Supervision of CRNAs

Does Medicare Require CRNAs to be Supervised by an Anesthesiologist? 

No. Medicare only requires a physician to be present, this does NOT mean "supervision by an anesthesiologist." An anesthesiologist is only one type of physician that can supervise a CRNA. Currently, there is NO federal requirement stating that CRNAs must be supervised by anesthesiologists. Since 2001 the federal government has allowed states to opt out of the Medicare physician supervision requirement, meaning that CRNAs don't have to be supervised by any type of physician to be reimbursed by Medicare.

Why Supervision at All?

Physician supervision of CRNAs is required for facility reimbursement of anesthesia services by Medicare; it is not required for safety reasons. Under current Medicare rules, CRNAs must be supervised by a physician when delivering anesthesia services unless a state has opted out of this federal requirement and allows CRNAs to work without physician supervision. 

What does "opt out" mean exactly and why have states chosen this option?

To "opt out" of the Medicare physician supervision requirement means that a state is no longer required to have CRNAs supervised by physicians during the administration of anesthesia. This allows CRNAs to provide safe, cost-effective anesthesia care in any healthcare settings. This also provides the facilities a greater flexibility to deliver anesthesia services more tailored to the patients needs.

Opting Out Increases Access to Care

Opting out helps hospitals and ambulatory (out patient) surgery centers, typically in underserved areas, easily recruit certified and capable anesthesia providers without the high cost of an anesthesiologist or the misconception of safety concerns. This also gives medical facilities the ability to make their own decisions on how to best staff their anesthesia department, increasing access to care and keeping costs at bay.

Safety of CRNA v. Anesthesiologist

A study of anesthesia patient outcomes in opt‐out states and non opt‐out states conducted by RTI and published in the journal Health Affairs shows that nurse anesthesia care in the opt-out states is as safe as ever. 

This landmark study (and many others) confirms that there are no measurable differences in the quality or safety of anesthesia services delivered by CRNAs, by anesthesiologists, or by CRNAs being supervised by anesthesiologists. In fact, the RTI results show that, all other things being equal, anesthesia delivered only by CRNAs is as safe as – and in some cases safer than – anesthesia delivered only by anesthesiologists or by CRNAs supervised by anesthesiologists.

Why should nurse anesthetists be allowed to practice without a physician supervision?

In most situations, CRNAs practice with a surgeon or operating practitioner. In some cases such as, obstetrics or pain management, CRNAs practice without any physician supervision. Due to their extensive training and recent correlating data, CRNAs are perfectly capable and should be trusted to provide anesthesia services safely. Nurse anesthetists provide a cost effective solution to anesthesia services, leading to less waste and outstanding patient safety outcomes in our healthcare system.

Can it really hurt to have supervision?

Requiring supervise can be an unnecessary cost that is neither effective or efficient. CRNAs are able to provide safe and effective care without breaking the facilities budgetary restraints.

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