Certified Nurse Anesthetists Can Safely Go Solo, Study Suggests
TUESDAY Aug. 3, 2010 -- Patients have no increased risk of death or complications from surgery when nurse anesthetists work without physician oversight, a new study has found.
The findings challenge a requirement that nurse anesthetists be supervised by an anesthesiologist or surgeon in order for an operation to qualify for Medicare reimbursement, according to study authors Jerry Cromwell and Brian Dulisse of the Research Triangle Institute, a nonprofit organization based in North Carolina.
States can opt out of the requirement by petitioning the U.S. Centers for Medicare and Medicaid Services (CMS).
Cromwell and Dulisse analyzed 481,440 hospitalizations covered by Medicare and found that the frequency of nurse anesthetists providing anesthesia without anesthesiologist supervision increased between 1999 and 2005, from 17.6 percent to 21 percent in 14 opt-out states and from 7 percent to 10 percent in non-opt-out states.
The investigators also found no increased risk of patient death or complications in the opt-out states and no significant differences in patient outcomes in any of the three following situations: certified registered nurse anesthetists working without anesthesiologist supervision; anesthesiologists working alone; or the two types of anesthesia providers working together.
The study is published in the Aug. 3 issue of the journal Health Affairs.
"This study shows that patient safety was not compromised by the opt-out policy. We recommend that CMS change the policy so that governors no longer have to petition for their states to opt out of this Medicare requirement," Cromwell said in a news release from the journal's publisher.
Increased use of nurse anesthetists could help save health care costs because they typically earn less than anesthesiologists, Cromwell noted.
The American Society of Anesthesiologists has more about anesthesia.
Posted: August 2010
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