1. CRNA PRACTICE

2. Certified Registered Nurse Anesthetists (CRNAs)
CRNAs are highly educated, advanced practice registered nurses who deliver anesthesia to patients in exactly the same ways, for the same types of procedures, and just as safely as physician anesthesiologists.

3. CRNAs
CRNAs have been providing anesthesia care to patients in the United States for more than 150 years.
They first gave anesthesia to soldiers during the American Civil War.
CRNAs have been the main providers of anesthesia care to U.S. military personnel on the front lines since WWI.

4. CRNAs
CRNAs are trained to administer every type of anesthesia to all types of patients in any healthcare setting where anesthesia is delivered.
All anesthesia professionals give anesthesia the same way.

5. CRNA Education
Nurse anesthetists are required to have a minimum of seven to eight years of education, training and experience before they can become a CRNA.
Today’s CRNAs enter the workforce with a master’s or doctoral degree.
CRNAs have an average of three and one-half years of critical care experience before entering a nurse anesthesia program.

6. Anesthesia Provider Models
CRNA only
CRNA and anesthesiologist working together
Anesthesiologist only

7. CRNA-Only Practice
Research confirms that all three models are equally safe
CRNA-only practice model demonstrates high degree of patient safety, quality, and cost-effectiveness

8. Patient Safety
Numerous studies confirm that anesthesia care is equally safe regardless of whether it is provided by a CRNA working alone, an anesthesiologist working alone, or a CRNA working with an anesthesiologist, most notably the study titled “No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians” published in 2010 in Health Affairs.

9. Research Evidence Demonstrates the Value of CRNA Services
MEDICAL CARE Scope of Practice Laws and Anesthesia Complications: No Measurable Impact of Certified Registered Nurse Anesthetist Expanded Scope of Practice on Anesthesia-related Complications
NURSING ECONOMIC$ Geographical Imbalance of Anesthesia Providers and its Impact On the Uninsured and Vulnerable Populations
JOURNAL FOR HEALTHCARE QUALITY Complication Rates for Fluoroscopic Guided Interlaminar Lumbar Epidural Steroid Injections Performed by Certified Registered Nurse Anesthetists in Diverse Practice Settings
NURSING ECONOMIC$ Cost Effectiveness Analysis of Anesthesia Providers, Nursing Economic$, Hogan P, Seifert R, Moore C, Simonson B. (2010). 28, 3:
NURSING RESEARCH Anesthesia Staffing and Anesthetic Complications During Cesarean Delivery, Simonson D, Ahern M, Hendry M. (2007), Nursing Research, 56, 9-17.
HEALTH SERVICES RESEARCH Anesthesia Provider Model, Hospital Resources and Maternal Outcomes, Needleman J, Minnick AF (2009), Health Services Research, 44(Part I)
AANA JOURNAL Surgical Mortality and Type of Anesthesia Provider, Pine M, Holt KD, Lou YB, (2003), AANA Journal, 71:
THE COCHRANE LIBRARY Physician Anaesthetists Versus Non-Physician Providers of Anesthesia for Surgical Patients, Lewis SR, Nicholson A, Smith AF, Alderson P. (2014). Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD DOI: / CD pub2.

10. More on CRNA Safety
Nationally the average 2016 malpractice liability insurance premium for self-employed CRNAs was 33% less than it was in 1988.  When trended for inflation through 2016, the reduction in premiums was even greater (67%).
The Institute of Medicine, American Association of Nurse Anesthetists (AANA), and American Society of Anesthesiologists concur that anesthesia is approximately 50 times safer today than it was during the 1980s.

11. What affects how CRNAs can practice?
Supervision
What affects how CRNAs can practice?

12. Internal facility policies
CMS Rules/Fed. opt-out
Internal facility policies
Nursing law and rules
Other providers’ laws/rules
Reimbursement
Facility licensing law/rules

13. State and Federal Law
40 states have no supervision requirement in the state nursing law/rules
33 states have no supervision requirement in the state nursing law/rules OR the hospital licensing law/rules
17 states have opted out of the federal CMS/Medicare supervision requirement

14. Physician Supervision and CRNA Regulation
Federal
CMS conditions for Medicare Part A reimbursement include a physician supervision requirement for CRNAs in states that have not opted out
States can “Opt Out” of physician supervision requirement
State scope of practice – law, rule, regulation, opinion (e.g. Board of Nursing, Attorney General)
Facility bylaws

15. State Supervision Opt-Out
The Nov. 13, 2001 final rule allows governors in eligible states to request an “opt-out” (also known as an “exemption”) from the federal Medicare Part A physician supervision of CRNA requirement.

16. Prescriptive Authority
Federal Law:
The "traditional" practice of nurse anesthetists - ordering and directly administering controlled substances and other drugs preoperatively, intraoperatively, and postoperatively - does not constitute "prescribing" under federal law.

17. Prescriptive Authority
Federal Law
Because DEA has not regarded traditional CRNA practice as "prescribing" under federal law, most nurse anesthetists have not had to register with the DEA

18. Cost Effectiveness
A landmark 2010 study published in Nursing Economic$ shows that a CRNA working as the sole anesthesia provider is 25 percent more cost effective than the next most cost-effective anesthesia delivery model.

19. Compensation Comparison
The mean annual salary of anesthesiologists is approximately 2 ½ times greater than the salary of CRNAs.
Because Medicare pays the same fee for an anesthesia service whether it is provided by a CRNA, an anesthesiologist or both working together, the higher compensation of the anesthesiologist is borne by the hospital, healthcare facility or the patient.

20. The median total compensation for full-time employee CRNAs in 2015 was $175,000; this is up from $170,000 reported for 2014.
The median is the number that is normally used when looking at salary data since it’s less sensitive to extreme variations in data.
NOTE: Statistics are based on full-time CRNAs with total compensation greater than $1,000 and less than $400,000.
05/2016

21. Cost Savings for Facilities
Hospitals operate on very thin margins, often 1%-3%.
When hospitals are forced to employ anesthesiologists (total expense ~$500K/FTE) on every case, margins are dramatically impacted.

22. AANA RESOURCES SGA Staff 50 STATE CHARTS Other resources
Tracking legislation
Tracking language pertaining to CRNA practice
Practice Documents

25. QUESTIONS
SGA Staff
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