In an October 5 letter to President Biden, American Association of Nurse Anesthesiology (AANA) President Dina Velocci, DNP, CRNA, APRN, drew attention to the benefits the healthcare sector could incur with the elimination of anti-competitive policies.
Velocci called upon the White House Competition Council to develop robust provider nondiscrimination rules, remove unnecessary regulatory barriers such as Medicare’s physician supervision requirement for Certified Registered Nurse Anesthetists’ (CRNA) services, and implement full practice authority for CRNAs working in the Veterans Health Administration (VHA).
CRNAs play an essential role in ensuring that patients have access to critical anesthesia services, especially in rural and other underserved populations. Policies that increase competition among healthcare facilities will drive down healthcare costs and increase access to care for patients, allowing them to receive the care they need for surgery, labor and delivery, trauma stabilization, and chronic pain management.
“Meaningful implementation of [the Consolidated Appropriations Act of 2021] is important to protect patient access to critical services provided by CRNAs and other advanced practice providers (APPs) from discriminatory practices in the private insurance market,” wrote Velocci. “CRNAs, and other APPs acting within the scope of their license or certification under applicable state law or regulation, have experienced discrimination with respect to participation in and coverage of procedures that are clearly included in their state scope of practice. Such discrimination impairs access to needed healthcare services, consumer choice and competition, and impairs efforts to control healthcare cost growth. Further, this discrimination violates the federal provider nondiscrimination provision.”
The AANA also urged the White House to make the Medicare waiver of the physician supervision requirement for CRNAs permanent. “The [waiver] has shown the important need for healthcare professionals to work to the top of their scope to care for patients and highlights the important role that CRNAs play in our healthcare system …. During this pandemic, we have seen barriers to CRNA practice removed at both the state and federal levels, allowing CRNAs to provide critical, lifesaving care to patients. CRNAs are practicing independently during this crisis, working under stressful conditions in facilities across America, providing invaluable support by using their expertise in rapid systems assessment, airway management, managing ventilators, vascular volume resuscitation, placing of invasive lines and monitors, overseeing complex hemodynamic monitoring, emergency preparedness, and resource management.” Data shows that physician supervision does not impact quality of care and can increase costs.
In addition, the AANA drew attention to a United States Federal Trade Commission recommendation in 2016 to allow CRNAs working in all VHA facilities to practice at the top of their scope without barriers. However, today CRNAs are not allowed to work independently throughout the VHA. “Allowing CRNAs to work to the top of their scope also provides inherent cost savings,” wrote Velocci. To help ensure veterans have the high-quality care they have earned, AANA calls for development of national standards of practice that allow CRNAs and other providers to practice without supervision barriers.
