ASA Responds to CMS Proposed Rule to Reimburse Nurses for Chronic Pain Services

The American Society of Anesthesiologists (ASA) today urged the Centers for Medicare & Medicaid Services (CMS) to rescind its proposal that would create a new national payment policy for the diagnosis and treatment of chronic pain services by nurse anesthetists (NAs).

“Chronic pain is a medical condition from which at least 100 million patients suffer,” said ASA President Jerry A. Cohen, M.D. “Health care professionals who treat patients with chronic pain must be properly trained to diagnose the condition and determine which treatments may help lessen pain and increase function.”

According to the American Association of Nurse Anesthetists’ (AANA) Standards for Accreditation for Nurse Anesthesia Education Programs, NAs are not required to have any clinical experience with acute or chronic pain management as part of their formal education and training.

NAs are non-physician anesthetists, specializing in the provision of anesthesia care and participating in the administration of anesthesia in a variety of surgical cases. They are most commonly supervised by an anesthesiologist, but may also work under the supervision of other physicians.

"Current restrictions on nurse anesthetists providing chronic pain services are appropriate and necessary,” said ASA Chair of the Committee on Pain Medicine Richard W. Rosenquist, M.D. “Even in the hands of specially trained physicians, chronic pain procedures are inherently dangerous due to the anatomy and delicate structure of the spine and nerves upon which chronic pain interventions are performed.”

If a procedure is performed unnecessarily or inappropriately, it can significantly worsen a patient’s condition and increase costs to the federal government and patient, cautioned Dr. Rosenquist.

The June 2011 IOM Report, “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research,” found that many health care professionals have insufficient education and training in pain care and recommended additional educational and training programs to help providers improve their knowledge and skills in chronic pain.

ASA strongly believes the proposed rule is contrary to the recommendations of the IOM Report and will be detrimental to patients. If you are a patient or provider concerned about who will deliver chronic pain services, please contact CMS to make your voice heard today. Comment period will end at 5 p.m. ET on September 4, 2012. For more information on pain management and pain medicine, visit LifelinetoModernMedicine.com.