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ADVANCE Perspective: Nurses

Nurse Anesthetists Applaud CMS Ruling Protecting Patient Access to Pain Care

Published November 2, 2012 11:48 AM by Linda Jones
In August, Christine Zambricki, CRNA, MS, FAAN, senior director, Federal Affairs Strategies, with the American Association of Nurse Anesthetists, posted about possible changes in CMS regarding access to pain-management treatments provided by certified registered nurse anesthetists (CRNAs). CMS has released its decision. The following is a press release from the American Association of Nurse Anesthetists (AANA).

The American Association of Nurse Anesthetists (AANA) applauds the decision by the Centers for Medicare & Medicaid Services (CMS) to preserve patient access to chronic pain care delivered by Certified Registered Nurse Anesthetists (CRNAs).

"Many Americans depend on nurse anesthetists to treat their chronic pain safely and effectively," said Janice Izlar, CRNA, DNAP, president of the American Association of Nurse Anesthetists. "Thanks to yesterday's ruling, our patients can be secure in the knowledge that they'll continue to have access to the nurse anesthetists they know and trust."

For decades, Medicare has reimbursed CRNAs directly for chronic pain-management services that they're authorized to perform by the states in which they practice. The new CMS ruling confirms this longstanding practice and puts a uniform policy in place for the entire country, consistent with the Institute of Medicine's recommendation that Medicare cover services provided by advanced practice nurses to the full extent of their state scope of practice.

"America's 45,000 nurse anesthetists administer some 33 million anesthetics every year," said Izlar. "They're a crucial part of our nation's pain-care infrastructure, particularly in rural and medically underserved communities.

"With yesterday's ruling, the Medicare agency and the Administration have truly put the needs of patients first."

posted by Linda Jones


Wow! It's amazing how this article paints a nurse anesthetist's training, which is entirely anesthesia-based perioperative/peripartum pain management, with such broad strokes as to infer that they are somehow able to competently, safely, effectively and efficiently manage chronic pain. Explain to me how a water-downed post-graduate degree all of sudden qualifies nurse anesthetists to perform the practice of medicine... the field of pain medicine is a multidisciplinary field that has grown and evolved from the medical fields of anesthesiology, neurology, neurosurgery, PM&R, psychiatry, orthopedic surgery, among others. It requires formal training from a combination of these disciplines to be able to diagnose, treat and manage these patients - not only with procedural interventions, but also with medication management and being able to coordinate a multidisciplinary treatment plan. The CMS ruling is absolutely appalling and has the potential to backfire on the ever-expanding scope of practice ambitions of the nursing boards.

Mike November 21, 2012 10:22 PM
Boston MA

Im glad there will be more providers now to care for people in pain. Its regrettable that some pain specialists dont want nurses providing pain care- they would rather people do without any pain care. Some of the pain interventionalists are in the habit of criticizing other professionals-and they avoid taking a critical look at their own practices and shortcomings. Its time we had more professionals dedicated to helping people with chronic pain and this is a step in the right direction.

dave becker November 17, 2012 11:19 AM

 Any program that helps manage chronic pain for the high number of people living in pain who are under treated for their pain is good. For newcomers in pain management, it can take 3 - 6 weeks for their initial appointment with a pain specialists even after a referral from their PCP.

 A good web site for pain management is It is a good idea to inform your Congressman about laws limiting opioid therapy are not good for pain patients and medical professionals. To write or e-mail congress visit  Good luck!

Trey November 3, 2012 2:48 PM
Lubbock TX

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