Review of the laws regarding “supervision” of CRNAs and the outcomes in quality of care.

Anesthesia care provided by Certified Registered Nurse Anesthetists (CRNAs) and physician anesthesiologists is an important resource in our health care system today. While both types of clinicians are committed to providing safe anesthesia care, the two are subject to different regulations which has sparked conflict within the nursing and medical communities. This conflict primarily stems from a 2001 Centers for Medicare & Medicaid Services (CMS) rule change that allows states to opt out of the federal physician supervision requirement for CRNAs.1 In order for a state governor to opt out of this requirement, which applies to hospitals and ambulatory surgical centers, he or she must meet three criteria:

1) consult the state boards of medicine and nursing about issues related to access to and quality of anesthesia services in the state, 2) determine that opting out is consistent with state law (i.e., the state does not have its own physician supervision requirement for CRNAs), and 3) determine that opting out is in the best interests of the state’s citizens.2 It is important to clarify that “physician supervision” applies to all physicians who work with CRNAs, including surgeons and other proceduralists, as well as anesthesiologists. This holds true at both the federal (CMS) and state levels. Further, it is important to understand that other than in some New Jersey state statutes, CRNAs are not required to be supervised by, or even work with, anesthesiologists.