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ADVANCE Perspective: Nurses

Protecting Access to CRNAs Relieves Patient Pain

Published August 24, 2012 4:56 PM by Guest Blogger
Christine Zambricki, CRNA, MS, FAAN, is senior director, Federal Affairs Strategies, with the American Association of Nurse Anesthetists. 

In less than two weeks, officials at the Centers for Medicare & Medicaid Services will begin to sort through public comments on their proposal to protect patient access to the crucial pain-management treatments provided by Certified Registered Nurse Anesthetists (CRNAs).

CMS's decision will affect millions. Roughly a third of Americans -- including many Medicare beneficiaries -- are afflicted with chronic pain. And CRNAs are crucial to ensuring the availability of timely, effective pain-care treatment

CMS must therefore affirm its proposed rule to guarantee coverage of the care delivered by CRNAs, thereby safeguarding patient access to comprehensive pain care. If the agency doesn't, then millions of Americans will needlessly suffer.

Patient access to CRNAs came under attack last year when two Medicare contractors refused to reimburse nurse anesthetists for the healthcare services they provided unless a physician was present. Consequently, Medicare beneficiaries who had previously relied on CRNAs for their treatment suddenly lost access to them.

The contractors' decision affected patients in 18 states -- primarily in the rural western part of the country, where CRNAs are often the only provider of pain care. In many rural counties across the United States, CRNAs provide 100 percent of 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.

Already, America faces a crisis in access to adequate pain care. According to a recent study from the Institute of Medicine, regulatory, legal, institutional, financial, and geographical barriers prevent patients from receiving adequate pain care.

The Medicare contractors' decision only makes things worse.

Americans have made it clear they aren't pleased with this state of affairs. According to a new survey from The Mellman Group, a polling firm, 87 percent of Americans support Medicare continuing to reimburse CRNAs.

Another 85 percent indicate they believe it's important patients be able to see a nurse anesthetist or other health professional of their choosing. And four in five Americans have stated they are or would be very comfortable with a referral to a CRNA for pain treatment.

CRNAs aren't just crucial to the national drive to expand access to care. They also help trim overall health costs. A 2010 study in the Journal of Nursing Economic$ found that CRNAs working alone are 25 percent more cost-effective at delivering anesthesia than any other model.

Further, the pain management treatments delivered by CRNAs mitigate the need for far more expensive services, such as ambulance transport to distant healthcare facilities, surgical procedures, or even institutionalization in nursing homes.

In a single year, the cost of pain-management care in the United States exceeds $600 billion. Putting CRNAs out of business will only raise that figure. With healthcare costs spiraling ever upward and threatening to bankrupt public and private payers alike, that makes no sense.

Fortunately, CMS recognizes the importance of preserving patient access to CRNAs. If its draft rule stands, then individual Medicare contractors will not be able to arbitrarily limit patients' ability to seek treatment from nurse anesthetists. That's the right call -- for patients and the broader healthcare system.

posted by Guest Blogger


In August, Christine Zambricki, CRNA, MS, FAAN, senior director, Federal Affairs Strategies, with the

November 2, 2012 11:48 AM

With the Institute of Medicine reporting in “Relieving Pain in America” that approximately 100 million Americans suffer from unrelenting chronic pain, healthcare professionals including advanced practice nurses such as Certified Registered Nurse Anesthetists (CRNAs) are absolutely required and ready to address this patient need.

Pain management is a newly evolving field.  The educational preparation of CRNAs ensures that they have the foundation of knowledge and skills required to provide chronic pain management services, which are part of the continuum of anesthesia care that extends from local pain relief to general anesthesia.  Those CRNAs providing pain management today have obtained the necessary knowledge. skills and expertise through workshops, cadaver labs, lectures and supervised clinical experience.  All professions should work together to build upon this solid base of knowledge, increasing their understanding of the diagnosis, prevention and treatment of chronic pain in order to improve access to quality pain care in this country.  In this way we can enhance the quality of life and the psychological well being of our patients.

Physician-run “pill mills” are a particularly vexing problem in contemporary society.  Not only do most CRNA pain management services  reduce patient need for prescription pain medications taken at home; the profession of nurse anesthesia has been diligent and effective at work with the Drug Enforcement Agency to promote evidence-based Risk Evaluation and Management Systems (REMS) intended to curtail diversion and misuse of narcotic and opioid medications.  All healthcare professionals must vigilantly reduce “pill mills” through professional education and sanctions where necessary.

Christine Zambricki September 5, 2012 10:48 AM


Are you an MD trained in pain management?

Mandy Wright, nursing - student, Georgia State University September 2, 2012 10:08 PM
Atlanta GA

CRNAs have no training in chronic pain. You are misleading the public by implying that CRNAs can provide chronic pain management; The only legitimate training for chronic pain management is through a 1-2 year fellowship after a MD finishes an anesthesiology, neurology or PMRS residency. Due to the fact that chronic pain management has expanded to all these specialists there is not, nor will there ever be a shortage of legitimate well trained providers. Legitmiate chronic pain management is not running a pill mill, which is what happens when non trained providers try to practice pain management. The medical community is battling the opiod epidemic by expanding chronic pain management training to many well qualified specialists, emphasizing proper screening for diversion, abuse and dependence. This training also includes many technically advanced and potentially risky procedures to reduce pain. Unfortunately CRNAs are trying to take financial advantage of a very vulnerable patient group by false advertising and promoting  services that they are not trained to provide. If their efforts are successful they will actually decrease access of patients to legitimate, well trained providers by deceiving patients into believing that they are seeing a trained provider. This is the ultimate in medical fraud and patient deception. Be prepared for increased opiod deaths and drug market if CRNAs are allowed to prescribe pain medication.

seth August 26, 2012 10:18 PM
shreveport LA

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