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CRNA Court Victory is a Win for Rural Hospitals

John Commins, for HealthLeaders Media, March 28, 2012

A California appeals court this month ruled that certified registered nurse anesthetists in that state do not need physician supervision to do their jobs.

It's a clear victory for rural hospitals in California that have complained that requiring physician supervision of CRNAs adds unneeded costs and limits the range of surgery services they can provide.

The March 15 decision by the First District Court of Appeal in San Francisco really isn't a surprise. California is already one of 16 states that have opted out of a federal mandate that denies Medicare reimbursements to hospitals that allow CRNAs to work without physician supervision. Republican Gov. Arnold Schwarzenegger opted out in 2009, and his Democratic successor Jerry Brown supported the decision.      

The suit was brought by the California Medical Association and the California Society of Anesthesiologists and it's not clear if they plan an appeal. CMA on its website says it is "disappointed with the decision" and is "exploring all legal, regulatory and legislative options."

Not surprisingly, California Hospital Association spokeswoman Jan Emerson-Shea told HealthLeaders Mediathat CHA was "very pleased by the decision."

There has been a lot of back-and-forth arguing between CRNAs, anesthesiologists, and CHA about whether or not patient safety is compromised when states opt out of the supervision requirement. Obviously, in a perfect world, it's always preferable to have the highest-trained medical professionals administering or supervising care.

It's not clear, however, if any studies show that patient care suffers when CRNAs provide unsupervised care. 

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2 comments on "CRNA Court Victory is a Win for Rural Hospitals"


16788087 (3/29/2012 at 2:25 PM)
excellent comment by Barry. I would like to add, one thing often overlooked in the conversation about utility/cost of 'CRNA vs. Anesthesiologist' is much of the value add that physician anesthesiologists can bring to the 'service' of anesthesia that nurses, by definition, cannot. Examples being; most MD Anesthesiologists are well trained and experienced with providing ultrasound guided regional anesthesia, training and experience in acute post op pain management, ability to act as a physician consultant with deep understanding of the wide breath and depth of disease states, training and experience in the use of ultrasound for cardiac evaluation, training and experience in managing a patients' preoperative evaluation, and thus saving dollars and improving outcomes. There are many functions anesthesiologists, trained and encultured as physicians, can perform that nurses, by their training and culture cannot, is not within their scope of practice, or are not comfortable with. The challenge for the specialty of anesthesiology, and especially for older generation anesthesiologists, is to show our value perioperatively and OUTside of the operating room. As noted, precision medicine is making the technical practice of anesthesiology to be a lower level function as compared to how anesthesia was practiced decades ago-thus, O.R anesthesia is being disintermediated away from needing physicians. However, there is much within the purvue of Perioperative medicine that physician anesthesiologists are uniquely qualified to do, and should step up to do, so as not to make this specialty obsolete.

Barry W. Brasfield, M.D. (3/28/2012 at 6:31 PM)
The relationships between anesthesiologists and CRNAs represent what Clayton Christiansen ("The Innovator's Prescription")would classify as a "disruptive innovation": anesthesiologists, through research and training, have rendered anesthesia care so safe that it is virtually impossible to statistically demonstrate any difference in the "quality of care." Therefore, provision of anesthesia is no longer an "intuitive" medical service, but a "precision" medical service. The marketplace will continue to adjust to this development over the next decade or more...