The American Association of Nurse Anesthetists makes a bold proclamation of their full practice, safety, independent capabilities, and economic advantage for our modern healthcare system.
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Before we begin a discussion on the topic you should probably follow this link to the AANA's original statement.
Firstly, I have to disclose that I am in my third year of nurse anesthesia training preparing for graduation, so I am not a board certified CRNA yet. Anything I say is coming from the perspective of a new generation of CRNA DNP training which I've noted can be slightly different from those of older generations. I am also the elected political representative of my class throughout our program so I do stay more engaged and informed than some other anesthesia trainees. Last disclosure, I do serve the AANA and work on a committee that serves the board of directors.
Now, to understand where this new bold statement from the AANA came from I think it's necessary to understand it is in response to the ASA's statement about the Anesthesia Care Team last fall. Their statement unabashedly self-aggrandizes themselves and downplays CRNAs actual role as experts and independent anesthesia providers. In fact, they use wording that implies better education and training from their own assistants (AAs) than nurse anesthetists who has been providing safe competent anesthesia since the civil war.
Although, most CRNAs don't blame them for making a political statement like this promoting themselves and downplaying their competitors in the marketplace. That is the duty of a professional organization, to promote that organization. Anesthesia has been aggressively political since the early 1900s when physicians decided to start learning anesthesia and tried to make it illegal in California for a nurse anesthetist to continue practicing anesthesia. Who wants competitors if you think you can eliminate them, it just makes business sense.
After the political statement made last October by the ASA large amounts of CRNAs were outraged and demanded an immediate defending response from the AANA. The AANA is always careful and intentional in what it does, so they created a task force of influential and level headed CRNAs who would investigate the issue and come up with a diplomatic response. They spent 6 months discussing this and coming up with the response you are now reading. This statement was intentional and well thought out. It is supported and celebrated by a huge majority of CRNAs/SRNAs judging from responses in person and in private CRNA forums consisting of tens of thousands of CRNAs.
It's disconcerting that I have seen some negative comments online by people who aren't physicians. You would expect many physicians to react negatively to a non-physician provider talking about their education, training, and similar patient outcomes but it is odd to see some others ill-informed negativity.
The biggest confusing issue I see people have is that in the AANA's statement that is in response to the ASA's care team statement is that billing methods are often fraudulent. What many may not understand is that in a medical direction billing model (which is what the ASA is wanting everywhere) involves meeting 7 TEFRA requirements to bill for CMS. These requirements are very often not met even when physicians bill in medical direction, which is Medicare fraud. This is not just anecdotal. The ASA produced research they performed themselves that was published recognizing that a huge number of medical direction practices are not meeting the 7 TEFRA requirements. Medical direction benefits the physician because they can bill for 4 different cases at once while they are not providing the anesthesia but 4 different CRNAs are performing the anesthesia. You can see why they would want this to be a standard delivery method of anesthesia. Even when their own research shows they are fraudulently billing in many places they continue to push this model. This model is oftentimes the most restrictive and oppressive to CRNAs who choose to work with that anesthesia group. It is also one of the more costly models for hospitals to sustain, so it's not economically responsible or sustainable for many facilities.
CRNAs mention these issues with medical direction because it supports the movement nationwide for the collaborative model of anesthesia care. This model requires that both CRNAs and MDAs be independent full practice providers who work together on a team. They are equal partners and practice under their own license to provide safe high-quality anesthesia to their patients. In this model, there are no 7 TEFRA regulations so Medicare fraud is not an issue. The economic reason some in anesthesia will not like this anesthesia delivery model is that you can not bill for services of 4 CRNAs at once providing anesthesia. Each provider can only bill for their own anesthesia for a single case. It would do away with someone sitting in the break room drinking coffee while 4 other providers are working and earning you profit. You can see why certain people would not want this to happen.
I just wanted to clear that portion up about the AANA's statement so it had some context and people who are not in the anesthesia realm understand where that came from. Those of us in anesthesia are just so used to that issue I think we forget others are not informed about it.
