Lou Ann Wilroy, CEO

I want to thank the Denver Post for their excellent editorial on September 9, 2010 urging Governor Ritter to allow Colorado to become the 16th state to opt out of the Medicare rule that requires nurse anesthetists to work under the supervision of a physician, dentist or podiatrist.

In the same issue of the newspaper Dr. Daniel Janik, president of the Colorado Society of Anesthesiologists, has a guest commentary warning against the opt out. The Colorado Rural Health Center agrees with Dr. Janik that having a physician present when anesthesia is administered is preferable. But what is also relevant, and is not discussed in the column, is that sometimes physicians are not immediately available in the rural setting.

Certified Registered Nurse Anesthetists are qualified to deliver anesthesia care for trauma stabilization before transport, pain management, obstetrics (especially epidurals), and in many other situations. These highly trained and skilled nurses are doing critical work in our rural hospitals, and they deserve our thanks and support. As the Denver Post notes, “in Colorado’s 42 rural hospitals, 38 provide anesthesia services, but 24 of them don’t have anesthesiologists on staff.” In 63% of the rural hospitals where anesthesia services are available, the care is delivered solely by CRNAs.

What neither the editorial nor the guest commentary from Dr. Janik do not shed light on is the fact that opting out of the Medicare rule does not change the way anesthesia is delivered today in rural Colorado. With the opt out, high quality anesthesia services will continue to be provided by CRNAs and attending physicians will continue to be involved and responsible for patient care. However, rural hospitals in Colorado will no longer be subject to this federal regulatory burden that causes barriers to access to care due to compliance challenges. Patients will have access to anesthesia care in a more seamless and timely manner at the local rural community level.

The Colorado Rural Health Center has advocated for the opt out since it became available as an option for states in 2001 and we continue to urge Governor Ritter to decide in favor of the opt out provision. As the Denver Post persuasively stated, “Allowing nurse anesthetists to work without the supervision of a doctor is an acknowledgement of the difficulties that rural hospitals face in providing access to care. Such a move would give them the flexibility to deliver services without lowering the standard of care that is expected.”