Ahrens’ sentiments when she said that "the MNA strongly supports Governor Martz’s decision that it is in the best interest of our rural state to opt out of the federal rule requiring physician supervision of Certified Registered Nurse Anesthetists. We are very proud of nurse anesthetists in Montana, who have an excellent patient safety record. The governor’s decision provides better access to anesthesia care, especially in rural and medically underserved regions of our state."
"Nurse anesthetists have safely provided anesthesia care to Montana patients since the earliest days of surgery in this state," said Mike Barts, CRNA, ARNP, president of the Montana Association of Nurse Anesthetists (MTANA). "MTANA applauds Gov. Martz for recognizing this and for taking this action." Barts added that Montana CRNAs will continue to work cooperatively with the states’ physicians as before.
The decision to opt out brings closure to an issue the MTANA and the MNA have advocated for since the federal opt-out rule was adopted in 2001.
According to an Institute of Medicine report published in October 1999, anesthesia care today is nearly 50 times safer than it was in the early 1980s. CRNAs administer approximately 65 percent of the anesthetics given each year in the United States, and they are the predominant anesthesia providers in rural and medically underserved areas, for expectant mothers, and for the nation’s military servicemen and women during peacetime and wartime.