Governor of Oregon Removes Physician Supervision for Nurse Anesthetists
Park Ridge, Ill. – Oregon has become the eleventh state to opt out of the federal physician supervision requirement. The opt-out is effective immediately.
Taking advantage of an anesthesia care rule that allows states to become exempt from the supervision requirement, Oregon Governor Theodore Kulongoski wrote to the Centers for Medicare & Medicaid Services (CMS) that his state was opting out because "I have determined that it is in the best interest of Oregon citizens to exercise this exemption...In many of Oregon's small rural hospitals, CRNAs are the only, or primary, anesthesia providers."
Since December 2001, ten other states have opted out of the federal physician supervision requirement, including: Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, and Alaska.
The anesthesia care rule that enables states to opt out of the supervision requirement was published by CMS in the Federal Register [66 FR 56762-56769] on Nov. 13, 2001. The rule allows a governor to notify CMS in writing of the state’s desire to opt out (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 injury related to the removal of physician supervision of CRNAs.
Governor Thomas Vilsack of Iowa, where 91 of the state’s 118 hospitals rely solely on nurse anesthetists to provide anesthesia care, wrote to the governor of another state in July 2003 that he had "received many letters from hospital administrators, physicians and healthcare organizations praising the overwhelming success of the opt-out. I have also received notice from the Iowa Board of Nursing and the Iowa Department of Public Health that the quality of care given by CRNAs has never been higher."
Vilsack added that "…Iowa has proven the intent of the opt-out change is a complete success in practice."
According to an Institute of Medicine report published in October 1999, anesthesia care today is nearly 50 times safer than it was 20 years ago. CRNAs administer 65 percent of the anesthetics given each year in the United States and are the predominant anesthesia providers in rural and other medically underserved areas. Without these advanced practice nurses many of the facilities serving these areas would be unable to maintain surgical, obstetric, and trauma stabilization services.
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