Unsupervised Nurse Anesthetists Pose No Increased Risk, Study Says

Allowing nurse anesthetists to provide anesthesia services without supervision from a doctor does not put patients at risk, according to a study in an issue of Health Affairs.

The study’s authors say the findings call into question a requirement that nurse anesthetists be supervised by an anesthesiologist or surgeon to receive Medicare reimbursement. States can “opt out” of the requirement, but only by petitioning the Centers for Medicare & Medicaid Services. The study confirms that certified registered nurse anesthetists, who receive high-level training, are able to provide the same level of services as anesthesiologists at potentially lower cost.

 “This study shows that patient safety was not compromised by the opt-out policy,” says Jerry Cromwell, a senior fellow in health economics at the Research Triangle Institute and coauthor of the study. “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.”

The study analyzed rates of death and complications from surgery in the 14 states that “opted-out” and found no increase in the odds of a patient dying or experiencing complications. They also found no significant differences when they compared patient outcomes across three scenarios: certified registered nurse anesthetists working without anesthesiologist supervision, anesthesiologists working alone, or the two types of provider working together on a case.