For millions of Americans living in rural communities, access to care is no longer something they can take for granted. Hospitals are closing, maternity wards are disappearing, and patients are traveling farther for surgeries and specialty care that were once available close to home.
A recent analysis from HHS found that rural hospitals are more vulnerable to closure or conversion than urban hospitals. In fact, 700 rural hospitals, or one-third of all rural facilities in the country, are at risk of closing according to data from the Center for Healthcare Quality and Payment Reform. When facilities lose services or shut their doors altogether, patients may face longer travel times, delayed treatment, and fewer options for receiving care in their own communities.
Anesthesia care rarely gets the same coverage as hospital closures or provider shortages, yet it directly affects whether many healthcare services remain available locally.
Anesthesia is not a standalone service. It is the foundation that makes surgery, labor and delivery, trauma care, pain management, and many diagnostic and therapeutic procedures possible. When hospitals struggle to maintain anesthesia coverage, entire lines of care can become difficult, and sometimes impossible, to sustain.
Rural communities need reliable access to anesthesia care close to home.
Certified registered nurse anesthetists are an essential part of the solution. In fact, CRNAs are the providers on the ground, helping rural hospitals remain open by providing critical anesthesia care in a majority of communities that may otherwise have limited or no access to these services.
Opt-outs help preserve patient access
As healthcare leaders look for ways to strengthen patient access amid persistent workforce shortages, policymakers should focus on removing unnecessary barriers that make it harder to deliver care.
Federal physician supervision requirements for CRNAs can limit how hospitals and health systems deploy qualified anesthesia professionals.
In 2001, the CMS established an opt-out framework that allows states to be exempted from the federal supervision requirement when doing so is consistent with state law and in the best interests of citizens.
To date, 27 states and Guam have opted out of the federal supervision requirement, including recent action in Vermont and Ohio.
Rural hospitals operate under very different circumstances than large urban health systems. Staffing models that work in metropolitan environments may, simply, not work for small facilities with limited resources and ongoing workforce challenges. Flexibility matters when hospitals are struggling to recruit and retain clinicians. Rural healthcare leaders need the ability to organize care based on local workforce realities, patient needs, and state law. The one-size-fits-all federal requirement is a barrier and they know it.
At the onset of the COVID-19 public health emergency, efficient access to care became imperative. One of the first actions taken by CMS was to suspend the federal supervision requirements in anesthesia. This allowed our healthcare system to focus on efficiency, safety, and outcomes. It is regrettable that prioritizing these qualities was only temporary.
Patients experience access and outcomes
For patients, these discussions are not about regulatory frameworks, professional titles, or long-running healthcare policy debates. They are about whether a surgery can be scheduled without months of delay, whether a mother can give birth closer to home, and whether emergency care is available when every minute matters.
These are the standards that we should use to evaluate anesthesia care.
CRNAs are already bridging the rural care gap
CRNAs provide care in every setting where anesthesia is delivered, and represent more than 80% of anesthesia providers in rural counties. Their presence helps ensure patients, especially in rural and underserved communities, maintain operating rooms, preserve obstetrical services, support emergency procedures, and keep essential services available locally.
Addressing workforce shortages will require full use of the healthcare professionals already serving their communities across the country, including allowing every licensed professional to practice to the full extent of their education, training and licensure.
Communities across the country increasingly rely on CRNAs to keep care local, timely, and accessible.
The path forward
Rural hospitals are facing growing demand, workforce shortages, and financial pressures. Policies that limit staffing flexibility make those challenges harder to address.
States that have chosen to opt out of unnecessary federal supervision requirements have recognized reality: patients need timely access to safe anesthesia care, rural hospitals need flexibility, and CRNAs are already trusted providers in the communities most at risk of losing care.
Every patient should be able to access safe, timely anesthesia care close to home. This should be the goal.
Patients, hospitals, and communities all benefit when healthcare systems have the flexibility to deploy qualified anesthesia professionals where they are needed most.
Bill Bruce is CEO of the American Association of Nurse Anesthesiology.
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