CRNA in clinical situation
Male CRNA
CRNA in a clinical situation
Female CRNA
CRNA in a clinical situation
Anesthesia care:

Five urgent challenges, one new paradigm

Health care administrators and legislators look to CRNAs for answers
Rural road

Issues

  • Rural hospital closures at a historic high as a pandemic spreads
  • Even leading hospital systems are found to be under-resourced
  • Concern for an alarming lack of available OB, surgical and, now, even preventive care

Opportunity

CRNAs (Certified Registered Nurse Anesthetists) have proven themselves on the front lines of the COVID-19 pandemic.

As the virus spread, the federal government suspended the CMS physician supervision requirement for CRNAs. A number of states also suspended unnecessary supervision rules and limits on their scope of practice. As a result, many CRNAs are safely practicing to the full extent of their education and experience. Many more patients can now get the care they need, and healthcare facilities have the flexibility to assign providers as situations dictate. Because of the temporary changes to the law, CRNAs have been able to step up and safely fill essential healthcare needs during a time of national crisis.

Even before COVID-19 struck, CRNAs were already the de facto anesthesia providers in the vast majority of rural hospitals and medically under served areas as well as the predominant provider for maternity patients.

As more than 50 percent of the US anesthesia workforce, CRNAs have long been recognized for their specialized skills in airway management, intubation, advanced patient assessment and excellent patient safety record. Yet, progress has been slow in allowing them full scope of practice. Just recently, CRNAs won the right to be the sole provider for pre-operative anesthesia evaluation in Ambulatory Surgical Centers.

In all, 18 states have now opted out of the federal Medicare requirement that calls for physician supervision of CRNAs.

In the real world—operating rooms— surgeons typically defer to CRNAs as the experts in anesthesia care, regardless of whether their state requires physician supervision.

Enlightened public policy can further expand access for all patients, no matter where they live.

U.S. currency

Issues

  • Physician anesthesiologist supervision adds unnecessary cost
  • Medicare reimbursement is being eroded

Opportunity

Landmark studies show the most cost-effective anesthesia delivery model is a CRNA working without physician anesthesiologist supervision.

A better way to preserve profits

In healthcare publications such as Becker’s ASC Review, experts maintain it is actually fiscally irresponsible to pay a non-revenue generating physician anesthesiologist two to three times the salary of a CRNA when the evidence has shown an additional provider does not improve quality, outcomes, morbidity or mortality.

 

Keep more of your Medicare revenue

Medicare pays the same fee for anesthesia services provided by a CRNA, a physician anesthesiologist, or both working together. CRNAs help protect Medicare revenue by providing lower-cost care than more expensive physician anesthesiologists.

Reduce surgical liability

CRNAs carry insurance coverage for all the services they provide. Excellent claims experience has brought CRNA malpractice liability premiums down an average 68 percent from 30 years ago, when adjusted for inflation. The downward trajectory continues.

CRNAs

Issues

  • Patient safety cannot be compromised
  • Outcome metrics are increasingly tied to reimbursement

Opportunity

There is no difference in safety and outcomes between CRNAs working alone vs. with a physician anesthesiologist.

In fact, experts predict an expansion of CRNA-only anesthesia services across the country in light of their near Six Sigma safety record and ability to provide high-quality, cost-effective anesthesia care.

CRNAs have a solid record of commitment to patient safety. Malpractice premiums for CRNAs decline every year even as their responsibilities increase, reflecting the value they bring to anesthesia care.

CRNAs spend more time with patients prior to, during and after surgical procedures, providing continuity, greater safety and an enhanced patient experience.

CRNAs have rigorous academic and clinical requirements for recertification, focused on clinical best practices and the latest advancements in patient care.

As care delivery becomes more accountable, the CRNA approach will continue to drive a higher standard of care and maximize outcomes-linked reimbursement models.

Male CRNA

Issues

  • Competition for anesthesia providers
  • Lack of staffing flexibility
  • Increased need for respiratory support care

Opportunity

As the need for anesthesia care grows, it becomes more difficult—and expensive—to recruit and retain physician anesthesiologists.

