May 4, 2020
By Dr. Murray Feldstein, M.D.
The Goldwater Institute has been a staunch supporter of allowing skilled healthcare professionals to practice at the top of their medical education and training. These long-standing reform efforts are important all the time but are now critical as we respond to COVID-19.
Two important reforms allow certified registered anesthetists (CRNA) more medical autonomy to perform procedures that they are educated and trained to do. SB 1336, which passed the Arizona Legislature and was signed into law by Governor Doug Ducey in 2017, and, more recently, an effort to waive CRNAs out of direct supervision rules under the federal Medicare program are making an important difference.
An anesthetist (CRNA) is a registered nurse who takes additional specialty training after graduation from nursing school and is certified to administer anesthesia. An anesthesiologist is a medical doctor (MD) who takes additional specialty training after graduation from medical school and is also certified to administer anesthesia. Nurse anesthetists have served our country since the Civil War and been the predominant providers of anesthesia in frontline hospitals in every war since then.
They also are the most common—and sometimes only—anesthesia providers in rural hospitals. I recently spoke to Randy Quinn about the effect of lifting these restrictions on CRNAs during this crisis. Randy is a CRNA and managing partner of a group of nurse anesthetists in southern Arizona. He is also a former president of the Arizona Board of Nursing.
Randy explained that in the short time since the Medicare requirement for supervision has been removed, the nurses signed contracts with several hospitals desperate for their skills. Santa Cruz Regional Hospital in Green Valley is now facing a financial crisis (due to the cancellation of all elective surgeries during the pandemic) as well as a dangerous shortage of critical care providers. Nurse anesthetists are experienced at intubating and ventilating patients, which are highly specialized skills that the most severe COVID-19 patients require, until they are capable of breathing on their own. CRNAs will now be part of the vital team of MD intensivists and respiratory specialists manning the Santa Cruz ICU during this crisis.
Arizona became the 18th state to liberate the anesthetists from the arbitrary Medicare regulation. The first was Iowa in 2001, the same year that states were allowed opt out of the rule. In the ensuing decades, there has been no evidence that patient care was compromised in any way. Yet 32 states still had not seen fit to follow Arizona’s example, probably because of political pressure from organized medical groups.
That is, until the pandemic made this reform a higher priority. Since Governor Ducey waived the requirement in Arizona, 12 other governors have issued executive orders, which are temporary during this emergency, to remove the requirement for supervision of nurse anesthetists, and the Centers for Medicare & Medicaid Services lifted it altogether for the duration of the emergency. This is a reform that should be made permanent in states across the country.
Dr. Murray Feldstein is a Visiting Fellow at the Goldwater Institute.