American Association of Nurse Anesthetists Urges HHS to Permanently Remove Barriers to CRNA Practice

PARK RIDGE, Ill. (AANA)—As COVID-19 cases surge across the country, the American Association of Nurse Anesthetists (AANA) is urging the U.S. Department of Health and Human Services (HHS) to make a waiver that suspends physician supervision requirements of nurse anesthetists permanent.

This past spring, the Centers for Medicare & Medicaid Services (CMS) temporarily suspended the supervision requirements for Certified Registered Nurse Anesthetists (CRNAs) to increase the capacity of the U.S. healthcare delivery system during the pandemic. The HHS issued a “request for information” Dec. 1 to determine the costs and benefits of making this waiver and other policies permanent.

“The removal of physician supervision is the right thing to do for our patients and our healthcare system,” according to AANA President Steven M. Sertich, CRNA, MAE, JD, Esq. “We have seen CRNAs traveling from their homes to help provide critical care in states that have seen spikes in COVID-19. As CRNAs increasingly practice independently during this crisis, managing delicate intubations of COVID patients, managing ventilators, and working under stressful conditions in facilities across America, we have already shown that these barriers to practice do not benefit patients and the larger healthcare system.”

Recognizing the pivotal role CRNAs play in providing access to the highest quality care, the federal government and several governors removed many barriers to CRNA practice during this crisis. This is in addition to 18 states that have previously opted out of supervision requirements.

Numerous studies have demonstrated the safety and high quality of nurse anesthesia care, leading researchers to recommend that costly and duplicative supervision requirements for CRNAs be eliminated. A study published in Health Affairs noted that “(no) harm (is) found when nurse anesthetists work without physician supervision.”

The permanent removal of physician supervision of CRNAs aligns with CMS’s Rural Health Strategy, which cited maximizing scope of practice for providers as one of its key recommendations in its report, “Reforming America’s Healthcare System through Choice and Competition.” It also conforms to recommendations from the New England Journal of Medicine.

Throughout the public health emergency, facilities have required all providers to work to the top of their education and state scope of practice. CRNAs are highly educated, highly trained professionals. Prior to graduating with an advanced degree as an expert in the field of anesthesiology, CRNAs complete seven to eight-plus years of healthcare and anesthesia education and more than 9,000 hours of clinical training including thousands of hours in ICUs. This expertise makes them uniquely suited to aid in combating the COVID-19 crisis.