Opt-out hits #10

Specialties CRNA



Tenth State Removes Physician Supervision for Nurse Anesthetists; Anesthesia Safety Remains at All-Time High

PARK RIDGE, Ill. - Alaska became the tenth state in less than two years, and the third state in the last three weeks, to opt out of a federal physician supervision requirement for nurse anesthetists. The opt-out is effective immediately.

Taking advantage of an anesthesia care rule that allows states to become exempt from the supervision requirement, Alaska Governor Frank Murkowski wrote to the Centers for Medicare & Medicaid Services (CMS) that his state was opting out because "the exemption from this federal Medicare regulation will provide significant long-term benefits to all Alaskans."

"Based on the input I have received from medical staff and administrators of small rural hospitals in Alaska," Murkowski wrote, "I believe not exercising this exemption may severely limit the ability of rural hospitals to treat emergencies and provide other services requiring anesthesia care to Medicare patients." He added a note of assurance that "Medicare patients will continue to receive the high quality care required under state licensing laws."

Alaska's opt-out represents a milestone, as one-fifth of the nation's states now have opted out of the supervision requirement for nurse anesthetists. Earlier in October, North Dakota and Washington became the eighth and ninth states, respectively, to take this course of action. Other states that have opted out are Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, and Kansas.

The anesthesia care rule that enables states to opt out of the supervision requirement was published by CMS in the Federal Register [66 FR 56762-56769] on Nov. 13, 2001. The rule allows a governor to notify CMS in writing of the state's desire to opt out (be exempt from) the supervision requirement for Certified Registered Nurse Anesthetists (CRNAs) after the governor meets the following prerequisites: consults with the state's boards of medicine and nursing, determines that opting out of the requirement is consistent with state law, and decides that it is in the best interests of the state's citizens.

In the two years that states have been opting out of the supervision requirement, there have not been any reports of anesthesia patient deaths or injury related to the removal of physician supervision of CRNAs.

Governor Thomas Vilsack of Iowa, where 91 of the state's 118 hospitals rely solely on nurse anesthetists to provide anesthesia care, wrote to the governor of another state in July 2003 that he had "received many letters from hospital administrators, physicians and healthcare organizations praising the overwhelming success of the opt-out. I have also received notice from the Iowa Board of Nursing and the Iowa Department of Public Health that the quality of care given by CRNAs has never been higher."

Vilsack added that "...Iowa has proven the intent of the opt-out change is a complete success in practice."

According to an Institute of Medicine report published in October 1999, anesthesia care today is nearly 50 times safer than it was 20 years ago. CRNAs administer 65 percent of the anesthetics given each year in the United States and are the predominant anesthesia providers in rural and other medically underserved areas. Without these advanced practice nurses many of the facilities serving these areas would be unable to maintain surgical, obstetric, and trauma stabilization services.

***Gotta love Gov. Murkowski!! Anyone know anything about the new gov's elected this year and how they feel?

As a side note, CO., one of the other states in the opt-out is in a state of limbo right now because of the CSA's actions to block the opt-out. Seems I can't find any unbiased info regarding the block, can anyone find anything?


612 Posts

Specializes in Anesthesia.

As a side note, CO., one of the other states in the opt-out is in a state of limbo right now because of the CSA's actions to block the opt-out. Seems I can't find any unbiased info regarding the block, can anyone find anything? [/b]

The CSA sued Gov Owens in March *before* he sent his Opt-Out letter to CMS, as he had announced he would do, claiming that the governor's action would "diminish economic opportunities for anesthesiologists." Last week a judge threw out their suit, saying that one cannot be sued for what one has not yet done. A mere technicality, of course.

We CRNAs in CO are still waiting for Gov Owens to lick that stamp.


53 Posts

Involved in group project on this topic

Didn't find much on Colorado

Denver post article:


ASA slant on gov's decision:


Hope it helps


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