May 2002
Volume 66 |
Number 5
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STATE BEAT
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| Wyoming Maintains Physician
Supervision of Nurse Anesthetists |
S. Diane Turpin, J.D., Assistant Director
Office of Governmental Affairs (State)
Wyoming Governor Jim Geringer considered an opt-out of
the Medicare requirement for physician supervision of nurse anesthetists
and decided "the current system is working well in our state."
The governor notified constituents in a letter dated March 22,
2002, that he is not opting the state out of the Medicare requirement.
In his letter, he stated, "After careful deliberation and
consultation with many providers, I have determined that the best
option at this time is to leave in the current language that provides
for physician supervision of CRNAs." The Wyoming Society
of Anesthesiologists and the Wyoming Medical Society worked tirelessly
to respond to the issues raised and are grateful for the governor's
thoughtful consideration of this issue.
It will come as no surprise that Minnesota Governor Jesse
Ventura has opted out of the physician supervision requirement,
although almost 80 percent of the citizens of Minnesota favor
physician supervision. Governor Ventura, whose mother was a nurse
anesthetist, supported the Clinton administration's rule that
would have eliminated physician supervision of nurse anesthetists
in all states.
The opt-out issue continues in Alaska, Kansas,
Montana, New Mexico, North Dakota,
Oregon and Washington. The process in Washington
is somewhat different from other states. The Department of Health
(DOH) is preparing a report for the governor that will address
"issues and concerns" raised by the medical, osteopathic
and nursing boards. The boards have been instructed to raise issues
related to access and quality of anesthesia care but not to make
recommendations as to whether or not the governor should opt out.
DOH's report is expected to be presented to the governor in June.
A somewhat unusual approach to an opt-out is under way in Hawaii.
Typically, consideration of an opt-out is initiated by the governor's
office requesting the views of the boards of medicine and nursing.
This is the approach specified in the Medicare rule. For reasons
that are not clear at this time, a resolution has been introduced
in the Hawaii legislature that would require the Department of
Health to establish a task force to make recommendations to the
governor regarding whether the state should opt out. While such
a task force could allow for greater public comment, the text
of the resolution appears to presuppose the outcome – that
it would be in the best interests of the state to opt out. H.R.
78 remains in committee and is not expected to pass before the
session ends. Even if the resolution passed and a task force addressed
the issue, the governor must adhere to the requirements in the
Medicare rule. He must consult with the boards of medicine and
nursing regarding access to and quality of care, find that an
opt-out is consistent with state law and determine that it is
in the best interests of the citizens of the state to opt out.
States considering an opt-out are located predominantly in the
Midwest and along the West Coast. The trend may be shifting now
with interest growing in Vermont. The Vermont State Board
of Nursing has circulated a survey to nurse anesthetists as well
as background information prepared by the American Association
of Nurse Anesthetists. The survey asks for practice location,
whether the nurse anesthetist is supervised and how and whether
the nurse anesthetist favors opting out. The board is seeking
this information "before it responds or doesn't respond"
to the option.
Office-Based Anesthesia
Readers will recall that the Florida District Court of
Appeals upheld the Board of Medicine's rule requiring anesthesiologist
participation in all Level III procedures performed in the office
setting. The Florida Senate considered an amendment to a health-care
package that would have eliminated this provision of the office
surgery rules. The amendment was defeated.
In Virginia, H.B. 213 passed the House and Senate to require
the Board of Medicine to establish qualifications for registration,
certification or licensure of physicians' offices for the performance
of outpatient surgery.
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