QUESTIONS & ANSWERS ABOUT CERTIFIED REGISTERED NURSE ANESTHETISTS (CRNAS)
WHY DOES OKLAHOMA NEED TO ELIMINATE PHYSICIAN SUPERVISION TO CREATE A SMART, SAFE ANESTHESIA DELIVERY MODEL?
Oklahoma's anesthesia regulations are antiquated and anti-patient. They limit access to anesthesia services at a time when more Oklahoma citizens have health insurance than ever before. Adopting regulations that create a smart, modern anesthesia delivery model would put Oklahoma patients first, ahead of an out-dated anesthesia model that favors turf wars over what is best for patients and taxpayers. It would put Oklahoma's anesthesia model in line with 40 other states.
At a time when healthcare delivery is changing, a smart, new anesthesia model would improve access to needed, often life-saving anesthesia care for thousands of patients at Oklahoma hospitals. It would give Oklahoma hospitals the flexibility to meet patient needs in underserved rural and urban communities alike.
Currently there are approximately 40 million people on medicare. That number is expected to double to 80 million by 2030. We must mobilize the workforce we have to prepare for the influx of our aging population.
WHAT IS A CERTIFIED REGISTERED NURSE ANESTHETIST?
Certified Registered Nurse Anesthetists (CRNAs) are highly skilled advanced practice registered nurses who specialize in the field of anesthesia and pain management. As licensed independent practitioners, CRNAs undergo significant post-graduate education and training resulting in a master’s or doctoral degree in nurse anesthesia. They are required to pass the National Certification Examination in order to practice. CRNAs provide the same anesthesia services as physician anesthesiologists, based on a foundation of acute care nursing and graduate education. CRNAs practice in all 50 states and safely administer more than 34 million anesthetics to patients each year in the United States.
CRNAs have been providing anesthesia care to patients in the United States for 150 years. The CRNA credential came into existence in 1956.
WHAT IS THE CRNA’S ROLE?
CRNAs are responsible for the safety of patients before, during and after surgery. They administer every type of anesthesia to all types of patients in any health care setting where anesthesia is required. CRNAs provide continuous pain relief and anesthesia, while sustaining patients’ critical life functions throughout surgical, obstetrical and other medical procedures.
In addition to anesthetic agents, CRNAs select and administer adjunct drugs to preserve life functions; they also use technologically advanced monitoring equipment and interpret a vast array of diagnostic information throughout the course of the anesthetic process.
WHAT DOES A CRNA DO DURING SURGERY?
As anesthesia professionals, CRNAs stay with their patients throughout the entire procedure, administering their anesthesia and monitoring their vital signs to ensure maximum safety and comfort.
During surgery, the patient’s life often rests in the hands of the CRNA. This incredible responsibility requires CRNAs to fully utilize every aspect of their anesthesia education and training, nursing skills, and scientific knowledge.
In addition to vigilantly monitoring the patient’s vital signs and modifying the anesthesia as needed, CRNAs also analyze situations, make decisions, communicate clearly with the other members of the surgical team, and respond quickly and appropriately in an emergency.
DO CRNAS WORK WITH PHYSICIANS?
Yes. Like all anesthesia professionals, CRNAs collaborate with other members of the surgical team including surgeons, endoscopists, radiologists, podiatrists, obstetricians and other physician specialists. State laws and regulations vary on requiring CRNAs to be supervised by a physician; well over half of all states do not require physician supervision. In any case, CRNAs are always independently responsible for their own actions. Surgeons quite properly defer to CRNAs as the experts in anesthesia care. Under state nurse practice acts or board of nursing rules as well as in accordance with their licensure, CRNAs deliver comprehensive anesthesia care consisting of all accepted anesthetic techniques including general, regional (e.g., epidural, spinal, peripheral nerve block), sedation, local, and pain management.
IS ANESTHESIA SAFE?
Advances in pharmaceuticals, technology and training for CRNAs and anesthesiologists have contributed significantly to improvements in patient safety. According to the Institute of Medicine (IOM), the American Association of Nurse Anesthetists, and the American Society of Anesthesiologists, anesthesia care is nearly 50 times safer than it was just 30 years ago, and in a 1999 report the IOM identified anesthesia as one of the safest health care specialties.
Today, perioperative deaths attributed to anesthesia occur approximately once for every 250,000-300,000 anesthetics provided, representing a dramatic increase in patient safety despite an aging U.S. population and older, sicker patients being treated in operating rooms nationwide. Numerous outcomes studies have confirmed the safety record of CRNAs and demonstrated that there is no difference in the quality of anesthesia care provided by CRNAs and anesthesiologists.
HOW DO CRNAS IMPACT HEALTHCARE?
