During delivery of her strong statement before the subcommittee, Setnor pointed out that CRNAs are trained for and have consistently demonstrated their competence in providing anesthesia services without supervision, even in challenging environments such as battlefield. Currently, all CRNAs graduating from a nurse anesthesia program are doctorally prepared. In addition, CRNAs are prepared at the bachelor’s level as a registered nurse and are required to practice for a minimum of one year as an intensive care nurse before they can attend a nurse anesthesia program. Setnor stressed the need to allow CRNAs to apply this extensive training in delivering healthcare to our nation’s veterans.
“Removing barriers to care, including removal of burdensome supervision requirements, is not controversial and is supported by many organizations that do not have a vested and self-serving financial interest in maintaining the antiquated status quo,” Setnor said. “These include two past Administrations, the Bipartisan Policy Center, the AARP, the National Rural Health Association, the Brookings Institute, and Americans for Prosperity, among others. The men and women who have selflessly served our nation deserve the highest quality of care and all scientific evidence and multiple independent groups have concluded that that is CRNA care.”
Currently, only seven states have rules in their Nurse Practice Acts or the State Boards of Nursing that require physician supervision of CRNA services. Twenty-four states have opted out of Medicare’s supervision requirement for CRNAs. Only one state requires the supervision by a physician anesthesiologist when a CRNA is providing care, and even then, only at ambulatory surgical centers.
In some states, CRNAs are the sole anesthesia providers in nearly 100 percent of rural hospitals, affording these medical facilities obstetrical, surgical, trauma stabilization, and pain management capabilities. Setnor highlighted Iowa as an example.
“At both Iowa City and Des Moines facilities all CRNAs practice independently to the full extent of their education and training, thus, enabling physician anesthesiologists to do their own cases. This decreases wait times, increases access to quality care and improves patient safety and satisfaction. All anesthesia providers do high acuity/complex cases and take call independent of each other. Both facilities consistently rank among the most highly rated of VA facilities.”
Despite erroneous testimony from the American Medical Association and American Society of Anesthesiology, Setnor pointed out that supervision has no proven benefits to patients but has proven costs and detriments. An autonomous CRNA collaborating with a surgeon is the most cost-effective model for anesthesia delivery and used by healthcare facilities throughout the nation. Reimbursement and payment trends have shown a steady increase in the utilization of this practice model, implying an increase in CRNA autonomous practice. Providing the VA healthcare system with the same option will reduce costs without negatively impacting delivery of care.
“The VA in its 2016 final rule stated that CRNAs provide high-quality care. Additionally, 90 percent of veteran households in a survey stated they support allowing direct access to CRNAs within the VA,” Setnor said. “The physician anesthesiologists’ false narrative that the VA is planning to replace all anesthesiologists with CRNAs is an outright falsehood. AANA maintains that both anesthesiologists and CRNAs must be available to provide direct patient services, and that VA facilities should be afforded the ability to choose the best anesthesia delivery model that meets their needs.”