122311 - Iowa Nurse Anesthesia Safer than Ever 10 Years after Physician Supervision Requirement Removed

​For Immediate Release
December 23, 2011

Iowa Nurse Anesthesia Safer than Ever 10 Years After
 Physician Supervision Requirement Removed

Recent studies confirm safety, cost-effectiveness of Certified Registered Nurse Anesthetists
Park Ridge, Ill.—Ten years ago, in a historic, precedent-setting move, Iowa became the first state to opt out of the federal physician supervision requirement for nurse anesthetists. Recent studies have confirmed the safety and cost-effectiveness of Certified Registered Nurse Anesthetists (CRNAs) without physician supervision.


In December 2001, 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 physician supervision requirement, then-Iowa Governor Thomas Vilsack sent a letter to CMS informing the agency that “it is in the best interest of the state of Iowa to opt out of the current physician supervision requirement….”  Since then, not a single report of a bad anesthesia outcome has been attributed to the change.
Vilsack is currently the Secretary of Agriculture for the Obama Administration.
“This was a great decision for the citizens of Iowa 10 years ago, and continues to be today.  The opt-out insured that the residents of this state would have access to the anesthesia care they need,” said Mindy Miller, CRNA, MSN, ARNP, president of the Iowa 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.”
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.
Two recent studies revealed that Vilsack 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,” which was published in the August 2010 issue of Health Affairs, examined nearly 500,000 individual cases in the first 14 opt-out states, including Iowa, and confirmed what previous studies have shown: CRNAs provide the same safe, high-quality care with or without physician supervision.
The study titled “Cost Effectiveness Analysis of Anesthesia Providers,” conducted by Virginia-based The Lewin Group and published in the May/June 2010 issue of the Journal of Nursing Economic$, showed that CRNAs acting as the sole anesthesia provider cost 25 percent less than the second lowest-cost anesthesia care 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 Lewin researchers also stated that there is no evidence in the scientific literature to suggest that anesthesia care is safer when a nurse anesthetist is supervised by a physician.
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 his 2001 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, CRNAs are the exclusive providers of anesthesia services in nearly 80 percent of the state’s hospitals.
To date, a total of 16 states have opted out of the federal supervision requirement: Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California and Colorado.