Anesthesiologists say states oppose Medicare nurse anesthetist proposal

The American Society of Anesthesiologists in Park Ridge, IL, says that every state medical society in the United States and most major medical specialties are opposing a Health Care Financing Administration (HCFA) proposal to no longer require that nurse anesthetists with advanced training be supervised by a physician when administering anesthesia in a hospital setting.

The doctors say the medical community’s show of support challenges the agency’s stated reason for the change — to give states control over health care matters.

"There is a distinct difference between medicine and politics," says Ronald A. Mackenzie, DO, president of the American Society of Anesthesiologists. "We in medicine do not implement a change without knowing that we first will do no harm’ to the patient. Many politicians, however, are willing to implement changes, knowing they can reassess their decisions and, if necessary, change them back. Doctors practicing medicine cannot do that."

The doctors say HCFA should keep the current level of physician involvement unless science shows that patients will not be harmed by the proposed change. They say a Pennsylvania study due to be published this summer showed a significantly higher patient death rate when a nurse is not supervised by an anesthesiologist.

But officials of the American Association of Nurse Anesthetists (AANA) in Park Ridge, IL, representing certified registered nurse anesthetists, say, "senior citizens will be just as safe as they’ve always been."

A Wirthlin Worldwide study of seniors conducted last year showed that two-thirds of the Medicare patients questioned said it was not necessary for nurse anesthetists to be supervised by their surgeon as along as the two work collaboratively during the operation.

AANA president Jan Stewart, CRNA, tells State Health Watch that when HCFA introduced its proposal, "this decision removes the supervision requirement for a hospital to be paid by Medicare. It doesn’t affect providers. I think that if you walk down a hospital corridor six months after this takes effect, you won’t see any difference. This is not a change in practice, just in billing. I think the opposition has blown it all out of proportion. Doctors may believe there is some control slipping away from them, but they never really had it."