CRNA PRACTICE Certified Registered Nurse Anesthetists (CRNAs) • CRNAs are highly educated, advanced practice registered nurses who deliver anesthesia to patients in exactly the same ways, for the same types of procedures, and just as safely as physician anesthesiologists. CRNAs • CRNAs have been providing anesthesia care to patients in the United States for more than 150 years. • They first gave anesthesia to soldiers during the American Civil War. • CRNAs have been the main providers of anesthesia care to U.S. military personnel on the front lines since WWI. CRNAs • CRNAs are trained to administer every type of anesthesia to all types of patients in any healthcare setting where anesthesia is delivered. • All anesthesia professionals give anesthesia the same way. CRNA Education • Nurse anesthetists are required to have a minimum of seven to eight years of education, training and experience before they can become a CRNA. • Today’s CRNAs enter the workforce with a master’s or doctoral degree. • CRNAs have an average of three and one-half years of critical care experience before entering a nurse anesthesia program. Anesthesia Provider Models • CRNA only • CRNA and anesthesiologist working together • Anesthesiologist only CRNA-Only Practice • Research confirms that all three models are equally safe • CRNA-only practice model demonstrates high degree of patient safety, quality, and cost-effectiveness Patient Safety • Numerous studies confirm that anesthesia care is equally safe regardless of whether it is provided by a CRNA working alone, an anesthesiologist working alone, or a CRNA working with an anesthesiologist, most notably the study titled “No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians” published in 2010 in Health Affairs. Research Evidence Demonstrates the Value of CRNA Services • • • • • • • • MEDICAL CARE Scope of Practice Laws and Anesthesia Complications: No Measurable Impact of Certified Registered Nurse Anesthetist Expanded Scope of Practice on Anesthesia-related Complications NURSING ECONOMIC$ Geographical Imbalance of Anesthesia Providers and its Impact On the Uninsured and Vulnerable Populations JOURNAL FOR HEALTHCARE QUALITY Complication Rates for Fluoroscopic Guided Interlaminar Lumbar Epidural Steroid Injections Performed by Certified Registered Nurse Anesthetists in Diverse Practice Settings NURSING ECONOMIC$ Cost Effectiveness Analysis of Anesthesia Providers, Nursing Economic$, Hogan P, Seifert R, Moore C, Simonson B. (2010). 28, 3:159-169. NURSING RESEARCH Anesthesia Staffing and Anesthetic Complications During Cesarean Delivery, Simonson D, Ahern M, Hendry M. (2007), Nursing Research, 56, 9-17. HEALTH SERVICES RESEARCH Anesthesia Provider Model, Hospital Resources and Maternal Outcomes, Needleman J, Minnick AF (2009), Health Services Research, 44(Part I)464-82. AANA JOURNAL Surgical Mortality and Type of Anesthesia Provider, Pine M, Holt KD, Lou YB, (2003), AANA Journal, 71:109-116. THE COCHRANE LIBRARY Physician Anaesthetists Versus Non-Physician Providers of Anesthesia for Surgical Patients, Lewis SR, Nicholson A, Smith AF, Alderson P. (2014). Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD010357. DOI: 10.1002/14651858.CD010357.pub2. More on CRNA Safety • Nationally the average 2016 malpractice liability insurance premium for self-employed CRNAs was 33% less than it was in 1988. When trended for inflation through 2016, the reduction in premiums was even greater (67%). • The Institute of Medicine, American Association of Nurse Anesthetists (AANA), and American Society of Anesthesiologists concur that anesthesia is approximately 50 times safer today than it was during the 1980s. Supervision What affects how CRNAs can practice? aana.com CMS Rules/Fed. opt-out Internal facility policies Nursing law and rules Reimbursement Other providers’ laws/rules Facility licensing law/rules aana.com State and Federal Law • 40 states have no supervision requirement in the state nursing law/rules • 33 states have no supervision requirement in the state nursing law/rules OR the hospital licensing law/rules • 17 states have opted out of the federal CMS/Medicare supervision requirement aana.com Physician Supervision and CRNA Regulation • • • Federal – CMS conditions for Medicare Part A reimbursement include a physician supervision requirement for CRNAs in states that have not opted out – States can “Opt Out” of physician supervision requirement State scope of practice – law, rule, regulation, opinion (e.g. Board of Nursing, Attorney General) Facility bylaws State Supervision Opt-Out • The Nov. 13, 2001 final rule allows governors in eligible states to request an “opt-out” (also known as an “exemption”) from the federal Medicare Part A physician supervision of CRNA requirement. Prescriptive Authority • Federal Law: – The "traditional" practice of nurse anesthetists - ordering and directly administering controlled substances and other drugs preoperatively, intraoperatively, and postoperatively - does not constitute "prescribing" under federal law. aana.com Prescriptive Authority • Federal Law – Because DEA has not regarded traditional CRNA practice as "prescribing" under federal law, most nurse anesthetists have not had to register with the DEA aana.com Cost Effectiveness • A landmark 2010 study published in Nursing Economic$ shows that a CRNA working as the sole anesthesia provider is 25 percent more cost effective than the next most cost-effective anesthesia delivery model. Compensation Comparison • The mean annual salary of anesthesiologists is approximately 2 ½ times greater than the salary of CRNAs. • Because Medicare pays the same fee for an anesthesia service whether it is provided by a CRNA, an anesthesiologist or both working together, the higher compensation of the anesthesiologist is borne by the hospital, healthcare facility or the patient. 2015 Total Compensation for Full-time Employee CRNAs $230 000 (n=2,787) $179 030 $175 000 Mean Median $200 000 $150 737 25th percentile 75th percentile 90th percentile 05/2016 Cost Savings for Facilities • Hospitals operate on very thin margins, often 1%-3%. • When hospitals are forced to employ anesthesiologists (total expense ~$500K/FTE) on every case, margins are dramatically impacted. AANA RESOURCES • SGA Staff • 50 STATE CHARTS • Other resources – Tracking legislation – Tracking language pertaining to CRNA practice – Practice Documents aana.com aana.com QUESTIONS • SGA Staff – sga@aana.com – Tel:847-655-1130
