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Nurse anesthetists: To Reimburse or Not to Reimburse?

Posted Nov 06 2012 12:00am

The Centers for Medicare and Medicaid Services (CMS) recently approved reimbursing nurse anesthetists for care provided to Medicare beneficiaries .

Critics say it jeopardizes patient safety, while supporters say it extends health care to pain patients who are often underserved by the medical community.

The American Association of Nurse Anesthetists (AANA) (unsurprisingly) applauds the decision . Janice Izlar, President of the AANA stated:

Many Americans depend on nurse anesthetists to treat their chronic pain safely and effectively. Thanks to yesterday’s ruling, our patients can be secure in the knowledge that they’ll continue to have access to the nurse anesthetists they know and trust.

Anesthesiologists and other physicians (unsurprisingly) do not approve of the ruling . They cite problems of patient safety including the potential for increased painkiller abuse.

In my opinion, licensing certified registered nurse anesthetists (CRNA) is a good thing. CRNAs cost less than anesthesiologists. Does an anesthesiologist have more training than a CRNA? Yes. Would anesthesiologists provide higher quality care for complex cases? Yes. Would anesthesiologists provide higher quality care for typical cases? Maybe not if CRNAs can spend more time with patients or if CRNAs can specialize in particular pain procedures such as epidurals during pregnancy or–more relevant to Medicare–pain management during hip replacement. CRNAs certainly would reduce the per person cost of medical care.

Allowing CRNAs to bill may not, however, reduce overall healthcare costs if CRNAs now administer painkillers in cases where they were not used before. Medicare’s payment for home health services aimed to reduce cost by diverting care from the expensive skilled nursing setting to the less expensive home health setting. Providers, however, began using home health care in cases for which SNF care was not used and thus overall spending increased.

However, CRNA are much more close substitutes for anesthesiologists than home health care is for SNF (i.e., most people could use help around their house and additional medical care). Further, the Medicare ruling isn’t a change in the benefits covered, just who can perform these services.

Overall, allowing nurse anesthetists to provide care to Medicare beneficiaries in pain will not only improve care, but can also reduce costs.

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