U.S. Representatives Sam Graves, a republican from Missouri, and Jared Huffman, a democrat from California, have reintroduced the "Save America's Rural Hospitals Act," which would expand the scope of practice for certified registered nurse anesthetists, allowing them to work without physician supervision.
It would remove the need for CRNA supervision under Medicare part A and would include non-medically directed CRNA services as a mandatory benefit for Medicaid. It would also provide enhanced payments to rural healthcare providers.
CRNAs in several health systems have been practicing without supervision for the last few years due to increased healthcare flexibilities caused by COVID-19, according to a Feb. 22 press release.
This legislation is supported by the American Association of Nurse Anesthesiology and the Rural Health Action Alliance.
"CRNAs are the primary providers of anesthesia care in rural settings and have been instrumental in delivering care during the pandemic to patients where they live and when they need it. Often, CRNAs serve as the sole anesthesia provider in rural hospitals, affording these facilities the capability to provide many necessary procedures," Angela Mund, DNP, CRNA, president of AANA, said in the release.
Other organizations, including the American Medical Association, stand opposed to 'scope creep' for CRNAs. The AMA warns that expanding nurse's scope of practice could harm patients. Ninety-five percent of U.S. voters want a physician in charge of their care decisions, according to an AMA report.
The AMA has outwardly opposed similar legislation expanding scope for CRNAs in states, including New Jersey.
In a letter to New Jersey legislative leaders, AMA Executive Vice President and CEO James Madara, MD, said that the organization opposes CRNA scope creep because CRNAs don't have the same amount of training and education as physicians, scope creep can lead to higher patient costs, scope expansions don't improve rural healthcare access and physician supervision is important for patient safety.