There is currently a federal requirement that Certified Registered Nurse Anesthetists (CRNAs) must be supervised by a physician when providing anesthesia services. However, in 2001, the Centers for Medicare and Medicaid ruled that states may independently opt-out (become exempt) from the federal rule of supervision.
There are multiple reasons why opt-out is important. First, it eliminates confusion that the term “supervision” entails. CRNAs provide the majority of anesthesia within the rural communities in the United States, often without an Anesthesiologist within hours of the facility. Therefore, the supervision tends to fall onto the surgeon/dentist/podiatrist etc. For these providers, the idea of “supervising” can create fear of liability that is unnecessary. Next, physician supervision has not proven to increase the safety of care. Multiple studies have proven that anesthesia care is equally safe regardless of being administered by a CRNA or Anesthesiologist. Ultimately, opt-out allows local control for facilities to decide on how they can best approach quality care for their patients. Overall, there are currently 17 states that have implemented opt-out (see image below1). Hopefully Arizona will join the other 17 states and opt-out sometime in the future.
1. Simpson, C. (2012). State beat: 2012 summary of state activities. Retrieved from http://www.asahq.org/resources/publications/newsletter-articles/2012/july2012/state-beat-2012-summary-of-state-activities