Medicare requires that CRNAs must be supervised unless the governor of a state submits a letter to CMS certifying that three conditions have been met: 1) the governor has consulted with the state board of medicine and nursing about anesthesia access; 2) the governor has concluded it is in the best interest of the state to opt out; and 3) the opt out is consistent with state law.
The ability of CRNAs to administer anesthesia without physician supervision has been a battle ground issue in many states between anesthesiology and CRNA groups, according to a report in the Wall Street Journal Health Blog. In recent years, declining anesthesiology incomes has aligned with a proliferation of surgical settings and a push by hospitals and other surgical settings to use CRNAs. This push has placed additional pressure on anesthesiologists’ incomes and, in many cases, has caused anesthesiologists to more actively pursue ways to protect and maintain their revenue.
States that opt out of the supervision requirement usually do so to increase access to anesthesia services, especially in remote areas of the state. However, this decision is sometimes countered by anesthesiologists, as the CSA is currently doing, who argue that unsupervised anesthesia by CRNAs could negatively impact quality of care for Medicare patients.
The CSA and CMA claim in their suit that Gov. Schwarzenegger’s decision to opt out contradicts court decisions in the state requiring physician supervision of anesthesia care “to ensure it is done properly,” according to the news release.
“Maintaining physician supervision of anesthesia is important for safety of care delivered to all patients,” said Linda Hertzberg, MD, president of the CSA, in the release. “Unfortunately, the governor is saying that some patients don’t deserve the same protections that the rest of us do.”
The two groups also claim no evidence is available to suggest the governor directly met with state boards prior to submitting the letter, as is required by CMS. The Governor’s Office claims it followed proper protocol, according to the WSJ report.
Read the CSA and CMA release on the CRNA supervision lawsuit (pdf).
Read the Wall Street Journal Health Blog‘s report on the California suit on CRNA supervision.