Perks physician anesthesiologists are asking for—and getting

Recent trends show a sharp increase in signing bonuses, among the highest amounts ever tracked. Paid relocation, paid continuing medical education, health insurance and malpractice insurance are standard offerings, as reported by physician search firm Merritt Hawkins. In addition, some search assignments include medical education loan repayments, which tend to be in the $80,000 range.

Physician availability is also impaired by burnout

A longitudinal study by Mayo Clinic shows a 43% higher likelihood that a physician would reduce their work hours in response to certain types of work pressures. Demographic changes also contribute; physician anesthesiologists are getting older, 55 years old on average.

Increasingly, CRNAs are filling the role

More CRNAs than ever before are mobile, working at several facilities. They maintain their own 1099 and locum tenens malpractice policies, increasing their ability to provide much-needed staffing flexibility.

The CRNA anesthesia staffing model provides facilities with the most cost-effective and versatile option.

Medication overload

Issues

  • A serious need for personalized, non-opioid solutions
  • Systemic lack of resources for chronic pain management

Opportunity

As with many social issues, overcoming opioid addiction requires boots on the ground.

Physician anesthesiologists often aren’t able to fully assess and manage post-surgical and chronic pain in the time they have with patients.

But CRNAs have that proximity, plus the knowledge, skills and commitment to move pain management forward, opiod-free. Collaborating with professional, governmental and community organizations, CRNAs across the country are actively leading in hundreds of initiatives to curb abuse and provide effective, responsible pain management.

These include:

Enhanced Recovery after Surgery (ERAS®)

Patient-centered, evidence-based, multidisciplinary team-developed pathways for a culture to reduce the patient’s surgical stress response, optimize physiologic function and facilitate recovery. These care pathways form an integrated continuum as the patient moves from home through the pre-hospital, pre-admission, pre-operative, intra-operative and post-operative phases of surgery and the return home.

Enhanced Recovery After Surgery: How CRNAs are reducing opioid use, improving outcomes, and lowering costs (PDF)

Opioid Safety and Advocacy State Toolkit

AANA offers this toolkit checklist to provide guidance and help identify opportunities to create, lead or serve when asked to be involved in a state or community initiative.

Opioid Safety and Advocacy State Toolkit (PDF)

Challenge #1
Preserve access to care
Rural road

Issues

  • Rural hospital closures at a historic high as a pandemic spreads
  • Even leading hospital systems are found to be under-resourced
  • Concern for an alarming lack of available OB, surgical and, now, even preventive care

Opportunity

CRNAs (Certified Registered Nurse Anesthetists) have proven themselves on the front lines of the COVID-19 pandemic.

As the virus spread, the federal government suspended the CMS physician supervision requirement for CRNAs. A number of states also suspended unnecessary supervision rules and limits on their scope of practice. As a result, many CRNAs are safely practicing to the full extent of their education and experience. Many more patients can now get the care they need, and healthcare facilities have the flexibility to assign providers as situations dictate. Because of the temporary changes to the law, CRNAs have been able to step up and safely fill essential healthcare needs during a time of national crisis.

Even before COVID-19 struck, CRNAs were already the de facto anesthesia providers in the vast majority of rural hospitals and medically under served areas as well as the predominant provider for maternity patients.

As more than 50 percent of the US anesthesia workforce, CRNAs have long been recognized for their specialized skills in airway management, intubation, advanced patient assessment and excellent patient safety record. Yet, progress has been slow in allowing them full scope of practice. Just recently, CRNAs won the right to be the sole provider for pre-operative anesthesia evaluation in Ambulatory Surgical Centers.

In all, 18 states have now opted out of the federal Medicare requirement that calls for physician supervision of CRNAs.

In the real world—operating rooms— surgeons typically defer to CRNAs as the experts in anesthesia care, regardless of whether their state requires physician supervision.

Enlightened public policy can further expand access for all patients, no matter where they live.

Challenge #2
Reduce costs
U.S. currency

Issues

  • Physician anesthesiologist supervision adds unnecessary cost
  • Medicare reimbursement is being eroded

Opportunity

Landmark studies show the most cost-effective anesthesia delivery model is a CRNA working without physician anesthesiologist supervision.

A better way to preserve profits

In healthcare publications such as Becker’s ASC Review, experts maintain it is actually fiscally irresponsible to pay a non-revenue generating physician anesthesiologist two to three times the salary of a CRNA when the evidence has shown an additional provider does not improve quality, outcomes, morbidity or mortality.

