AANA urges CMS to remove costly physician supervision requirements, other barriers

Oct. 9, 2020

The American Association of Nurse Anesthetists (AANA) announced it has partnered with 10 national nursing organizations to submit comments in response to the 2021 Medicare Physician Fee Schedule proposed rule, calling for the removal of costly physician supervision and removal of practice barriers for Certified Registered Nurse Anesthetists (CRNAs) and other advanced practice registered nurses. 

More than 5,200 CRNAs, student registered nurse anesthetists, and their supporters responded, making up nearly 15 percent of those who submitted comments to the proposed rule. 

The AANA is a signatory to an October 5 letter from the Advanced Practice Registered Nurses (APRNs) Workgroup to the Centers for Medicare & Medicaid Services (CMS) in response to its 2021 preview of the Physician Fee Schedule. As of 2018, more than 182,000 APRNs were caring for Medicare members, particularly in rural and medically underserved communities. “America’s growing numbers of highly educated APRNs advance healthcare access and quality improvement in the United States and promote cost-effective healthcare delivery,” according to the signatories. 

“We encourage CMS to continue to move forward … to remove payment disparities on APRNs which will provide needed financial support and flexibility to practices. We also encourage CMS to work with Congress to waive the budget neutrality requirement for FY 2021 due to the impact that reimbursement cuts for certain services could impact healthcare professionals at this trying economic time,” cited the letter.  

CRNAs are advanced practice registered nurses who provide anesthesia and pain management services. In 1986, they became the first nursing specialty accorded direct reimbursement rights by Medicare. CRNAs provide direct care for patients in every setting where anesthesia is delivered. 

Among other comments, the letter specifically recommended that CRNAs be authorized to supervise diagnostic tests to increase testing capacity and maximize the healthcare workforce. It also called on CMS to continue to remove Medicare physician supervision barriers placed on APRNs that are more stringent that many federal and state laws require. 

Authorizing “APRNs to practice to the top of their license would lower healthcare costs and increase access to care, particularly in rural and underserved communities,” stated the letter.  According to Federal Trade Commission and National Academy of Medicine reports cited in the joint letter, removing restrictive scope of practice laws reduces healthcare costs with no negative impact on patient care. 

CRNAs are qualified to make independent judgments regarding all aspects of anesthesia care based on their education, licensure and certification. 

AANA has the release.