Tracy Young, CRNA, was recently appointed president of the American Association of Nurse Anesthesiology and is co-founder and chief operating officer of Essential Anesthesia Management. He recently joined Becker’s to discuss his priorities as AANA’s new president, including workforce access, reimbursement pressure and his vision for the profession’s next chapter.
Editor’s note: This conversation has been edited for length and clarity.
Question: What are the biggest priorities for AANA in the next year?
Tracy Young: When we think about the three biggest issues facing CRNAs today, the first is workforce and access to care. We make sure we have enough anesthesia professionals in the right places to meet the growing demand for surgical and anesthesia care. Demand for anesthesia is continuing to increase while many communities are struggling with the provider shortage. It’s particularly important in rural America, where CRNAs provide over 80% of all the anesthesia in rural counties across the United States. When we think about the workforce conversation, it’s not just about CRNAs — it’s really about patients. It’s about their access to care, their ability to get their surgery, their cancer screenings, their obstetrical care, pain procedures and other necessary healthcare services when and where they need them.
Q: You have mentioned that scope-of-practice remains a key concern for the AANA. What concrete steps is AANA taking on the physician-supervision issue?
TY: Instead of first steps, I look at it more as a continuation of previous efforts. We’ve had 27 states now opt out of the federal supervision requirement in CMS’ conditions of participation. We want to continue those efforts until we get to all 50 states — or ideally, we’d love to have CMS remove that outdated and unnecessary physician-supervision requirement altogether. With 27 states having already opted out, there’s solid evidence that the safety profile is there, and that it benefits both communities and hospitals.
Q: How is the reimbursement environment affecting hospitals and anesthesia providers?
TY: When we think about the economic environment surrounding anesthesia, we’re seeing rising costs and decreasing reimbursement. This is causing sustainability issues across many hospitals and service areas — whether it’s ASCs or [obstetrics] departments. We’re starting to see more OB deserts across the United States, and part of that is due to rising costs and decreasing reimbursement. UnitedHealthcare implemented a 15% reduction in CRNA reimbursement last year. Those costs are being passed on to hospitals. CRNAs are in short supply — they’re not taking a 15% reduction in their salaries and compensation. That cost is just being passed on to hospitals who are facing that burden. Among rural hospitals today, we have more on the brink of financial failure than we’ve ever had in the history of the United States. Passing this cost onto them is making it more difficult for them to operate, and they’re having to make difficult decisions about whether to cut services in their communities. When they do, patients may have to drive 60 miles, 90 miles or even further just to get some of the basic care they can no longer receive in their communities.
Q: What do you see as the common thread running through all of these issues?
TY: When you look at the many issues facing the anesthesia profession today, the common denominator is access. Do patients have access to anesthesia professionals? Can CRNAs practice to the full extent of their education? Can future CRNAs afford the education required to enter the profession? It’s getting more costly with the doctoral degree as the entering degree for the profession, but we’re also seeing federal policies that could decrease the loan amounts CRNAs would be able to get to pursue their doctoral degree in anesthesia. All of these things center around the access issue for patients. CRNAs really are the answer to the access issues we see across many communities, whether they be underserved communities, even in inner cities, or across rural America.
Q: What is AANA doing differently under your leadership to close the education and communication gap between CRNAs and other stakeholders?
TY: One of the things we’re really trying to do is put CRNAs as the authoritative voice in nurse anesthesiology. One of the routes we’re taking to do that is a new website we just created called Anesthesia Answers. I’m particularly excited about its launch because it expands AANA’s mission beyond serving the profession and directly connects with patients. Anesthesia is incredibly safe today, but it is still one of the areas in healthcare that creates tremendous anxiety for patients. Anesthesia Answers gives patients and families a trusted source where they can get straightforward, evidence-based information about what to expect before, during and after anesthesia. The content was developed by CRNAs for patients in an easy-to-understand, digestible format to help decrease their anxiety and help them take a more active role in their own anesthesia care.
Q: If you looked back five years from now on your time as AANA president, what would you hope to have accomplished?
TY: In a broad sense, I’d like to leave the association and the profession in a better place than where I found it. However, the AANA is much larger than any one president or any one initiative. With over 70,000 members with a diverse background practicing in diverse areas, the AANA needs to be their professional home — that we are the voice for the profession — and bringing what I like to call a big tent mentality to our association and to our profession. Our mission is critical. It is our North Star. It is our guiding principle. We just created a new strategic plan that is laser-focused on just a few areas we’re really excited about for the future. In my role as president, I see my role as making sure our board of directors, our committee members — which is made up of more than 80 CRNAs — our CEO, and all of the staff who work for the AANA stay focused on that mission, and we’re all rowing in the same direction. If we continue to do that, I think we’ll see some meaningful advances in nurse anesthesiology.
Q: Anything else you’d like to add?
TY: I’m excited. I think there’s a lot of momentum in the nurse anesthesiology profession right now. We’re just coming off our largest-ever annual Congress in Boston. We had over 4,700 AANA members present live and in attendance, which is over 2,000 more than just two years ago at our San Diego meeting. I feel we have a lot of momentum. I feel we have a solid base. I want to unify the profession under this big tent and keep us focused on the mission. We’re living in a very polar time in our society right now, whether it be political polarity, whether it be people having different ideas of where the profession should go. I want to keep everyone focused on the mission, which is advancing the profession of nurse anesthesiology. And I think if we can do that without all the side projects and without all the distractions that could potentially pull us in different directions, that’s where we’re going to get some meaningful advances.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
