BLOCKED NO LONGER CRNAs now have temporary permission from the FDA to provide anesthesia services without physician supervision.

In a letter to the U.S. Department of Health and Human Services, the American Association of Nurse Anesthetists (AANA) requested Secretary Alex Azar to permanently remove physician supervision requirements for Certified Registered Nurse Anesthetists (CRNAs). The request follows CMS's recent temporary suspension of the requirement, a move intended to let nurse anesthetists independently staff intensive care units and operating rooms during the COVID-19 crisis.

"Permanently removing these barriers will increase competition, network adequacy and make much needed reforms to the healthcare system," writes the AANA, which has been pushing to end physician supervision of CRNAs for decades. "The patients benefitting from this move will serve as a positive example for removing these barriers for all advanced practice registered nurses following the health crisis."

The American Society of Anesthesiologists (ASA) believes the removal of the restrictions are unnecessary. "It's disappointing to me," says ASA President Mary Dale Peterson, MD, FASA. "The ASA has always promoted the physician-led anesthesia care team model, working with our nurse anesthetists and anesthesiologist assistants. That's what we've been doing during this pandemic. At some of the hardest-hit hospitals in New York City, anesthesiologists have built SWAT teams to perform intubations or line placements, repurpose anesthesia gas machines or help with ventilation management."

Dr. Peterson acknowledges the federal government, CMS and several state governments have tried to help the nation's pandemic response by releasing or lifting some of the regulatory environment. "I think they wanted to make sure we had the flexibility to move around resources during the crisis," she says. "We all appreciate that. But when the crisis is over, we need to return to optimal levels of care, not crisis levels of care."

For longtime CRNA Jay Horowitz of Quality Anesthesia Care in Sarasota, Fla., this is simply the latest salvo in the eternal ASA-AANA battle. "The argument about removing the requirement for physician supervision has been going on probably since the mid-90s," he says.

Mr. Horowitz says the ASA and AANA have spent tens of millions of dollars in lobbying fees to fight this battle over the years. He understands why ASA is pushing back against the removal of supervisory restrictions, but he sees the COVID-19 crisis as a squandered opportunity. "It dismays me how this whole situation has become so politicized in so many different ways," he says. "It was such a great opportunity for everybody to work together both in the macro sense and in the micro sense, and we're getting very little of that. It's terribly disappointing and dismaying. To me, it's always been a battle over power, control and money.—