Kentucky Gov. Beshear Removes Physician Supervision for Nurse Anesthetists

For Immediate Release
April 26, 2012
For more information
Contact Marlene McDowell 
Removal of federal requirement strongly supported by recent studies
Park Ridge, Ill.—Kentucky has become the 17th state to opt out of the federal physician supervision requirement for Certified Registered Nurse Anesthetists (CRNAs). A full one-third of all states have now taken advantage of a rule implemented by the Bush Administration in 2001 giving governors the ability to opt out of the supervision requirement and ensure citizens access to safe, cost-effective anesthesia care, especially in medically underserved areas.
Kentucky Gov. Steve Beshear wrote to the Centers for Medicare & Medicaid Services (CMS) on April 25, 2012, that “it is in the best interest of Kentucky’s citizens to opt out of the current federal physician supervision requirement in order to improve access to critical services.” Gov. Beshear noted in his letter that opting out was recommended by the Kentucky Cabinet for Health and Family Services and requested by the Kentucky Hospital Association and Kentucky Association of Nurse Anesthetists. The governor also stated that he “consulted with the Kentucky Board of Medical Examiners and the Kentucky Board of Nursing about issues related to access to and quality of anesthesia services in Kentucky” before concluding that the removal of supervision for nurse anesthetists was in the best interests of Kentucky’s citizens.
The CMS received Gov. Beshear’s letter on April 26, at which time the opt-out immediately went into effect.
Since 2001, 16 other states have opted out of the federal physician supervision requirement, including Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, and Colorado. While the supervision requirement is merely a factor in Medicare reimbursement to healthcare facilities and not a matter of patient safety, it is still important to note that not a single negative anesthesia patient outcome has been attributed to a state opting out of the supervision requirement.
“Opting out of the supervision requirement is great news for Kentucky hospitals, critical-access hospitals, ambulatory surgical centers, and the communities they serve,” said Debra Barber, CRNA, MS, president of the Kentucky Association of Nurse Anesthetists (KyANA). “CRNAs have provided safe anesthesia care for more than 150 years to patients of all ages, for all types of procedures, and in every setting in which anesthesia care is delivered.  Since the first opt-out in December 2001, access to high quality anesthesia care has increased and patient safety has remained the standard. KyANA applauds Gov. Beshear for recognizing this and for taking this action.” 
Two recent studies reinforce Beshear’s decision 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.
About the Kentucky Association of Nurse Anesthetists
The Kentucky Association of Nurse Anesthetists represents nearly 700 nurse anesthetists. The mission of the association is to advance patient safety and facilitate access to high quality anesthesia care. Presently, in 24 of Kentucky's 70 counties where anesthesia services are provided, nurse anesthetists are the sole anesthesia professionals.