The American Society of Anesthesiologists (ASA) today expressed its serious concern regarding the Centers for Medicare & Medicaid Services’ (CMS) decision to adopt a new and untested national policy that will allow Medicare funds to be used to pay untrained providers to diagnose and treat chronic pain. The policy jeopardizes patient safety, lowers the quality of health care and increases the risk for fraud and prescription drug abuse.
“The basic premise of this rule is flawed,” said ASA President John M. Zerwas, M.D. “At a time when government health care programs are spending millions of dollars pursuing comparative effectiveness, value-based payments and other quality related measures, it is baffling that CMS would pursue a policy departing so considerably from using evidence-based norms and the ‘triple aim’ of improving care, improving health and reducing cost.”
Additionally, CMS overruled its Medicare administrative contractors (MACs) that reviewed this issue. These contractors 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.
“Current restrictions on nurse anesthetists providing chronic pain services are appropriate and necessary because nurse anesthetists simply lack the training and education to accurately diagnose, evaluate and treat patients with chronic pain,” explained 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.”
By advancing this policy, CMS effectively endorses a group of providers caring for Medicare patients even as the agency itself acknowledges in the final rule that it is unable to assess whether such providers are competent and qualified to deliver the care:
“We are unable, at this time, to assess the appropriateness of the CRNA training relating to specific procedures. We are also unaware of any data regarding the safety of chronic pain management services when furnished by different types of professionals.”
ASA stands firm that the ambitions of certain providers must not trump patient safety and quality care.
The Centers for Disease Control & Prevention (CDC) has labeled prescription drug abuse an epidemic, and, in addition to the Institute of Medicine (IOM) 2011 report Relieving Pain in America, the White House Office of National Drug Control Policy (ONDCP) has called for more education and training on opioids. Such actions illustrate a clear disconnect between CMS and other government agencies that make the safety of all Americans their top priority through greater education. Regrettably, the final rule failed to address this threat to public health.
“Nurse anesthetists lack the ability to safely and effectively treat patients with chronic pain using a comprehensive approach, and to appropriately manage the medical conditions contributing to their pain. Paying nurse anesthetists to provide chronic pain services undermines efforts by these and other federal agencies to curb prescription drug abuse,” continued Dr. Zerwas.