Here are five major moves in the anesthesia industry that have recently gained traction:
1. Anthem Blue Cross Blue Shield reversed its decision on a controversial anesthesia reimbursement policy update, which would have introduced a new reimbursement structure based on CMS physician work time values. Twenty-three anesthesiologists and certified registered nurse anesthetists connected with Becker's to discuss their thoughts.
2. The District of Columbia's health department is considering allowing CRNAs to use the title "nurse anesthesiologist." In a letter to the department, the American Medical Association said the title is "misleading and confusing to patients," adding that "anesthesiologist" has been, and should be, reserved for physicians. The organization also outlined the differences in education, with physician anesthesiologists logging 15,000 clinical training hours and CRNAs recording only 2,600 hours.
President of the American Association of Nurse Anesthesiology, Jan Setnor, MSN, CRNA, contested this statistic, telling Becker's post-graduate anesthesia programs provide nearly 10,000 additional hours of clinical experience.
"Anesthesiologists are healthcare specialists who administer anesthesia — nurses have administered anesthesia for more than 150 years, therefore making 'nurse anesthesiologist' an appropriate title," Ms. Setnor said.
3. The AANA filed a petition with a U.S. district court compelling Xavier Beccera, Secretary of Health and Human Services, to enforce the provider non-discrimination provision of the Affordable Care Act against insurance companies and health plans. The non-discrimination provision was passed in 2010 to prohibit commercial payers from discriminating against providers on the basis of licensure, including setting up different reimbursement policies for those providers delivering the same high-quality healthcare services.
4. The ASA filed a trademark complaint against the recently renamed AANA, alleging that its use of the word "anesthesiology" is "deceptively misdescriptive." The complaint was filed in June to the U.S. Trademark Trial and Appeal Board, and aims to prevent the AANA from registering a trademark for the new title. If the ASA wins, it could sue the nurses organization in federal court. AANA has, to this point, denied all allegations, according to the report.
5. In September, the California Department of Public Health stepped in amid confusion about CRNAs' role in hospitals. In a Sept. 6 letter to hospitals, the health department outlined state and federal requirements for using CRNAs to provide anesthesia services. The department clarified that CRNAs are not permitted to practice medicine or surgery but can perform certain medical functions, such as administering treatments, drawing blood and responding to health changes, under standardized procedures developed in collaboration with physicians and health systems.
The letter clarified that "[in] California, a CRNA administering anesthesia services is not required to be under the supervision of the operating practitioner or of an anesthesiologist, however they may only provide services within their scope of practice."
It specifically cited the Nursing Practice Act in the ruling of California Society of Anesthesiologists vs. Supreme Court in 2012, which states "CRNAs have legal authority to administer anesthesia after a physician orders a course of treatment that includes anesthesia."
The letter also states that:
- Anesthesia care must be provided at the discretion of a qualified physician.
- Use of CRNAs must be approved by hospital administration.
- CRNAs can administer anesthesia drugs only when ordered by a physician.
- Contracted CRNAs are subject to the bylaws of hospitals where they are administering anesthesia