February Marks 10-Year Anniversary of Landmark Decision Ensuring Nebraskans Access to Safe, Cost-Effective Anesthesia Care

Park Ridge, Ill.—Ten years ago this month Nebraska became the second state to opt out of the federal physician supervision requirement for Certified Registered Nurse Anesthetists (CRNAs). The landmark decision by then-Governor Mike Johanns, which was supported by both the Nebraska Association of Nurse Anesthetists (NANA) and the state Board of Medicine and Surgery (BOMS), ensured Nebraskans access to safe, cost-effective anesthesia care, particularly in rural and other medically underserved areas of the state.
In February 2002, less than three months after the Centers for Medicare & Medicaid Services (CMS) published its anesthesia care rule granting state governors the ability to opt out of the supervision requirement, Gov. Johanns sent a letter to CMS informing the agency that “it is in the best interest of the State’s citizens to exercise this exemption.” Johanns is currently a senator for the state of Nebraska.
“This was a great decision for the residents of Nebraska 10 years ago, and continues to be today. The opt-out insured that patients throughout the state have access to the anesthesia care they need,” said NANA President Benjamin Huls, CRNA, MS. “In Nebraska, CRNAs have long provided the majority of the anesthesia care to patients of all ages, for all types of procedures, and in every setting in which anesthesia care is delivered.”
Two recent studies have confirmed that Sen. Johanns showed tremendous foresight in opting out of the physician supervision requirement. The study titled “No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians,” conducted by RTI International and published in the August 2010 issue of Health Affairs, examined nearly 500,000 individual cases involving anesthesia and confirmed what previous studies have shown: CRNAs provide safe, high-quality care that is the same with or without physician supervision.
The other study, titled “Cost Effectiveness Analysis of Anesthesia Providers,” was conducted by Virginia-based The Lewin Group and published in the May/June 2010 issue of the Journal of Nursing Economic$. This study considered the different anesthesia delivery models in use in the United States today, and showed that CRNAs acting as the sole anesthesia provider cost 25 percent less than the second lowest cost model. On the other end of the cost scale, the model in which one anesthesiologist supervises one CRNA is the least cost efficient model. The researchers also confirmed that there is no research to indicate that CRNAs and physician anesthesiologists aren’t equally safe providers.
The results of the Lewin study were particularly compelling for people living in rural and other areas of the United States where anesthesiologists often choose not to practice for economic reasons. The safe, cost-effective anesthesia care provided by nurse anesthetists has been a mainstay in these areas for more than 100 years, ensuring millions of patients access to surgical, obstetrical, trauma stabilization, and diagnostic procedures.
In a ringing 2002 endorsement, the Nebraska BOMS told Johanns in a strongly worded letter that it “believes that such a [federal supervision] requirement would negatively impact health accessibility for Nebraska residents and recommends that you exercise the option of exemption from the requirement of physician supervision of CRNAs in the state of Nebraska.”
The Nebraska Board of Nursing (BON) echoed the sentiments of the BOMS. In a letter to Johanns, the BON emphasized “the benefit this opt-out will have for physicians, facilities, and the citizens of the State of Nebraska,” and stated that it “strongly encourages” the governor to apply for the opt-out.
Since 2001, 16 states have opted out of the federal physician supervision requirement for nurse anesthetists: Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, and Colorado.
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