Park Ridge, Ill.
For Immediate Release For more information
December 13, 2001 Contact Christopher Bettin
In a historic, precedent-setting move, Iowa has become the first state to opt out of the federal physician supervision requirement for nurse anesthetists.
Less than one month 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, Iowa Governor Thomas Vilsack sent a letter to CMS on December 12 informing CMS that "it is in the best interest of the state of Iowa to opt-out of the current Physician Supervision Requirement…." The opt-out is effective immediately.
The CMS rule, published in the Federal Register [66 FR 56762-56769] on November 13, 2001, allows a governor to notify CMS in writing of the state’s desire to be exempt from the supervision requirement for nurse anesthetists 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 his letter to CMS, Vilsack stated that he had consulted with the state boards of medicine and nursing "to ensure that the quality of care provided by nurse anesthetists in the state of Iowa is of the highest degree and that the opt-out ensures access to anesthesia care in Iowa’s 118 hospitals that have surgical suites." The governor further pointed out that in Iowa, Certified Registered Nurse Anesthetists (CRNAs) are the exclusive providers of anesthesia services in 91 of the state’s 118 hospitals. Other rural states throughout the country have similar ratios.
As always, Iowa’s CRNAs will work closely with surgeons, obstetricians, and other doctors in the delivery of safe, high-quality patient care. In 1999, the Institute of Medicine published a report stating that anesthesia care today is nearly 50 times safer than it was 20 years ago. CMS echoed that statement in the Federal Register last January. CRNAs provide 65 percent of all anesthesia care delivered each year in the United States.
"This is a great decision for the citizens of Iowa, many of whom live in rural communities and rely on CRNAs to provide safe anesthesia care for surgeries, delivering babies, and emergency healthcare," said Deborah A. Chambers, CRNA, president of the 28,000-member American Association of Nurse Anesthetists. "In Iowa, 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."
Chambers pointed to comments published by CMS in the Federal Register on January 18, 2001, confirming the administration’s confidence in the states to effectively regulate healthcare providers. "States have an excellent track record of protecting patient health through their own regulations," CMS wrote. "We respect State control and oversight of health professionals by deferring to State licensing laws to regulate professional practice."
Nurse anesthetists have been practicing for more than 100 years, giving them the longest history of any anesthesia provider. They are critical care nurses with a graduate degree in anesthesia. Graduates of nurse anesthesia programs must pass a national certification examination to become a CRNA, and must complete 40 hours of continuing education every two years to continue practicing as a CRNA.
"As Governor of Iowa," Vilsack wrote to CMS, "I have concluded it is in the best interest of the state of Iowa to opt-out of the current Physician Supervision Requirement, that the opt-out is consistent with state law and is requested on behalf of the citizens of the state of Iowa, hospitals, ambulatory surgical centers and critical access hospitals."
The governor noted in his letter that Iowa will apply for funding to "scientifically measure" the anesthesia care provided by unsupervised physician and nurse anesthesia providers following the opt out, although such an effort would appear to unnecessarily duplicate plans laid out by CMS in the November 13 rule. In published comments that accompanied the rule, CMS said the Agency for Healthcare Research and Quality will "conduct a study of anesthesia outcomes in those States that choose to opt-out of the CRNA supervision requirement compared to those States that have not."