As healthcare costs continue to increase and access to care remains challenging for many people, Certified Registered Nurse Anesthetists (CRNAs) are a clear solution to the nation’s healthcare struggles. As advanced practice registered nurses, CRNAs fill critical leadership roles, are involved in every aspect of anesthesia service, and provide essential care in tens of thousands of communities, particularly in rural and medically underserved parts of the United States. CRNAs are also cost-beneficial for both patients and healthcare facilities.
Over the past year, as multiple waves of COVID-19 have spread through the United States, CRNAs have used their skills in advanced airway and ventilation management, vascular volume resuscitation, and advanced patient assessment, among others, to care for critically ill patients. They have taken the lead in the face of ongoing and serious medication, equipment, and staffing shortages.
The Centers for Medicare & Medicaid Services (CMS) recently said CRNAs are among the most utilized healthcare professionals in the country, and it ranked CRNAs among the top 20 specialties that served the most beneficiaries in non-telehealth care from March 2020 through June 2020. The agency said its decision to waive the physician supervision requirement for CRNAs was among its top healthcare accomplishments between 2017 and 2020. The waiver has since been extended, after the U.S. Department of Health and Human Services extended the COVID-19 public health emergency into April.
Key studies also show that CRNAs reduce costs while using the same procedures as physician anesthesiologists. A 2016 study in Nursing Economic$, “Cost-Effectiveness Analysis of Anesthesia Providers,” found that nurse anesthesia care is 25% more cost-effective than the next least costly anesthesia delivery model. Although Medicare provides the same fee for anesthesia services provided by a CRNA, physician anesthesiologist, or both working in tandem, CRNAs provide lower-cost care than physician anesthesiologists, helping to protect Medicare revenue.
The landmark Nursing Economic$ paper found that as demand for healthcare continues to rise, increasing the number of CRNAs and allowing them to practice in the most efficient delivery models will be essential to containing costs and maintaining quality care. The researchers also concluded that CRNAs are much less expensive to educate and train compared with physician anesthesiologists.
CRNAs have a demonstrated safety record, and they spend more time with patients before, during, and after surgical procedures. A 2010 report in Health Affairs, “No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians,” confirmed that anesthesia care provided by a CRNA practicing independently from physicians is safe. Furthermore, they are qualified to make independent judgments about all aspects of anesthesia care based on their education, licensure, and certification — and are the only anesthesia professionals with critical care experience prior to starting formal anesthesia education.
Nurse anesthetists have rigorous academic and clinical requirements for recertification, involving clinical best practices and the most up-to-date advancements in patient care. Meanwhile, as CRNAs’ responsibilities increase, their malpractice premiums have decreased every year — another indication of the value they bring to patient care. Given their safety record and ability to provide high-quality, cost-effective care, experts expect CRNA-only anesthesia services to expand nationwide.
In rural parts of the country, the value of CRNAs is especially clear. More than 80% of the anesthesia providers in rural counties are CRNAs, and one-half of rural hospitals in the United States use a CRNA-only model for obstetric care. Additionally, county-level analyses of CRNAs and anesthesiologists indicate the greater availability of CRNAs in counties with more vulnerable populations, including those who are uninsured, eligible for Medicaid, and unemployed.
Rep. Jan Schakowsky (D-IL) recently introduced in the House of Representatives a resolution “Recognizing the roles and the contributions of America’s Certified Registered Nurse Anesthetists (CRNAs) and their role in providing quality health care for the public” (H.Res.807). The resolution calls attention to the role of CRNAs as the primary providers of anesthesia care in rural America, and highlights CRNA practice in the military. “(CRNAs) have been the main provider of anesthesia care to United States military personnel on the front lines since World War I, including all current United States military actions around the globe.”
Matthew McCullough MS, CRNA, APN-A, Senior Vice President, Chief Compliance Officer, UltraCare Anesthesia Partners, notes that their business — a full-service anesthesia and staffing company that services locations in 13 states — is predominantly owned by CRNAs. Before the COVID-19 pandemic hit, McCullough says the company provided “a traditional model of anesthesia delivery.” But now, they are more “intimately involved in COVID-19-related functions,” he says, and have been “called upon by several different health systems in the area to provide CRNAs, APNs in anesthesia to function in a non-anesthesia role assisting in running COVID units.”
As the pandemic continues, healthcare administrators looking to provide value at their facilities while reducing costs would do well to consider CRNA-only models of care. Post-COVID, permanent removal of physician supervision of CRNAs will benefit both patients and healthcare facilities, as many canceled or postponed surgeries will need to be rescheduled. Permanent removal will also help ensure that patients come first while increasing competition and network adequacy.
A longtime AANA member, Moore served as the AANA treasurer in 2016-17 and before that as a region director on the AANA Board of Directors for two years. Previously, Moore worked as the director of Perioperative and Anesthesia Services at Passavant Area Hospital in Jacksonville, Illinois, where he managed a $35 million budget and more than 100 employees. Moore is also a retired commissioned officer of the U.S. Army Reserve with more than 22 years of military service.