Hospital Administrators and Legislators

A Certified Registered Nurse Anesthetist (CRNA) is a type of Advanced Practice Registered Nurse (APRN) who specializes in anesthesiology.  CRNAs are highly trained with either a Master’s degree or Doctoral degree and have passed a National Board Certification exam in order to practice.  CRNAs provide professional, safe, and cost-effective anesthesia and pain management services for hospitals, ambulatory surgery centers, and office base practices. CRNAs in New Hampshire work in two major practice models, one being independently and the other being a care team model where they work in conjunction with a physician anesthesiologist. As healthcare reimbursement continues to diminish the care team model is becoming less fiscally responsible due to the unnecessary redundancy in anesthesia providers according to a 2016 study done by the Lewin Group.

Proponents of the care team model would suggest that this redundancy in anesthesia providers creates a necessary measure of safety that is not present in an independent CRNA model of anesthesia. However, in a study in the journal of U.S Heath Care Work Force in 2010 showed “no evidence that opting out of the oversight requirement resulted in an increased inpatient deaths or complications”.

In June 2002, New Hampshire became one of currently 17 progressive states under Governor Jeanne Shaheen to enact a 2001 federal rule allowing states to opt-out of the Center for Medicare and Medicaid Services (CMS) requirement that CRNAs be supervised by a physician for facility reimbursement. CRNAs in New Hampshire currently provide sole independent anesthesia care in the majority of the critical access hospital throughout the state of New Hampshire. Regardless of whether a state has opted-out of the CMS requirement, CRNAs are not required to be supervised by a physician anesthesiologist. The Institute of Medicine in its October 2010 brief on the Future of Nursing has recommended that CRNAs be allowed to “practice to the full extent of their education and training”. In the Journal of Medical Care, a study entitled Scope of Practice Law and Anesthesia Complications: No measurable Impact of Certified Registered Nurse Anesthetist Expanded Scope of Practice on Anesthesia Complications, concluded that there was virtually no evidence that the odds of complication of anesthesia increased when anesthesia was provided by an independent CRNA over a care team model.

In today’s healthcare arena, hospitals continuously struggle to find the balance of providing the highest level of health care possible while still remaining fiscally responsible. CRNAs are an integral and pivotal provider of anesthesia services offered at every hospital in New Hampshire. They are more cost effective then their physician anesthesiologist counterparts, provide the same services, and have a proven record of safe, professional, effective anesthesia care.

If you have any further questions about providing your community with the most fiscally responsible model of anesthesia care, please contact the New Hampshire Society of Nurse Anesthetists at: info@nhana.org