Colorodo CRNA's win right to administer anestetics without Dr supervision

smiling_ru · May 23, 2003

That reporter was mistaken, Colorado will be the EIGHTH state to opt out.

javajunkie · May 24, 2003

Don't forget Nebraska, Kansas, New Mexico, New Hampshire, Minnesota, Idaho, and Iowa.

Brenna's Dad · May 25, 2003

So, is that 42 left to go then?

nilepoc · May 28, 2003

Only problem is, that of the remaining 42 states, only

10 more (JAMA estimate),

22 more (AANA estimate), if hospital licensing is not taken into account, this was a major issue in Colorado.

12 more (Dept. of Health and human Services) if hospital licensing is taken into account.

no more states (ASA estimate) the one they capitulated on was New Hampshire. Even then they ran FUD (fear uncertainty and doubt campaigns on the radio, and actively tried to oust the governor).

Have state laws and licensing requirements compatible with an opt out.

It should also be noted, that Oregon already has independent practice legislation in place. Why they have not opted out is a wonder. they aslo have a CRNA charter.

(note the above figures have the eight opt outs accounted for, i.e. 22 = 30)

Gee, can you tell I am doing a presentation on this in less than a week?

nilepoc · Jun 1, 2003

BTW, I think that this newspaper jumped the gun. I have not been able to find any references corraborating Colorado as an opted out state.

If any of you know of any, i would appreciate hearing about it.

loisane · Jun 1, 2003

nilepoc,

Gov. Owens of Colorado has requested the opt out. It is not in effect yet, because the Colorado ASA has filed a lawsuit trying to prevent the opt out. The court case is still pending.

BTW, have you heard the latest consequence of the supervision issue? JCAHO has always categorized CRNAs as "licensed independent practitioners". I'm not sure what all that means, but apparantly it grants us authority to do certain things under JCAHO guidelines that would otherwise require a physician. Anyway, JCAHO has now decided CRNAs may only be LIPs in opt out states. This may have pretty significant implications for hospital policies in non-opt out states. AANA is just beginning to tackle this latest development.

loisane crna

nilepoc · Jun 1, 2003

Thank you Loisane, I figured that was the case, as the lawsuit between the ASA and the Governor of Colorado has yet to be decided. I would imagine that the ASA will be able to drag this out in the courts for quite a while.

I have read quite a few things about the recent JCAHO decision.

I have reflected on it a bit, and I feel that if this was a physician backed decision, they may have cut their nose off to spite their face.

I think that while immediately, this will cause problems with small hospitals in rural areas. There are not enough MDAs currently practicing to cover the anesthesia need of these areas. As such, It will have the longterm effect, of forcing the hospitals in these areas to fight for the independant practice of CRNAs. So, I see more states being forced to consider opting out, in order to provide care for their citizens. If JCAHO really enforces this, I think there are going to be a large number of governors considering CRNA practice in the near future.

Regarding AA practice, I am a bit baffled. If this was backed by the ASA, it is not going to help them get AAs more recognition. In fact, in the short term, it is going to drive CRNAs into the city, to directly compete with AAs in urban areas.

I am not sure how this new JCAHO change will pan out, but I am hopeful.

craig

loisane · Jun 1, 2003

nilepoc,

I think (hope) you may be right about the change in JCAHO policy actually encouraging more opt outs. It is a case of those "unintended consequences" they tell us about in health policies class.

Personally, I don't think this is a direct ASA strategy. More likely a logical outgrowth of the overall "physician bias" held by the entire JCAHO operation.

loisane crna

Brenna's Dad · Jun 2, 2003

Interesting comments Nilepoc. However, will JCAHO not simply revert to the old standby, ie. the surgeon is supervising the CRNA, or is this no longer possible?

loisane · Jun 2, 2003

Brenna's Dad,

It is more complicated than that. There is the issue of "supervision" as relates to the individual states nurse practice act (if the NPA addresses supervision). Then there is the issue of supervision regarding billing requirements-which is where the recent battle was fought in regard to Medicare billing.

Then there is the issue of supervision as it relates to individual hospital's policies. If the hospital participates in the Joint Commision for the Accreditation of Health Care Organizations (which is voluntary, but pretty widely done by many institutions), then JCAHO's policies are going to effect the type of policies the hospital institutes in order to stay JCAHO compliant.

Licensed independent practitioner is a JCAHO defined term. I am sure there are must be many implications for the term, but I am only aware of one example. One JCAHO policy is that a physician (they may even require a MDA, I am not sure) must OK the patients discharge out of PACU. In the past they have allowed CRNAs to perform this task, because of CRNAs status as LIPs.

Now JCAHO (without any input from, or notice to the CRNA community or association) has decided that the decision on Medicare supervision affects their definition of LIP. Now they will only recognize CRNAs as LIP in opt out states.

It is hard for me to make any sense of this. After all, states that do not opt out are in no different shape now than before the new Medicare ruling. So how does that justify a JCAHO policy change? I am sure there will be alot of discussion, on many levels about this one. We'll all stay posted for the latest.

loisane crna