According to an opinion article written in the Arkansas Democrat Gazette, SB184/HB1238, a bill in the Arkansas legislature, aims to remove the anesthesia care team model requirement in Arkansas and allow Certified Registered Nurse Anesthetists (CRNAs) to administer anesthesia without any physician supervision. In a medically directed model, a physician anesthesiologist must approve and supervise CRNAs during administration of anesthesiology. The letter, written by an RN who became a Physician Anesthesiologist states that 45 states, the District of Columbia and the Veterans Association currently require physician “involvement” in anesthesia care. The author concludes that Physician supervision of anesthesia ensures patients receive safe, high-quality care and urges Arkansans to contact their Representatives in opposition. She claims the proposed legislation provides no benefit and will not lower health-care costs.
With many years of experience advising anesthesia groups, hospitals and health systems in states across the nation, EHC has seen and worked with a variety of anesthesia staffing models ranging from All MD to Care Team to models with independent CRNA’s. We have seen high quality care provided in all models and we have directly observed that these disparate staffing approaches may be be effective from both an efficiency and cost perspective.
Attempts at academic study of quality and outcomes between various models have been mixed, with data available to support physician involvement or CRNA-only care. In the midst of legislation proposed in several states that aims to change the scope of supervision (potentially adding to the 17 states which have chosen to opt-out of the CMS physician supervision requirement for anesthesia) there is a great deal of political dialogue and controversy.
In our opinion, hospitals and groups should focus on crafting a delivery model which meets their needs within the parameters of their state regulations. The solution should be carefully designed by taking into account the unique medical culture at the facility, case complexity, local and regional practice patterns, and the cost implications when choosing between various models. As a closing thought, despite the claims of the author of the article reviewed, many commercial payers do reduce payment for unsupervised services by a CRNA, thus reducing cost for insurers and potentially patients in the form of copay and deductibles. Furthermore, in many scenarios, complete or partial use of unsupervised CRNA’s would reduce the overall cost of anesthesia staffing for a given set of coverage requirements, thus potentially decreasing subsidy cost to the hospital.