There is no increased risk of death or complications from surgery when nurse anesthetists work without a physician by their side, a new study published this week in Health Affairs reported, but anesthesiologists express their concerns.

Until somewhat recently, the Centers for Medicare and Medicaid Services reimbursement rules for anesthesia providers prohibited payments to nurse anesthetists who administered anesthesia without physician supervision. But in 1997, the agency passed a proposed rule — finalized in 2001 — that allowed state law to determine which professionals could administer anesthesia and the level of supervision required. CMS based its decision on a “lack of evidence to support … [the] requirement for [surgeon or anesthesiologist] supervision of Certified Registered Nurse Anesthetists,” according to the Health Affairs article.

The study, driven by the 1997 decision, looked at death and complication rates from surgery from 1999 to 2005 in the 14 states that opted out of the physician supervision requirement. States can choose to opt out by petitioning CMS.
The findings showed that there was no increase in the risk of a patient dying or experiencing complications in these states. The researchers also found no significant differences when they compared patient outcomes across three scenarios, including certified registered nurse anesthetists working without supervision; anesthesiologists working alone; or both providers working together.

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

But Alexander Hannenberg, president of American Society of Anesthesiologists, said the cost-effective claim is an “obvious falsehood" because the health care costs are the same regardless of who delivers the anesthesia - a team will split the payment equally.

“It’s a misrepresentation of the facts,” he told DOTmed News.

The American Association of Nurse Anesthetists (AANA) supports the findings, declaring they demonstrate the CMS physician supervision rule is “obsolete and unnecessary.”

“The results validate what we have known all along — that the quality of care and safety record of nurse anesthetists is of the highest caliber, regardless of physician supervision,” said James Walker, president of AANA in prepared remarks. “The opt-out states have given nurse anesthetists the opportunity to prove, beyond a shadow of a doubt, what patients are most interested in knowing, and that is whether anesthesia is equally safe when provided by CRNAs or their physician counterparts. I’m happy to emphatically report that yes, it is.”

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