Colorado Gov. Bill Ritter is considering opting out of the federal Medicare rule requiring physician supervision of nurse anesthetists in order to help rural hospitals deal with a shortage of providers.

Fifteen individual states, most of which have large rural areas, have already chosen to opt out of the 2001 Centers for Medicare and Medicaid Services rule requiring nurse anesthetists to be supervised by a physician while administering anesthesia. The Rocky Mountain State's potential opt-out is being supported by the Colorado Rural Health Center, which says hospitals in remote areas are having difficulty recruiting anesthesiologists or finding other types of physicians willing to take on the responsibility of supervising CRNAs.

Asked their opinions on a statewide opt out last month, the Colorado Board of Nursing unanimously supported the plan, while the state Medical Board approved it on a narrow 7-to-6 vote.

However, the Colorado Society of Anesthesiologists staunchly opposes "any change in physician supervision" and has run newspaper and radio ads arguing against the opt out. In a letter to the governor, CSA President Daniel J. Janik, MD, argues that "quality of care would be imperiled" if Colorado opted out of the 2001 physician supervision rule, and he cites surveys showing patients and surgeons in the state are opposed to the plan.

The American Association of Nurse Anesthetists did not immediately return calls for comment, but recently touted a study showing little difference between complication and mortality rates in opt-out states vs. states with the physician supervision rule. (That study was funded by the AANA.)

UPDATE: Jennifer Harenberg, CRNA, president of the Colorado Association of Nurse Anesthetists, says that her organization "has no doubt that Governor Ritter has the best interests of Colorado's residents in mind. In fact," she continues in an e-mailed statement, "it is abundantly clear from the data that an opt-out would in no way compromise patient safety and would, in fact, help ensure patient access to care, especially in medically underserved areas."

Gov. Ritter reportedly plans to consult with health officials in the 15 other states that have already opted out of the rule before deciding whether to request a statewide or rural opt out, or maintain the status quo.

Irene Tsikitas

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