Protecting Access to CRNAs Relieves Patient Pain
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.