Study: Doc supervision of nurse anesthetists is expensive, ineffective and 'irrational'

Nurse anesthetists working unsupervised are just as effective as those overseen by physicians, medical researchers said this month. 

The experts are calling on Medicare to repeal a long-standing rule that nurse anesthetists must be supervised by doctors — a message being trumpeted by the nurse anesthetist lobby.

"The results validate what we have known all along — that the quality of care and safety record of nurse anesthetists is of the highest caliber, regardless of physician supervision," said James Walker, president of the American Association of Nurse Anesthetists (AANA).

At issue are current Centers for Medicare and Medicaid Services (CMS) rules requiring surgeons or anesthesiologists to oversee the services provided by certified registered nurse anesthetists (CRNA). In 2001, CMS empowered states to opt out of that requirement, which 15 states have done since then. 

The distinction allowed researchers at the Research Triangle Institute (RTI) to compare the outcomes of procedures performed by supervised CRNAs and those working solo. The results?

"We don't find any statistical differences for CNRAs working alone," Jerry Cromwell, senior fellow in health economics at the RTI and author of the recent report, told reporters on a phone call Monday. The findings are an indication, Cromwell said, that Medicare's physician supervision requirement is "unnecessary," "irrational" and "superfluous." 

"It really doesn't make sense to me," he added.

The findings, published in the August issue of Health Affairs, are based on a nationwide examination of inpatient surgical mortality rates, and seven complications related to anesthesia treatments for surgical procedures performed between 1999 and 2005. The researchers used CNRA claims data surrounding 480,000 such procedures, 69,000 of which took place in the opt-out states.

Paul Santoro, the AANA's president-elect, told reporters Monday that the current supervision rule "hinders patient access to care and raises healthcare costs." 

Indeed, a recent Lewin Group study found that CNRAs working alone cost 25 percent less than the next cheapest model for delivering anesthesia services to patients. That study was published in the Journal of Nursing Economics in May. 

Read the response from the anesthesiologist lobby here