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NYT CRNA Editorial Hits The Fan: Drops an A-Bomb
Yesterday, the New York Times published an editorial commenting on a recent study which came to the conclusion that Certified Registered Nurse Anesthetists (CRNA) deliver safe, independent anesthesia care, which is made no safer when medical supervision by an anesthesiologist or surgeon is mandated. The study wrapped up with a recommendation that the Medicare state optional supervision requirement be universally dropped, as it has been in 15 states.
The Editorial was masterful in its simplicity, and in its A-Bomb (our new coined phrase- Anesthesia Bomb): Risk from anesthesia is “minuscule” regardless of whether a CRNA or MD administers it. CRNAs cost a lot less to train and employ and health care reform makes this a serious consideration.
The A-Bomb’s fallout has only just begun and is sure to spread in this long fought, down and dirty turf war imposed by the American Society of Anesthesiologists.
First from Capital Hill: TheHill.com:
Editorialists at The New York Times jumped this week into the hotly contested issue of whether doctors or nurses should be chiefly responsible for providing anesthesia care — and suggest that the cost savings related to nurse-administered treatments shouldn’t be ignored.
Under current Medicare rules, surgeons or anesthesiologists must oversee the care provided by certified registered nurse anesthetists (CRNA) in order for those treatments to be reimbursed. In 2001, the Centers for Medicare and Medicaid Services allowed states to opt out of that requirement, which 15 states have done.
The different state models have allowed researchers to compare the outcomes of care delivered by CRNAs working alone to that of CRNAs monitored by a physician. In a report published last month, experts at the Research Triangle Institute found there was no measurable difference, in terms of quality of care, between the two models.
Next: Corrections Page One Blog
New York Times article discusses the ability of a nurse to deliver anesthesia without supervision. It brings in the American Society of Anesthesiologists without properly discussing their stake in government regulation requiring anesthesiologists to supervise nurses.
The two studies — hotly disputed by the American Society of Anesthesiologists — essentially concluded that there is no significant difference in the quality of care when the anesthetic is delivered by a certified registered nurse anesthetist or by an anesthesiologist. The studies were paid for by the professional association for the nurses, a potential conflict of interest, but were conducted by researchers at respected organizations.
The Times notes the conflict of interest of nurses, but not of anesthesiologists. As Corrections sees it, anesthesiologists have a readily identifiable conflict of interest, while it isn’t immediately clear that nurses do, upon further inspection.
Nursing Helper doesn’t have the most basic understanding of the 130 year history of nurse anesthetist practice, or who taught whom what, why, and when, but worth the read and does make some good points in the full article as all corners weigh in:
To some extent, MD anesthesiologists have become a victim of their own excellence. Deaths during the administration of anesthesia occur at a paltry rate of 1/250,00 cases nowadays. This remarkable improvement can be attributed solely to technical improvements in the monitoring of patients during a procedure. Things like continuous pulse oximetry, end tidal CO2 monitoring, and fiberoptic-based intubation equipment have almost completely eliminated major morbidity from the profession. This is a good thing. But maybe not so good for anesthesiologists. They practice in a very algorithmic, checklist-based manner.
Thus, it was relatively easy to teach their methods to CRNAs during a period when the exponential rise in operative case loads made it necessary to incorporate “anesthesiology assistants” into a practice, thereby allowing one attending physician to cover multiple rooms. That recent studies have confirmed what everyone else in the OR already knew — that it didn’t really matter who was behind the drape while a cholecystectomy was ongoing — is hardly a surprise.
Be sure to visit the links and read the entire contributions.
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- ASA Response To NY Times A-Bomb Editorial On CRNA Supervision: Paradigm Shift?
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