CRNAs are the primary providers of anesthesia care in rural America, affording tens of millions of rural Americans access to surgical, obstetrical, trauma stabilization, and pain management services without having to travel long distances to receive needed care.
In Oklahoma, CRNAs provide 80% of all anesthesia statewide.
86% of MD Anesthesiologists practice ONLY in Oklahoma and Tulsa county. CRNAs provide the VAST majority of anesthesia in the 75 other counties.
In some states, CRNAs are the sole anesthesia professionals in nearly 100 percent of rural hospitals.
CRNAs also provide a significant amount of anesthesia and related care in urban and suburban health care facilities, and are the primary anesthesia professionals in many medically underserved inner city areas.
HOW DO CRNAS IMPACT INSURANCE?
The importance of access to CRNA care has been recognized by the inclusion of “non-discriminatory” language in the federal Affordable Care Act. This provision ensures that a group health plan or an insurance issuer will support a competitive, high-quality health care marketplace by recognizing CRNAs who provide covered services within their scope of practice.
In 2010, Congress enacted into law a Provider Nondiscrimination provision that prohibits health plans from discriminating against qualified licensed healthcare professionals, such as CRNAs, solely on the basis of their licensure. This bipartisan law took effect Jan. 1, 2014, and it is supported by the American Association of Nurse Anesthetists (AANA) and the Patients Access to Responsible Care Alliance (PARCA), a major coalition of advanced practice registered nurses (APRNs) and allied health professionals recognized by Medicare as Part B providers. The law promotes access to healthcare and consumer choice of healthcare professionals, and helps reduce healthcare costs through competition.
Managed care plans recognize CRNAs for providing high quality anesthesia care with reduced expense to patients and insurance companies. The cost efficiency of CRNAs helps control escalating healthcare costs.
IS THERE A COST DIFFERENTIAL BETWEEN AN ANESTHESIOLOGIST AND A CRNA? IF THE COST IS THE SAME, WHY NOT GET A PHYSICIAN?
Yes, there is a cost differential between an anesthesiologist and a CRNA. The mean annual compensation for an anesthesiologist is about $400,000, nearly two and one-half times that of a CRNA, whose median total compensation is about $165,000. Because Medicare pays the same fee for an anesthesia service whether it is provided by a CRNA, an anesthesiologist, or both working together, the higher cost of the anesthesiologist is borne by someone – the hospital, the health care facility, or the patient.
Another perspective on the cost differential between CRNAs and anesthesiologists is found in the landmark 2010 study titled “Cost Effectiveness of Anesthesia Providers” conducted by The Lewin Group and published in the Journal of Nursing Economic$. The study showed that the most cost-effective anesthesia model is a CRNA practicing solo, which was 25 percent less expensive than the next lowest-cost model (an anesthesiologist directing four CRNAs), and far more cost-effective than the most expensive model (an anesthesiologist directing a single CRNA). In terms of cost to society, this same paper found that the marginal cost of pre-anesthesia and anesthesia graduate education for a CRNA is $161,809 compared to the comparable cost of educating an anesthesiologist: $1,083,795.
WHERE DO CRNAS WORK?
CRNAs practice in any health care setting in which anesthesia is delivered, including traditional hospital surgical suites and obstetrical delivery rooms, ambulatory surgery centers, pain clinics and physicians’ offices.
CRNAs are the hands on providers of more than 34 million anesthetics delivered each year in the United States. They provide the majority of anesthesia care in the Veterans Administration and U.S. Military.
CRNAs are the primary anesthesia providers in rural America, enabling health care facilities in these medically underserved areas to offer obstetrical, surgical, trauma stabilization. In some states, CRNAs are the sole anesthesia providers in nearly 100 percent of the rural hospitals.
IS IT POSSIBLE FOR A NURSE TO EVER BE AS WELL TRAINED AS A PHYSICIAN?
CRNAs and anesthesiologists undergo similar education and training, and research shows that CRNAs deliver anesthesia care that is the same high quality as that of anesthesiologists. The focus should be on health outcomes for our citizens, not titles.
CRNAs are highly educated advanced practice registered nurses who specialize in anesthesia, have extensive experience in acute care settings, and hold advanced degrees in addition to their undergraduate nursing education and training. America’s 50,000 CRNAs administer approximately 34 million anesthetics to patients each year in the United States. CRNAs are the primary anesthesia providers in rural America, the military and the Veterans Administration. Additionally, CRNAs practice in collaboration with other healthcare professionals in every setting where anesthesia is delivered.
In 2010, North Carolina based Research Triangle International (RTI) published the results of a research study on anesthesia safety in opt-out states. The paper, titled “No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians” (Health Affairs, August 2010), shows that patient outcomes in states that have opted out of the Medicare physician supervision requirement for nurse anesthetists are the same or better than outcomes in states that have not opted out.
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.