According to the new study, it confirms that certified
registered nurse anesthetists (CRNAs), those who received high-level training,
have the capacity to provide the same level of services as anesthesiologists at
virtually lower cost.
It started when Medicare refuse to reimburse for anesthesia
services unless a physician is overseeing the procedure. States can choose to
do without this requirement by petitioning CMS, and 14 states had done so as of
2005. California,
who opted out last year, was being challenged in court by two physicians?
associations.
It was analyzed by two researchers at the independent,
nonprofit Research Triangle Institute, the inpatient mortality and complication
rated from the 481,440 hospitalizations attended to by Medicare in both opt-out
and non-opt-out states, between 1999-2005. The researchers studied three different ways anesthesia can be
administered. The three ways are: by anesthesiologists working
alone; CRNAs working with no supervision; and both CRNAs and anesthesiologists
working as a team.
They say that there was no evidence that ?patients are prone
to increased surgical risk if anesthesiologists won?t supervise CRNAs.? The researchers also found out that
anesthesiologists would likely work on more complex cases than did CRNAs, and
they controlled for that aspect in their study.
The researchers recommended CMS to go back to its original
purpose of letting nurse anesthetists to work without the supervision of
surgeon or anesthesiologist minus the state governments to formally file a
petition for an exemption. According to them it would free surgeons from the
legal accountability for anesthesia services administered by other professionals.
It would also result to a more cost-effective care as the solo practice of
certified registered nurse anesthetists grows. The American Association of Nurse Anesthetists funded the said study.
A senior fellow in health economics at RTI and one to the
study?s authors, Jerry Cromwell, said that the two types of providers experience
about the same amount of actual anesthesia-related clinical and classroom
training. It is also expected that physicians get further training in med
school and residency on other physiological systems and specialties. He said
that physicians? training is truly valuable in managing ICUs and managing pain
control. From a statistical stand point,
at the level of the operating room those skills don?t seem to have any effect,
further explained by the study?s author.
Cromwell also points out that nurses were the predominant
providers of anesthesia for nearly 150 years.
To become a CRNA one needs to have a Bachelor of Science
degree in nursing or related field. After the Bachelor of Science degree in
nursing they still need one year of critical care experience before proceeding
to a two- or three-year master?s program in anesthesia (with clinical training)
and certification exam. In 2008-09, CRNAs recruited through staffing Merritt
Hawkins receives an average salary of $189,000. On the other hand,
Anesthesiologists, receives $344,000.
The American Society of Anesthesiologists had something to
say about the study. The group?s criticisms cover the research?s reliance on
billing data and an inadequate number of cases that would be crucial to detect
any difference in mortality.