National CRNA Week Resources & Advocacy Guide (2021)

The 22nd Annual National Certified Registered Nurse Anesthetist (CRNA) Week will take place from January 24-30, 2021. Hosted by the American Association of Nurse Anesthetists (AANA), National CRNA Week is an annual celebration of the nation’s nearly 54,000 CRNAs and student registered nurse anesthetists, who collectively provide more than 49 million anesthetics every year. It’s also an opportunity to raise awareness about the CRNA profession, and the advocacy issues that CRNAs are pursuing to better provide safe, cost-effective treatment to their patients.

Nurse anesthetists have been providing anesthesia to patients in the US for over 150 years, dating back to the battlefields of the Civil War. Today, the CRNA credential identifies advanced practice registered nurses (APRNs) who have completed graduate-level education and earned a high degree of autonomy within the profession. CRNA services include pre-anesthesia evaluation, administering anesthetics, monitoring and interpreting a patient’s vital signs, and managing a patient throughout surgery.

CRNAs provide anesthetics to patients in every practice setting, and for every type of surgery and procedure. They also play a critical role in serving rural and veteran populations. In some states, CRNAs are the sole anesthesia professionals in rural hospitals, and nurse anesthesia predominates in veteran hospitals and the US Armed Forces. CRNAs ensure patient access to care at a cost-effective rate, too: nurse anesthesia care is 25 percent more affordable than the next least-costly anesthesia delivery model.

Researchers studying anesthesia safety have found no differences in care between CRNAs and anesthesiologists. CRNA care is safe, cost-effective, and a critical resource for the rural and veteran communities. But barriers remain to unlocking the full potential of the profession, and CRNAs are banding together to make their voices heard on these issues.

To get a look at the top advocacy issues for CRNAs this year, and how you can get involved, read on.

Reducing Barriers to Practice for CRNAs

Currently, there are 17 states that have no physician supervision requirements for CRNAs. But that leaves 33 states where CRNAs face restrictions in providing the care that they are trained for and experienced in providing. Those restrictions prevent them from being the force-multiplying resource that they could be.

Physician supervision of CRNAs has never been a matter of safety but instead tied to the ability of a facility to receive reimbursement from the Centers for Medicare & Medicaid Services (CMS) for providing anesthesia care to patients. But often the cost of having a supervising physician anesthesiologist is greater than the cost of having two additional, experienced CRNAs in the anesthesiology department.

In October 2019, Executive Order #13980 called on the US Department of Health and Human Services (HHS) to remove burdensome regulatory barriers to care within a year. Section 5 of that order specifically directed HHS to ensure that services provided are appropriately reimbursed in accordance with the work performed, rather than the title of the provider’s occupation.

At the beginning of the Covid-19 pandemic, CMS temporarily removed physician supervision requirements for CRNAs. That move should become permanent. As the pandemic recedes, there will be an increased demand for elective surgeries that were delayed during the surge in Covid-19 patients. And giving CRNAs more freedom to operate will, in turn, give patients more choices, and lower the cost of care.

Helping CRNAs Help Veterans

Nurse anesthetists have historically provided much of the anesthesia to active duty military in combat arenas. Today, more than 1,000 CRNAs serve in the Veterans Health Administration (VHA), but the VHA can take further steps to unlock CRNAs as a resource for veteran care.

In 2016, the Department of Veterans Affairs (VA) granted three out of four advanced practice registered nursing (APRN) specialties full practice authority (FPA). The only APRN specialty excluded was the CRNA. In the years since the VA has experienced continued shortages in regards to anesthesia services, and veterans have endured long wait times and the cancellation of surgical procedures.

The VA spends $100 million on contracts with outside anesthesiologists. The current CRNA workforce at the VA, if granted FPA, could increase access to anesthesia care at no added cost. Instead, the VA’s CRNAs are encumbered by their supervision requirements with anesthesiologists.

CRNAs have full practice authority in every branch of the US military and are the predominant provider of anesthesia on forward surgical teams and in combat support hospitals, where 90 percent of the forward surgical teams are staffed by CRNAs. If CRNAs are capable of delivering care to active duty military, there is no reason they can’t deliver that same level of care, under safer circumstances, to veterans.

Full practice authority for CRNAs in the VA is supported by the Air Force Sergeants Association (AFSA), the Iraq and Afghanistan Veterans of America (IAVA), the Paralyzed Veterans of America (PVA), and several others.

Promoting Access to Rural Healthcare

Nurse anesthesia services are crucial to rural healthcare. CRNAs provide more than 70 percent of the anesthesia services in rural hospitals, and their presence allows a healthcare facility to offer surgical, obstetrical, trauma stabilization, interventional diagnostic, and pain management services.

CRNAs can increase access to rural healthcare, and improve the finances of the healthcare system overall, by providing top-quality care at a third of the cost of a physician anesthesiologist. But rural healthcare is in danger: 163 rural hospitals have closed since 2010, and another 673 are in jeopardy.

The Critical Access and Rural Equality (CARE) Act, first proposed in 2017, would ensure that rural hospitals can keep their doors open. Part of the legislation would restore CRNA standby and on-call payment eligibility, ensuring coverage and reimbursement of the most common costs of care, and allowing CRNAs to continue to provide safe and essential services to rural communities. First proposed in 2017, the CARE Act still hasn’t passed, but the public can and does continue to lobby its representatives for action.

How to Get Involved

National CRNA Week is an opportunity to raise awareness about the safe, cost-effective anesthesia care that CRNAs can and do provide to the nation. Its host, AANA, is the leading advocate for CRNAs and patient safety related to anesthesia care, with nearly 54,000 members. Their government affairs division reviews over 11,000 state legislative bills and regulatory proposals annually to determine the potential impact to CRNA practice. They also maintain one of the nation’s most influential political action committees, the CRNA-PAC.

Collectively, AANA represents a powerful voice that lobbies for federal and state policy changes that empower CRNAs and improve patient safety. In addition to their advocacy, AANA participates in research around health policy, anesthesia science, education, clinical practice, and leadership.

AANA membership offers benefits to the individual CRNA, too. Members gain access to professional publications, continuing education opportunities, and other career resources. Learn more about how to get involved with National CRNA Week on AANA’s website.

Matt Zbrog

Matt Zbrog

Writer

Matt Zbrog is a writer and researcher from Southern California, and he believes a strong society demands a stronger healthcare system. Since early 2018, he’s written extensively about emerging topics in healthcare administration, healthcare research, and healthcare education. Drawing upon interviews with hospital CEOs, nurse practitioners, nursing professors, and advocacy groups, his writing and research are focused on learning from those who know the subject best.