Jorge Valdes: Allow nurse anesthetists to practice autonomously
Published: Friday, January 31, 2014 at 4:41 p.m.
Last Modified: Friday, January 31, 2014 at 4:41 p.m.
As the overall landscape of Florida's health care delivery system continues to change and adapt to provisions of the Affordable Care Act and legislative reform, there is one reality that should not be ignored as the 2014 legislative session approaches. The delivery models for some of the most common types of care and services within Florida's health care system are antiquated and unnecessarily driving up costs. In particular, Florida's anesthesia delivery model is outdated and needlessly costly -- leaving hospitals, insurers and ultimately Florida's patients to subsidize those added costs.
This year, Florida lawmakers should seriously consider allowing Florida's Certified Registered Nurse Anesthetists (CRNAs) to practice autonomously, to the full extent of their education and training in order to give hospitals, and medical centers the option to implement a less expensive business model. This change would yield savings to the health care system and patients - all without impacting quality of care or patient safety.
CRNAs are trained not only in the field of anesthesia care, but in pharmacology, pathophysiology, physics, and chemistry. CRNAs treat patients with coexisting diseases and see them through their pre and post anesthesia processes. In fact, in many scenarios in the practice of anesthesia care, CRNAs commonly serve as the sole anesthesia provider without requiring supervision, including in our military where CRNAs safely administer anesthesia to military personnel and their families. Further, 16 other states already allow CRNAs to practice without physician supervision, and studies conducted in those states have yielded irrefutable, documented evidence that CRNAs can deliver anesthesia care just as safely and accurately when administering anesthesia with or without the supervision of an attending physician.
A study published in the 2010 edition of the Journal of Nursing Economic$ concluded that CRNAs provide high-quality, cost-effective patient care, which was further confirmed by the findings published in a 2011 Institute of Medicine report, which strongly supported the argument that CRNAs, should play a critical role in increasing patient access to quality, affordable health care.
Independently-conducted research and data supports removing the physician supervision requirement and allowing CRNAs to work in collaboration with health care professionals. This would allow these highly-skilled-and-trained professionals to help improve the quality of patient care, increase patient satisfaction and reduce health care costs for Floridians by delivering the same type and quality of anesthesia care in a more cost-efficient manner.
Some opponents to this change want the legislature to believe this is a solution in search of a problem. Opponents also want the legislature to believe that we do not have an access problem in the field of anesthesia. The reality is, even if there is not a problem now, is there any doubt that with millions of new patients coming into the health care system via the Affordable Care Act, that there will not be an influx of patients requiring medical procedures in the future, thereby straining the anesthesiology workforce?
Further, opponents also want the legislature to believe there is no cost benefit to making this change in the regulation of anesthesia care. This is simply not true. There is no doubt that by eliminating the illusory supervision required of Anesthesiologists, one of the most compensated specialists in the health care realm, that savings to the system will be achieved. By eliminating the need for subsidies paid by hospitals to anesthesia groups, to the tune of $150,000 per anesthetizing location per year, Florida can save tens, if not hundreds, of millions of dollars a year in health care costs while maintaining the same quality of care.
Consider this one final thought: if we can already predict based on past trends that a workforce shortage is on the horizon for all areas of health care, including anesthesiology, then wouldn't this change be a forward-thinking solution that will benefit patients and an already financially-strapped health care system?
Jorge A. Valdes, is president of the Florida Association of Nurse Anesthetists.