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The battle between
certified registered nurse anesthetists and anesthesiologists is anything
but sedate |
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The battle between
certified registered nurse anesthetists and anesthesiologists is anything
but sedate |
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|||||| RELATED
Alabama Association of Nurse Anesthetists American Association of Nurse Anesthetists American Society of Anesthesiologists California Association of Nurse Anesthetists Health Care Financing Administration Michigan Association of Nurse Anesthetists North Carolina Association of Nurse Anesthetists |||||| What do you think? Should CRNAs be required to be supervised by physicians? ||||||
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By
Leigh
Morgan Proposed federal regulations are a bone of contention between certified registered nurse anesthetists and anesthesiologists—and now the battle involves the American Nurses Association (ANA) and congressional lawmakers as well. The debate took off last December when the Health Care Financing Administration (HCFA) recommended eliminating a long-standing rule requiring hospitals and ambulatory surgical centers to provide direct physician supervision of CRNAs in order to receive Medicare reimbursement. Under the proposed reversal, the federal government would drop the requirement for physician supervision, but states and individual hospitals could continue to require it. Nurse anesthetists have advocated such a policy change for years, according to Scot D. Foster, PhD, CRNA, president of the American Association of Nurse Anesthetists (AANA). According to Foster,
CRNAs provide the same care to patients with or without physician
supervision. The findings "strongly contradict those who are trying to build opposition to the HCFA-proposed rule on the grounds that states should not be trusted to make decisions on physician supervision for the administration of anesthesia," said David Herbert, director of federal government affairs for the AANA. Currently, 29 states do not require physician supervision of CRNAs. Chief among those voicing opposition is the American Society of Anesthesiologists, which argues that the new rule would jeopardize patient safety. "HCFA has recognized the importance of having a physician present when a lesser educated, lesser trained nurse anesthetist administers anesthesia," said William D. Owens, MD, president of the ASA. "Nurses do not have, nor should they be expected to have, the level of education or training necessary to medically assess patients before, during, or following surgery." The ASA has touted its own study of 6,000 Medicare surgical patients showing that outcomes are substantially improved in hospitals with board-certified anesthesiologists on staff. Recently, two lawmakers introduced bills to bolster the ASA’s efforts. Authored by Sen. Lauch Faircloth, R-N.C., and Rep. David Weldon, R-Fla., the measures would effectively freeze in place existing HCFA regulations. Last week, more than 100 ASA members gathered at Capitol Hill to rally in support of the legislation. Participants included more than a dozen anesthesiologists "who had previously practiced and trained as nurse anesthetists," said ASA spokesperson Michael Scott. HCFA’s proposal contains several provisions in addition to the nurse anesthetist rule, all aimed at making hospital participation in Medicare more outcomes-oriented. The ANA supports some provisions, such as requiring hospitals to disclose staffing levels. But it strenuously opposes others, such as a HCFA proposal to allow states to determine whether unlicensed or licensed workers can administer medication and whether a circulating assistant in the operating room must be an RN. While the ANA supports efforts to allow nurse anesthetists to work without physician supervision, the AANA jumped the gun when it urged nurses to write letters of support for the entire HCFA proposal, said Sara Foer, MPH, spokesperson for the ANA. "Nursing looks divided at the national level when HCFA gets thousands of letters saying, ‘I support this’ and thousands more saying, ‘I support only part of this’— which is what we all should be saying," she said. Foer estimated that HCFA received more than 45,000 responses to its proposal during an extended public comment period that ended April 20. It may take as long as three years for the federal agency to examine the commentary and issue its final recommendations. |
Turf
