Study Says Quality Not Hurt When Nurse Anesthetists Work Without Doc Guidance

A new study published Tuesday in Health Affairs suggests that nurse anesthetists' quality of work is not lower when they aren't supervised by a doctor, The Wall Street Journal Health Blog reports. "The background for this is that Medicare won't reimburse for anesthesia services unless a physician is supervising what's going on. States can opt out of this requirement by petitioning [the Centers for Medicare and Medicaid Services], and as of 2005, 14 states had done so." A similar move by California is being challenged by physicians' groups in that state. "Two researchers at the independent, nonprofit Research Triangle Institute analyzed inpatient mortality and complication rates from 481,440 hospitalizations covered by Medicare in both opt-out and non-opt-out states between 1999-2005. They looked at three different ways anesthesia can be provided — by [certified registered nurse anesthetists] working with no supervision, by anesthesiologists working alone and by both working in a team. There was no evidence that 'patients are exposed to increased surgical risk if nurse anesthetists work without physician supervision,' they write." The authors suggest CMS allow the nurse anesthetists to work independently of supervision (Hobson, 8/3).

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