There are lots of questions regarding this proposed action. The biggest is this: Many if not most small to medium military hospitals only have CRNAs providing anesthesia services. Most of the MDAs are in the bigger facilities.
Having said that, wouldn't it be a more productive for the VA/TRICARE to embrace more CRNA recruitment than scurry down the AA path?? As mentioned in the AANA urgent Alert notice, I think Department of Defense needs to conduct a study on the safety record, limited scope of practice, cost-effectiveness of AAs and give careful consideration, before approving them as new providers of anesthesia under the TRICARE system. In addition, since AAs cannot act independently, there should be a study on the financial impact of AAs in the TRICARE system too.
Just my thoughts.......
The U.S. Department of Defense (DoD) has proposed authorizing anesthesiologist assistants (AAs) as providers of anesthesia care under the TRICARE health plan for military personnel and dependents, in a proposed rule published in the Federal Register April 3 (68 FR 16247, 4/3/2003). In addition, the Director of Anesthesia Services of the Veterans Affairs (VA) Department is apparently in the process of adding AAs as a new anesthesia provider as well. There has been no congressional review about adding these new providers, and no assessment of their safety record or cost-effectiveness.
Now is the time for CRNAs to take action! I urge all CRNAs to contact their legislators in Washington and ask for them to contact the VA and the DoD and ask them to stop the introduction of AAs into either the VA or TRICARE program.
Note: We do not know the timing on the VA Handbook or when it will be approved so time is of the essence. As to the TRICARE proposed rule, comments are due by June 2, 2003. Please send them to: TRICARE Management Activity (TMA), Medical Benefits and Reimbursements Systems, 16401 East Centretech Parkway, Aurora, CO 80011-9043.