Supervision no longer required for nurse anesthetists

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Health Care Financing Administration

Supervision no longer required for nurse anesthetists

Posted 3-20-2000
By Todd Stein

Washington. The federal government put to rest a decades-long debate over the delivery of anesthesia by eliminating a Medicare rule requiring that nurse anesthetists be supervised by a physician.

The Health Care Financing Administration (HCFA), the government body that oversees Medicare, issued the ruling March 9 despite heavy lobbying from physicians’ groups opposing the change. Until now, federal rules required physician supervision of nurse anesthetists in order for hospitals and ambulatory surgical centers to be reimbursed for Medicare patients.

The victory for nurse anesthetists is largely symbolic because another part of Medicare’s rules has long allowed them to be reimbursed separately and did not require supervision. But the ruling marks the first time a federal body has taken sides in the divisive battle over nurse supervision, said Jan Stewart, CRNA, president of the 27,000-member American Association of Nurse Anesthetists (AANA). "This is validation that HCFA agrees with what we’ve been arguing all along, that nurse anesthetists are qualified to deliver anesthesia care on their own, without supervision," Stewart said.

Ronald MacKenzie, DO, the osteopathic president of the American Society of Anesthesiologists, did not return phone calls requesting a response to the ruling. But MacKenzie told NurseWeek in February that the ASA opposed any change to the Medicare rules because it could endanger patients’ lives. "We’re against unsupervised, independent nurse anesthesia. We don’t think it’s safe," MacKenzie said.

HCFA first proposed changing the supervision rule in December 1997, electing to defer to nursing statutes and board of nursing rules in 29 states, including California and Texas, which allow nurse anesthetists to practice without the supervision of a physician. Certified nurse anesthetists provide 65 percent of the 26 million anesthetics administered in the United States each year, according to the AANA.