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NHHA backs Governor Jeanne Shaheen's decision to allow local control over supervision of nurse anesthetists

The New Hampshire Hospital Association commends Governor Jeanne Shaheen for her decision to opt out of Medicare's physician supervision requirement for certified nurse anesthetists (CRNAs).

"We applaud the Governor for the work she did to study all the implications this issue has on New Hampshire, especially its small, rural hospitals," says Mike Hill, president of NHHA. "Permitting local control is essential if rural hospitals are to continue serving their communities and providing the high quality care they've delivered with the help of CRNAs for nearly 30 years."

The Centers for Medicare & Medicaid Services published its anesthesia care rule last November granting state governors the ability to exempt their states from the supervision requirement for nurse anesthetists after each governor meets the following requirements: consults with the state's boards of medicine and nursing, determines that opting out of the requirement is consistent with state law, and decides that it is in the best interest of the state's citizens.

NHHA fully supports the Governor's decision, which is consistent with New Hampshire law allowing for the independent practice of nurse practitioners. New Hampshire's rural hospitals and the patients they serve depend on nurse anesthetists to provide anesthesia to patients in need of surgery, emergency care and maternity care. Five of New Hampshire's rural hospitals are staffed exclusively by nurse anesthetists. Another five are staffed by nurse anesthetists and physician anesthesiologists who share coverage.

"CRNAs have an exceptional safety record," says Thomas Clairmont, president of Lakes Region General Hospital and Franklin Regional Hospital. "The surgeons at Lakes Region General Hospital and Franklin Regional Hospital unanimously support this opt-out - this clearly demonstrates our surgeons' comfort level with the quality of care being provided by CRNAs. In addition, our surgeons continue to stress that they don't have the anesthesia expertise to oversee the work of CRNAs - placing them in a supervisory role over the administration of anesthesia would not enhance patient safety."

It is extremely difficult for rural hospitals to attract and retain anesthesiologists. In rural areas, nurse anesthetists often provide the only local access to high quality anesthesia services.

As chairman of the Rural Health Coalition which includes 16 New Hampshire hospitals, Clairmont stressed the importance of this decision for rural hospitals: "The governor's choice to allow for the independent practice of CRNAs is the best choice for continued access to top quality surgical care for all of the patients of New Hampshire."

Nurse anesthetists have advanced education and specialized training in anesthesia, and they meet stringent continuing education and recertification requirements. Nurse anesthetists routinely work collaboratively with physicians. In 2000, after nurse practitioners had been practicing independently in New Hampshire for a decade, Medicare ranked our state first in the U.S. for quality health care.

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