National CRNA Week Resources & Advocacy Guide (2023)

The 23rd Annual National Certified Registered Nurse Anesthetist (CRNA) Week will take place from January 22-28, 2023. Hosted by the American Association of Nurse Anesthetists (AANA), National CRNA Week is an annual celebration of the nation’s nearly 59,000 CRNAs and student registered nurse anesthetists, who collectively provide more than 45 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 rural and veteran communities. But barriers remain to unlocking the profession’s full potential, and CRNAs are banding together to make their voices heard on these issues. 

Read on to get a look at the top advocacy issues for CRNAs this year from an expert in this field and how you can get involved.

Reducing Barriers to Practice for CRNAs

Currently, 22 states have no physician supervision requirements for CRNAs. But that leaves 28 states where CRNAs face restrictions in providing the care they are trained for and experienced. Those restrictions prevent them from being the force-multiplying resource that they could be. 

“The first barrier that’s out there is that you do have a Centers for Medicare & Medicaid Services, or CMS rule, that requires physician supervision for nurse anesthetists,” shares Dr. Pettey. “CRNAs can, in essence, practice independently, but the chart has to be signed off by a physician. They make all the decisions independently, but it is not truly independent practice.”

This CMS rule primarily dictates reimbursement policies 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. It can also reduce supervising physicians’ ability to perform procedures themselves.

“In some practices, you will have an anesthesiologist supervising four CRNAs. So there are five practitioners, but only four people are truly administering anesthesia. If supervision were not required, you could have five people doing anesthesia and taking care of patients independently,” Dr. Pettey shares. 

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 following 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. Many professionals believe 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. 

While Dr. Pettey believes it will be beneficial to make the temporary change permanent, he is unsure it will remain: “I think the big telltale sign will be if the Veterans Administration makes their change permanent first and allows CRNAs to continue to practice to their full extent. But honestly, I think it depends on who’s in power when this finally gets resolved. If you get a very conservative group who’s in charge, I can see it going back to the status quo once everything’s finally resolved,” he speculates.

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. 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. “Since 2016, there have been 980 rural hospitals that have closed in the United States. Most of that is financially driven. So every dollar that can be saved allows for the services to still be provided,” Dr. Pettey says. 

He continues, “Rural hospitals only have a finite amount of money. CRNAs have a quality track record and do not have the same cost attached to them as a physician. This is something that allows a rural hospital to be able to afford anesthesia services for their patients.”

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, ensure coverage and reimbursement of the most common care costs, and allow CRNAs to continue providing 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.  

Presently, there is a pending Rural America Health Corps Act federal legislation. If passed, this act would establish incentives in the form of up to $200,000 in student loan forgiveness for medical professionals who choose to practice in rural communities. This bipartisan bill stands to increase providers in rural communities, including CRNAs, who would be eligible for this program.