CRNA pro­fes­sion at a cross­roads

Modern Healthcare - - BY THE NUMBERS - By Adam Ruben­fire

A re­cent la­bor dis­pute in­volv­ing cer­ti­fied reg­is­tered nurse anes­thetists is putting a spot­light on the pro­fes­sion and its role in the in­dus­try.

Two hospi­tals owned by War­ren, Mich.-based St. John Prov­i­dence Health Sys­tem, a part of St. Louis-based As­cen­sion Health, re­cently out­sourced their CRNA staff, a com­mon move among hospi­tals un­der pres­sure to cut costs. But the hos­pi­tal re­port­edly did so quickly, with­out much warn­ing to its own CRNAs, lead­ing to a pub­lic re­la­tions disas­ter and job losses for nearly 90% of the hos­pi­tal’s ex­ist­ing CRNA staff.

Such poorly han­dled tran­si­tions can lead to not only the loss of qual­i­fied CRNAs, but frus­tra­tion among the sur­geons and anes­the­si­ol­o­gists who work closely with them, said Joanne Spetz, an eco­nom­ics pro­fes­sor at the Univer­sity of Cal­i­for­nia at San Fran­cisco’s In­sti­tute for Health Pol­icy Stud­ies.

But out­sourc­ing can help cut costs as CRNA-re­lated ex­penses rise. The av­er­age CRNA salary in 2014 was $158,900. Pri­vate prac­tices and na­tional man­age­ment com­pa­nies tend to bet­ter man­age the costs that come with em­ploy­ing CRNAs, such as fre­quent over­time pay, said Ja­cob Babins, a Huron Health­care con­sul­tant.

CRNAs, like many other ad­vanced-prac­tice nurs­ing fields, are also ask­ing for more au­thor­ity. The Amer­i­can As­so­ci­a­tion of Nurse Anes­thetists has pushed to al­low CRNAs to prac­tice with­out the su­per­vi­sion of a sur­geon or anes­the­si­ol­o­gist. Most states don’t have spe­cific lan­guage that re­quires CRNAs to be su­per­vised by a physi­cian, and 17 states have ex­plic­itly opted out of a CMS rule that re­quires such su­per­vi­sion, ac­cord­ing to the AANA.

That lack of ex­plicit lan­guage in some state laws creates ad­min­is­tra­tive is­sues, AANA Pres­i­dent Juan Quin­tana said. The AANA has suc­cess­fully clar­i­fied CRNA roles in mul­ti­ple states. “It be­comes a political foot­ball, not re­lated to our abil­ity and the strength of our prac­tice,” Quin­tana said.

The Amer­i­can So­ci­ety of Anes­the­si­ol­o­gists wants CRNAs to work in a team su­per­vised by an anes­the­si­ol­o­gist, said Pres­i­dent-elect Dr. Jef­frey Pla­gen­hoef. The group is con­cerned that CRNAs don’t have the train­ing or education re­quired to make quick de­ci­sions in acute sit­u­a­tions. “It’s ir­re­spon­si­ble of any­one to say that pa­tients should re­ceive care with­out physi­cian over­sight,” he said.

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