Following an announcement that Colorado Gov. Bill Ritter plans to opt out of the Medicare rule requiring physician supervision of CRNA-administered anesthesia, which would made Colorado the 16th state to do so, the Colorado Society of Anesthesiologists wrote a letter opposing the decision. The controversy has also been addressed by The New York Times and The Wall Street Journal.
2. Debate over whether CRNAs as the sole provider of anesthesia is a more cost-effective model.
A study published in the Journal of Nursing Economics and conducted by The Lewin Group concluded staffing CRNAs as sole anesthesia providers costs 25 percent less than the next least expensive model. Alexander A. Hannenberg, MD, president of the American Society of Anesthesiologists, discussed in Becker’s ASC Review seven reasons to question the study, including the fact that the scope of services provided by a physician anesthesiologist and CRNA is not equivalent. He called the Lewin Group study unsubstantiated, inaccurate and questionable.
3. Updates on the shortage of propofol.
In June, the American Society of Anesthesiologists published an update on the propofol shortage, answering questions about the shortage and providing resources to help providers struggling to obtain the anesthetic. In Becker’s ASC Review, Dr. Alan Berk discussed alternatives to propofol and ASA President Alexander Hannenberg and Mowles Medical Practice Management president Amy Mowles answered questions about the shortage’s effect on anesthesiologists and ASCs. Dr. Robert Goldstein of Somnia Anesthesia Services also offered his insight on the shortage’s effect on ASC operations and profitability.
4. Senate letter to HHS secretary urged review of anesthesia Medicare payments.
Sixteen U.S. Senators signed a letter to HHS Secretary Kathleen Sebelius calling for a review of Medicare payments for anesthesia services as possibly misvalued. The ASA reported that a 2007 analysis by the Government Accountability Office showed Medicare rates for anesthesia services are 33 percent of what commercial payors reimburse for the same service. The Senate letter (pdf), dated Aug. 23, followed a similar letter sent May 28 and signed by 75 members of the U.S. House of Representatives (pdf). The American Society of Anesthesiologists also commented on the letter to Ms. Sebelius, applauding ASA members for bringing the issue to the attention of the U.S. Senate.
5. Dramatic shortage of anesthesiologists and surplus of CRNAs projected by 2020.
A study by RAND Corp. in August found a current shortage of 3,800 anesthesiologists in the United States and projected a shortage of 12,500 anesthesiologists by 2020. The study also identified a current shortage of 1,282 nurse anesthetists but predicted that figure will become a surplus of 8,000 by 2020. The president-elect of the American Society of Anesthesiologists, Mark A. Warner, commented, “The projected shortage of anesthesiologists suggests this country will soon face a gap in anesthesiology services that is just important to Americans’ health as the projected physician gap for primary care services.”