 

Keep more of your Medicare revenue

Medicare pays the same fee for anesthesia services provided by a CRNA, a physician anesthesiologist, or both working together. CRNAs help protect Medicare revenue by providing lower-cost care than more expensive physician anesthesiologists.

Reduce surgical liability

CRNAs carry insurance coverage for all the services they provide. Excellent claims experience has brought CRNA malpractice liability premiums down an average 68 percent from 30 years ago, when adjusted for inflation. The downward trajectory continues.

Challenge #3
Protect patients and optimize outcomes
CRNAs

Issues

  • Patient safety cannot be compromised
  • Outcome metrics are increasingly tied to reimbursement

Opportunity

There is no difference in safety and outcomes between CRNAs working alone vs. with a physician anesthesiologist.

In fact, experts predict an expansion of CRNA-only anesthesia services across the country in light of their near Six Sigma safety record and ability to provide high-quality, cost-effective anesthesia care.

CRNAs have a solid record of commitment to patient safety. Malpractice premiums for CRNAs decline every year even as their responsibilities increase, reflecting the value they bring to anesthesia care.

CRNAs spend more time with patients prior to, during and after surgical procedures, providing continuity, greater safety and an enhanced patient experience.

CRNAs have rigorous academic and clinical requirements for recertification, focused on clinical best practices and the latest advancements in patient care.

As care delivery becomes more accountable, the CRNA approach will continue to drive a higher standard of care and maximize outcomes-linked reimbursement models.

Challenge #4
Fill the provider shortage
Male CRNA

Issues

  • Competition for anesthesia providers
  • Lack of staffing flexibility
  • Increased need for respiratory support care

Opportunity

As the need for anesthesia care grows, it becomes more difficult—and expensive—to recruit and retain physician anesthesiologists.

Perks physician anesthesiologists are asking for—and getting

Recent trends show a sharp increase in signing bonuses, among the highest amounts ever tracked. Paid relocation, paid continuing medical education, health insurance and malpractice insurance are standard offerings, as reported by physician search firm Merritt Hawkins. In addition, some search assignments include medical education loan repayments, which tend to be in the $80,000 range.

Physician availability is also impaired by burnout

A longitudinal study by Mayo Clinic shows a 43% higher likelihood that a physician would reduce their work hours in response to certain types of work pressures. Demographic changes also contribute; physician anesthesiologists are getting older, 55 years old on average.

Increasingly, CRNAs are filling the role

More CRNAs than ever before are mobile, working at several facilities. They maintain their own 1099 and locum tenens malpractice policies, increasing their ability to provide much-needed staffing flexibility.

The CRNA anesthesia staffing model provides facilities with the most cost-effective and versatile option.

Challenge #5
Fill the pain management void
Medication overload

Issues

  • A serious need for personalized, non-opioid solutions
  • Systemic lack of resources for chronic pain management

Opportunity

As with many social issues, overcoming opioid addiction requires boots on the ground.

Physician anesthesiologists often aren’t able to fully assess and manage post-surgical and chronic pain in the time they have with patients.

But CRNAs have that proximity, plus the knowledge, skills and commitment to move pain management forward, opiod-free. Collaborating with professional, governmental and community organizations, CRNAs across the country are actively leading in hundreds of initiatives to curb abuse and provide effective, responsible pain management.

These include:

Enhanced Recovery after Surgery (ERAS®)

Patient-centered, evidence-based, multidisciplinary team-developed pathways for a culture to reduce the patient’s surgical stress response, optimize physiologic function and facilitate recovery. These care pathways form an integrated continuum as the patient moves from home through the pre-hospital, pre-admission, pre-operative, intra-operative and post-operative phases of surgery and the return home.

Enhanced Recovery After Surgery: How CRNAs are reducing opioid use, improving outcomes, and lowering costs (PDF)

Opioid Safety and Advocacy State Toolkit

AANA offers this toolkit checklist to provide guidance and help identify opportunities to create, lead or serve when asked to be involved in a state or community initiative.

Opioid Safety and Advocacy State Toolkit (PDF)

Meet a CRNA and the people who depend on her