Tuesday, August 3, 2010

Study Supports Use of CRNAs without Physician Supervision

A study in Health Affairs shows that patient death rates have not increased among states that allow nurse anesthetists to administer services without the supervision of an anesthesiologist or surgeon.

The Centers for Medicare & Medicaid Services currently require that nurse anesthetists perform under the supervision of an anesthesiologist or surgeon in order to bill under Medicare; however, states have the ability to opt out of this requirement by petitioning CMS. Currently, 14 states have opted out.

The study showed that in the states that have opted out, anesthesiologists have taken on more complicated cases, or cases where the private insurance reimbursement was higher, while unsupervised nurse anesthetists have taken on more routine and Medicare-funded cases. The study compared the performance of nurse anesthetists working unsupervised, supervised nurse anesthetists, and anesthesiologists and surgeons, and found no difference among the number of patient complications and deaths allocated to each group.

The authors of the study encourage CMS to eliminate the supervision requirement, stating that allowing nurse anesthetists to work unsupervised is cost-effective, with no negative impact on patient safety. This would be especially helpful to smaller hospitals, which may not have an anesthesiologist on staff. This study serves as a reminder to MSPs that patient safety does not always have to mean "physician supervision."

Sources: BNA, Health Affairs

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