Medicare Payments to CRNAs Irk Anesthesiologists, Again

She's not alone in her thinking. Obviously, CMS agrees with AANA's position, since it restored reimbursements, but other organizations showed their support as well. In April, state hospital associations in Missouri, Iowa, Kansas, and Nebraska wrote a letter to Acting CMS Administrator Marilyn Tavenner arguing that rural hospitals, especially critical access hospitals, rely on CRNAs to provide care.

"It is very troubling that Medicare contractors are able to change the policy at their discretion without a public comment period or at minimum, education to providers," the letter said.

"The creation of a "black box" policy has the potential to create real hardship and access problems for many of the most vulnerable Medicare beneficiaries who reside in the rural areas of our states."

The non-profit advocacy group, AARP, also weighed in on the issue in a September letter to Tavenner, saying, "Without the availability of CRNAs' pain management services, many Medicare patients—particularly in rural areas—would either be forced into nursing homes for this chronic care or go without the treatment and greatly suffer."

Zambricki also adds that the CMS decision is consistent with Institute of Medicine recommendations.

"It's a wonderful example with the federal government making healthcare policy that's consistent with some of the best thinking" about medical care, she says.

Despite support for the ruling from a variety of organizations, there is a predictable outlier: The American Society of Anesthesiologists, which says the "policy jeopardizes patient safety, lowers the quality of health care and increases the risk for fraud and prescription drug abuse."