Guest Blog: Protecting Access to CRNAs Relieves Patient Pain

Posted on | September 5, 2012 | Comments Off on Guest Blog: Protecting Access to CRNAs Relieves Patient Pain

Christine Zambricki, CRNA, MA, FAAN

This week, officials at the Centers for Medicare & Medicaid Services (CMS) will formally begin considering a rule to protect patient access to pain-management care delivered by Certified Registered Nurse Anesthetists (CRNAs). If CMS doesn’t implement the rule, then many of the 100 million Americans who suffer from chronic pain will face a pain-care crisis.

Patients’ ability to access pain care came under attack in April 2011 when two Medicare contractors in the western United States stopped reimbursing CRNAs for the care they delivered, unless they were working under the supervision of a physician.

The contractors’ decision bucked years of established practice. Medicare has long reimbursed nurse anesthetists directly for the care they provide. But in the 18 states where the two contractors were active, Medicare beneficiaries who had previously relied on CRNAs for their treatment suddenly lost access to them.

Even with a full complement of CRNAs, Americans lack adequate access to pain care, according to a recent study from the Institute of Medicine.

The problem is particularly acute in rural areas. In many rural counties across the United States, CRNAs provide all the pain treatments received by patients. Without CRNAs, many Medicare beneficiaries would have to travel inordinate distances to seek care, move into institutions such as nursing homes, or — worst of all — go without treatment.

Indeed, that’s already happening.

One CRNA providing pain care to Arizona seniors recently closed up shop, unable to afford treating patients without being paid. The patients of a Kansas CRNA who could no longer provide pain management services faced a painful three-hour round trip to the city to get the regular care they needed.

A CRNA serving patients within 150 miles of Butte, Montana, continued providing care and submitting claims for payment that he knew would be denied because his patients had no other options.

Fortunately, CMS is headed in the right direction. Its proposed rule would maintain direct reimbursement for nurse anesthetists providing pain management services as long as they’re legally permitted to administer such services in the state where they work. And because every state but Louisiana allows CRNAs to deliver pain management, the CMS rule would effectively safeguard patient access to pain care across the country.

CMS recognizes that care delivered independently by CRNAs is every bit as safe and effective as that delivered under the direction of a doctor. A 2010 study published in Health Affairs examined 500,000 individual cases of CRNA-only anesthesia care and concluded that the care delivered was as safe as CRNA care provided under physician supervision.

Further, the pain management treatments delivered by CRNAs help reduce overall healthcare costs by mitigating the need for more expensive services, such as ambulance transport to distant healthcare facilities, surgical procedures, or care delivered in nursing homes.

The annual cost of pain management in the United States exceeds $600 billion. If CRNAs vanish as a treatment option for American patients, then that figure will go even higher. We simply can’t afford such an outcome.

CMS must enact its proposed rule to guarantee coverage of the care delivered by CRNAs. It’s the right call not just for those suffering from chronic pain but for the American healthcare system, too.

Christine Zambricki, CRNA, MS, FAAN, is senior director, Federal Affairs Strategies, with the American Association of Nurse Anesthetists.