Colorado becomes 16th State to Opt Out of
Physician Supervision Requirement for Nurse Anesthetists
Park Ridge, Ill. - On Monday, September 27, Colorado Gov. Bill Ritter announced that Colorado was opting out of the federal physician supervision requirement for nurse anesthetists, becoming the 16th state to do so.
The opt-out, which provides Colorado’s rural and critical access hospitals the flexibility they need to ensure patient access to high-quality anesthesia care, took effect on Tuesday, September 28. Prior to requesting the opt-out in a letter to the Centers for Medicare & Medicaid Services (CMS), Gov. Ritter consulted with the Colorado Medical Board, Colorado Board of Nursing, and Nurse Physician Advisory Task Force for Colorado Healthcare. All three organizations supported the move.
In addition, the Colorado Hospital Association worked closely with the Colorado Association of Nurse Anesthetists (CoANA) to secure the opt-out.
"The Colorado Association of Nurse Anesthetists applauds Gov. Ritter’s recognition that giving Colorado hospitals greater flexibility is good for Colorado and a positive step toward ensuring patients access to the quality healthcare that Certified Registered Nurse Anesthetists (CRNAs) provide," said CoANA President Jennifer Harenberg, CRNA.
Colorado becomes the 16th 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, Oregon, and Montana, South Dakota, Wisconsin, and California. 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 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.
Gov. Ritter had abundant new evidence upon which to base his decision to opt out. Two national studies recently published in leading journals confirmed the safety and cost-effectiveness of nurse anesthetists, important considerations given the current health reform environment.
The more recent of the two studies, titled “No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians
,” was conducted by the independent research firm RTI International and published in the August 2010 issue of Health Affairs
, the nation’s preeminent health policy journal. This study, which examined nearly 500,000 individual cases in the 14 states that had opted out of the supervision requirement between 2001 and 2005, revealed that patient outcomes did not differ between the opt-out states and states where the supervision requirement is in place. Further, the study confirmed that there are no differences in patient outcomes when anesthesia services are provided by CRNAs, physician anesthesiologists, or CRNAs supervised by physicians
“We find no evidence that opting out of the oversight requirement harms patients in any way,” said study author Jerry Cromwell, PhD. “Based on these findings we recommend that CMS repeal the supervision rule.”
The other study, titled “Cost Effectiveness Analysis of Anesthesia Providers
,” was conducted by The Lewin Group and published in the May/June issue of The Journal of Nursing Economics
. This study considered the different anesthesia delivery models in use in the United States today, including CRNAs acting solo, physician anesthesiologists acting solo, and various models in which a single anesthesiologist directs or supervises one to six CRNAs. The results show 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 study’s authors also completed a thorough review of the literature that compares the quality of anesthesia service by provider type or delivery model. This review of published studies shows that there are no measurable differences in quality of care between CRNAs and anesthesiologists or by delivery model.
About the American Association of Nurse Anesthetists