Tuesday, August 31, 2010
Nurse Anesthetists: Should They Work Without Supervision?
Allowing certified registered nurse anesthetists to work without the supervision of a doctor does not put patients at risk, according to a recent study that was published in Health Affairs, a monthly journal that also publishes peer-reviewed papers online weekly.
The findings bring up for discussion state laws that require CRNAs to work under the supervision of an anesthesiologist or surgeon in order to receive Medicare reimbursement.
The good news/bad news, depending on whether you are a nurse or physician, is that the authors believe this study confirms that CRNAs can provide the same level of services as anesthesiologists but potentially at a lower cost.
For the study, researchers analyzed the rates of death and complications from surgery in the 14 states that do not require CRNAs to be supervised by physicians. The investigators found that there was no increase in the odds of a patient dying or experiencing complications in these states.
Investigators also found that there were no significant differences in patient outcomes with these various scenarios:
• when CRNAs worked without anesthesiologist supervision
• when anesthesiologists worked alone
• when CRNAs and anesthesiologists work together
Here is a little more detail about the study:
The authors analyzed 481,440 hospitalizations covered by Medicare and found that between 1999 and 2005, the frequency of using CNRAs without supervision has increased in both the states that required supervision and those that did not.
“The authors speculate that the increase could be due to anesthesiologists’ taking on more privately insured cases and leaving more Medicare cases to certified registered nurse anesthetists,” according to Health Affairs.
Anesthesiologists also work on more complicated cases, possibly because anesthesiologists can choose their cases more often than CRNAs. (The more complex cases, often in teaching institutions, pay better.)
“Eliminating physician supervision will not only allow nurses to do what they are trained and highly qualified to do,” said coauthor Jerry Cromwell, a senior fellow in health economics at the Research Triangle Institute, “but it will encourage hospitals and surgeons to use a more cost-effective mix of anesthetists.”