6 things the VA can do to ensure veterans get the anesthesia care they need

Reports out of Colorado tell a shocking story of cancelled or postponed surgical procedures for veterans at the Denver Veterans Affairs Medical Center, forcing 65-90 veterans to go without needed care since early August.

The affected veterans include one who traveled across two states to reach the medical center only to find his procedure had been cancelled. While the full story out of Denver has yet to be told, horror stories about access-to-care issues within the VA system, many related to anesthesia delays, are popping up across the country on an almost daily basis.

Here’s what the Department of Veterans Affairs (VA) and Veterans Health Administration (VHA) can do to ensure that our nation’s veterans receive the anesthesia care they need.

1. Acknowledge that the problem is dire. At the beginning of 2017, the VA claimed there wasn’t an access to anesthesia care problem in VHA facilities despite substantial evidence to the contrary. A congressionally-mandated, independent assessment of VHA facilities had confirmed that due to lack of anesthesia support, veterans routinely experience delays for healthcare services such as cardiovascular surgery, colonoscopies, and procedures requiring anesthesia outside of the operating room. The VA has to acknowledge that a problem exists before the problem can be solved.

2. Prohibit 1:1 and 2:1 anesthesia provider ratios. The reason given for the nearly 100 cancelled and postponed procedures in Denver was a “shortage of anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs),” but the real culprit had nothing to do with a provider shortage—especially not an anesthesiologist shortage. The Denver facility and many other VA facilities across the country use a 1:1 or 2:1 anesthesia delivery model with one or two CRNAs to one anesthesiologist. The CRNAs provide the hands-on patient care and the anesthesiologists are available to provide a second set of hands or eyes as needed, rather than providing actual hands-on care. In Denver, if all 18 of the anesthesia providers working there regularly provided hands-on anesthesia care to veteran patients, rather than just the 10 who are CRNAs, the facility would increase opportunities for veterans to receive care by nearly 80 percent!

3. Make full use of the CRNAs and anesthesiologists already working in VHA facilities. The solution to anesthesia-related surgical delays in VHA facilities is obvious: Both CRNAs and anesthesiologists need to be providing anesthesia to patients. The VA does not require CRNAs to be supervised by an anesthesiologist (nor does the federal government, state governments, or the military service branches). Further, all anesthesia research studies since 2000 confirm that CRNAs and anesthesiologists are equally safe providers, so it’s not a safety issue. It is simply a waste of human and budgetary resources to not require anesthesiologists and CRNAs to both be the sole anesthesia providers for different cases taking place simultaneously.

4. Grant full scope of practice to CRNAs in the VA. In January 2017, the VA passed on an important opportunity to improve access to anesthesia care for military veterans—a decision for which our veterans have been paying the price ever since. The VA approved a final rule granting full practice authority to all advanced practice registered nursing specialties except CRNAs. Although the VA had initially included CRNAs in the full practice authority rule, they were ultimately excluded. The decision prevented VA CRNAs and anesthesiologists from being used to the full extent of their education, training and licensure, and ensured that veterans would not have increased access to surgical and other procedures requiring anesthesia care. By granting full practice authority to CRNAs, the VA would make full use of more than 900 CRNAs already practicing in VHA facilities, ensuring our nation’s veterans have access to essential surgical, emergency, obstetric and pain management healthcare services without needless delays or having to travel long distances for care.

5. Stop overpaying to outsource anesthesia services. The VHA wastes a great deal of financial resources that it simply cannot afford to waste, such as the 38 contracts with outside anesthesia providers at a cost of more than $100 million to taxpayers, clear evidence that available internal resources are not being used to their full advantage. Using the existing CRNA workforce in the VHA to its full practice authority would increase patient access to care without additional funding. In fact, it wouldn’t cost the VA, federal government or U.S. citizens one additional tax dollar to support.

6. Pause for a reality check. CRNAs are the primary anesthesia providers on the front lines of all U.S. military actions around the globe, and have been since WWI. If CRNAs can provide quality anesthesia care to wounded soldiers on battlefields without an anesthesiologist anywhere to be found, then they can safely and cost-effectively provide quality anesthesia care to our veterans back home in VHA facilities without an anesthesiologist looking over their shoulder.

Bruce Weiner, DNP, MSNA, CRNA, is president of the American Association of Nurse Anesthetists, which represents more than 52,000 nurse anesthetists.

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