Medicare Payments to CRNAs Irk Anesthesiologists, Again

Alexandra Wilson Pecci, for HealthLeaders Media , November 6, 2012

It argues that the Medicare contractors stopped paying CRNAs because it "concluded the assessment skills required for the diagnosis and treatment of chronic pain are not part of nurses' training curricula. By contrast, anesthesiologists' extensive medical training also includes a rotation in pain care during residency training, and those choosing to specialize in pain medicine must complete a minimum one year multidisciplinary pain fellowship."

If this refrain sounds familiar, that's because it is. The American Academy of Family Physicians released a report in September, arguing that despite the primary care shortage in the United States, "substituting NPs for doctors cannot be the answer. Nurse practitioners are not doctors, and responsible leaders of nursing acknowledge this fact."

"The interests of patients are best served when their care is provided by a physician or through an integrated practice supervised directly by a physician," report said. "We must not compromise quality for any American, and we don't have to."

Despite losing their reimbursements for nearly two years (the new rule won't go into effect until January 1st and doesn't allow for retroactive payments), Zambricki says some nurse anesthetists have continued to provide services for free, knowing how much their patients rely on them.

She says one CRNA she talked with had more than 800 unpaid bills, but never stopped taking care of his Medicare patients, reasoning, "I can't stop taking care of them; they're my neighbors."

"They really made the sacrifice," Zambricki says. "And they really hoped that this would be remedied."

Alexandra Wilson Pecci is a managing editor for HealthLeaders Media.

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