Gov. Jared Polis’ decision to fully “opt out” of the federal requirement that a physician supervise the administration of anesthesia by a nurse anesthetist – a requirement adhered to by the majority of states – jeopardizes Coloradans’ health and safety while failing to improve care or cut healthcare costs.
Governors are permitted to remove their states from the safety requirement for facilities billing Medicare or Medicaid after consulting with the state’s boards of medicine and nursing and determining opt-out is in the “best interests of the state’s citizens.” In this case, the governor – ignoring the state medical board’s unanimous opposition – said opting out provides an additional tool to help hospitals “provide care efficiently and safely.” The governor also said that “by allowing CRNAs to focus on patients rather than supervisors, the state can help hospitals be more efficient and ensure the skills of nurses are available to more patients.”
As a board-certified anesthesiologist with nearly 20 years of experience, I can unequivocally say these assertions are not supported by data or anecdotal evidence. Thirteen years ago, Gov. Bill Ritter issued an opt-out limited to critical access hospitals and specific rural hospitals. Since then, there has been no improvement of access to care nor any decrease in care costs – but there has been a reduction in the number of anesthesiologists in those facilities. The attempt to ensure the skills of nurses are available to more patients decreased access to physician anesthesiologists for all rural Coloradans, not just Medicare or Medicaid recipients.
Nationally, there have been five published, peer-reviewed studies since 2016 analyzing changes in access to care in states that enacted an opt-out. All five found that costs increased while access remained the same. While hospital groups argue they can cut patient costs associated with recruiting anesthesiologists and drawing from a larger pool of nurse anesthetists, Medicare – and in the majority of states, Medicaid – pay the same for anesthesia care regardless of who is providing it.
Anesthesia care is closely entwined with surgical and procedural outcomes. Appropriate management of a multitude of complexities starting with patient preparation through anesthesia administration and into recovery are key to a healthy outcome. Physician anesthesiologists are educated alongside surgeons, obstetricians, gynecologists and all other medical specialties. Having this background allows for effective diagnoses and treatment, which can be the difference between life and death. Studies confirm that when the degree of supervision is lessened, patients do worse, and clinical outcomes data shows more negative
outcomes when the care team is disrupted.
The governor’s decision comes at a time when primary care and emergency medicine physicians have been replaced by non-physicians, and hospitalized patients are often attended by non-physicians. In this setting, removing the physician anesthesiologist as a final safeguard will lead to unnecessary delays in care, cancellations, inappropriate consultation or testing, or injury, including death.
And patients innately understand. At a time when Americans are divided on nearly everything, poll after poll over the last decade shows most people want physicians to supervise nurses administering anesthesia and to handle anesthesia emergencies.
I urge every Coloradan to take this change by Gov. Polis seriously. Physicians, including the Colorado Board of Medicine, are being pushed out of the process at every decision point. As a physician, this is unacceptable. As a patient, this is frightening. Physicians should be available to patients when they seek care. If there is data supporting claims that supervision is keeping nurses from performing, Coloradans should see it. Physicians, experts in caring, diagnosis and treatment, should insist we are included in the quest for cheaper and more equitable healthcare.
We all need to work together to ensure our family, friends, neighbors and ourselves get the healthcare we deserve.
Dr. Gurdev Rai is a board certified anesthesiologist in Denver and board president of the Colorado Society of Anesthesiologists.
