KY 17th State To Opt Out Of Medicare CRNA Physician Supervision Requirement


The American Association of Nurse Anesthetists (AANA) is reporting that Kentucky has become the 17th state to Opt Out of the federal law which requires that a Certified registered Nurse Anesthetist (CRNA) be supervised by any licensed physician who is willing, regardless of specialty training, in order for services to be covered by Medicare or Medicaid. The question now has to be asked what purpose this absurd federal health insurance supervision law even serves at this point. Initially physician anesthesiologists (and now a decade later, like an angry horse trainer next to his dead mount still slinging the whip) shouted dire warnings to the nations elderly that their lives were now in grave danger should they require an anesthetic.  This despite the delivery of anesthesia being one of the safest areas of medicine and nursing that exists.

With hundreds of thousands of anesthetics now delivered in multiple states under the Opt Out exemption there is absolutely no evidence that the quality or safety of anesthesia care has declined anywhere. And why would it? This is an INSURANCE REGULATION. We can think of no other example in the history of health care where an insurance reimbursement regulation has been equated to a standard of care, dictating how patients should be treated. In a further insult to collective intelligence is the fact that CRNAs can ignore this insurance regulation when their patient is not covered by Medicare or Medicaid. In short they might perform 2 anesthetics without physician supervision and then be required to have a dentist, or podiatrist, or dermatologist, or ANY licensed physician/surgeon ‘supervise’ their next case if the hospital and the practitioners expect to get paid the measly sum Medicare allows. Otherwise the care is free. This is particularly taxing on rural hospitals. 

So, if states can Opt Out, and the regulation serves absolutely no useful function other than to create political bickering  and passing the buck to the states to deal with federal laws serving no function, how does the Centers for Medicare and Medicaid Services justify the continued enforcement of this nonsense? It is becoming quite clear that eventually all states will Opt Out as the physician anesthesiologist’s arguments wither and the true motivation, competition between themselves and CRNAs is the only one left supporting this insurance blockade breathes its last.

From the AANA:

Park Ridge, Ill.—Kentucky has become the 17th state to opt out of the federal physician supervision requirement for Certified Registered Nurse Anesthetists (CRNAs). A full one-third of all states have now taken advantage of a rule implemented by the Bush Administration in 2001 giving governors the ability to opt out of the supervision requirement and ensure citizens access to safe, cost-effective anesthesia care, especially in medically underserved areas.

Kentucky Gov. Steve Beshear wrote to the Centers for Medicare & Medicaid Services (CMS) on April 25, 2012, that “it is in the best interest of Kentucky’s citizens to opt out of the current federal physician supervision requirement in order to improve access to critical services.” Gov. Beshear noted in his letter that opting out was recommended by the Kentucky Cabinet for Health and Family Services and requested by the Kentucky Hospital Association and Kentucky Association of Nurse Anesthetists. The governor also stated that he “consulted with the Kentucky Board of Medical Examiners and the Kentucky Board of Nursing about issues related to access to and quality of anesthesia services in Kentucky” before concluding that the removal of supervision for nurse anesthetists was in the best interests of Kentucky’s citizens.

The CMS received Gov. Beshear’s letter on April 26, at which time the opt-out immediately went into effect.

Read the entire press release HERE. Scroll down to read the Opt Out letter below. 

Here is a history of the Opt Out thus far:

 Iowa (December 2001)
Nebraska (February 2002)
Idaho (March 2002)
Minnesota (April 2002)
New Hampshire (June 2002)
New Mexico (November 2002)
Kansas (March 2003)
North Dakota (October 2003)
Washington (October 2003)
Alaska (October 2003)
Oregon (December 2003)
Montana (January 2004)
(Gov. Judy Martz opted-out; Gov. Brian Schweitzer reversed the opt-out in May 2005, without citing any evidence to justify the decision. Subsequently, after the governor and his staff became more familiar with the reasons justifying the January 2004 opt-out, Gov. Schweitzer restored the opt-out in June 2005. Montana’s opt-out, therefore, is currently in effect.)
South Dakota (March 2005)
Wisconsin (June 2005)
California (effective July 17, 2009)
Colorado (September 2010) (For Critical Access Hospitals (CAHs) and specified rural hospitals)
Kentucky (April 2012) 


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