HCFA drops supervision requirement from CRNAs
Washington -- Despite two years of objections from physicians, the Health Care Financing Administration eliminated Medicare requirements that certified registered nurse anesthetists be supervised by physicians. The final rules are expected to be published in the Federal Register in June.
HCFA officials said states now may decide whether to require that anesthesiologists or other physicians supervise CRNAs. The American Society of Anesthesiologists says only New Hampshire allows CRNAs to practice independently; the American Assn. of Nurse Anesthetists contends that 29 states do not require physician supervision.
ASA and AMA argue that supervision should not be changed because of the potential increased risk to patients. But HCFA said there were no studies in the past 10 years showing negative patient outcomes when CRNAs were unsupervised.
ASA officials, however, said that preliminary results from a study of outcomes on 65,000 Pennsylvania Medicare patients would show a "28% higher mortality rate and a 21% higher failure-to-rescue rate when an anesthesiologist was not involved in supervising the nurse anesthetist." The ASA said the study would be published later this year.
"We are shocked and frankly outraged" by the HCFA regulation, said Ronald A. MacKenzie, DO, ASA president. "It is regrettable that HCFA apparently has an agenda entirely unrelated to patient safety."
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