By Mike Lillis
Editorialists at The New York Times jumped this week into the hotly contested issue of whether doctors or nurses should be chiefly responsible for providing anesthesia care — and suggest that the cost savings related to nurse-administered treatments shouldn't be ignored.
"It costs more than six times as much to train an anesthesiologist as a nurse anesthetist, and anesthesiologists earn twice as much a year, on average, as the nurses do ($150,000 for nurse anesthetists and $337,000 for anesthesiologists, according to a Rand Corporation analysis)," the Times editorialists wrote Tuesday. "Those costs are absorbed by various institutions and public programs within the health care system."
Under current Medicare rules, surgeons or anesthesiologists must oversee the care provided by certified registered nurse anesthetists (CRNA) in order for those treatments to be reimbursed. In 2001, the Centers for Medicare and Medicaid Services allowed states to opt out of that requirement, which 15 states have done.
The different state models have allowed researchers to compare the outcomes of care delivered by CRNAs working alone to that of CRNAs monitored by a physician. In a report published last month, experts at the Research Triangle Institute found there was no measurable difference, in terms of quality of care, between the two models.
The anesthesiologist lobby has been quick to defend its turf, arguing that the years of training endured by physicians makes them better suited to administer treatments — particularly in those cases where complications arise on the operating table. Patients prefer having the more experienced doctors deliver those services, the anesthesiologists say.
The Times notes that the mortality rate surrounding anesthesia care is tiny in both cases.
"From a patient’s point of view, it would seem preferable to have a broadly trained anesthesiologist perform or supervise anesthesia services, but, in truth, the risk is minuscule either way," the Times writes.
"As health reformers seek ways to curb medical spending, they need to consider whether this is a safe place to do it."