Medicare Nonphysician Clinicians

Nurse anesthetists: To Reimburse or Not to Reimburse?

The Centers for Medicare and Medicaid Services (CMS) recently approved reimbursing nurse anesthetists for care provided to Medicare beneficiaries.

Critics say it jeopardizes patient safety, while supporters say it extends health care to pain patients who are often underserved by the medical community.

The American Association of Nurse Anesthetists (AANA) (unsurprisingly) applauds the decision. Janice Izlar, President of the AANA stated:

Many Americans depend on nurse anesthetists to treat their chronic pain safely and effectively. Thanks to yesterday’s ruling, our patients can be secure in the knowledge that they’ll continue to have access to the nurse anesthetists they know and trust.

Anesthesiologists and other physicians (unsurprisingly) do not approve of the ruling. They cite problems of patient safety including the potential for increased painkiller abuse.

In my opinion, licensing certified registered nurse anesthetists (CRNA) is a good thing. CRNAs cost less than anesthesiologists. Does an anesthesiologist have more training than a CRNA? Yes. Would anesthesiologists provide higher quality care for complex cases? Yes. Would anesthesiologists provide higher quality care for typical cases? Maybe not if CRNAs can spend more time with patients or if CRNAs can specialize in particular pain procedures such as epidurals during pregnancy or–more relevant to Medicare–pain management during hip replacement. CRNAs certainly would reduce the per person cost of medical care.

Allowing CRNAs to bill may not, however, reduce overall healthcare costs if CRNAs now administer painkillers in cases where they were not used before. Medicare’s payment for home health services aimed to reduce cost by diverting care from the expensive skilled nursing setting to the less expensive home health setting. Providers, however, began using home health care in cases for which SNF care was not used and thus overall spending increased.

However, CRNA are much more close substitutes for anesthesiologists than home health care is for SNF (i.e., most people could use help around their house and additional medical care). Further, the Medicare ruling isn’t a change in the benefits covered, just who can perform these services.

Healthcare Economist’s Verdict

Overall, allowing nurse anesthetists to provide care to Medicare beneficiaries in pain will not only improve care, but can also reduce costs.

CRNA Licensing

There are about 45,000 nurse anesthetists in the U.S. They work predominantly in hospitals and surgery centers, where they numb pain for patients undergoing procedures such as hip replacements or births. They also create treatment plans for some patients with acute pain.

Nurse anesthetists in nearly every U.S. state currently can provide some chronic-pain treatment such as injecting steroids to reduce swelling or refilling implanted pumps with pain medications. In 24 states they also can write prescriptions for controlled substances, such as oxycodone. But under the new rule, far more nurse anesthetists could write prescriptions, if more choose to treat chronic pain.


  1. 1) You should not confuse CRNAs with your (kind of mistaken) image of midwives. They won’t really have more time to spend with patients.

    2) Chronic pain has become its own specialty. Block clinics are a scam. it should be limited to people who have done extra training, a fellowship or its equivalent. A CRNA who spent a year or two beyond their basic training could acquire the skills. probably two since they generally limit their training hours to 40/week. Few finish training with much regional experience, including epidurals.

    3) We use a lot of CRNAs in independent practice situations. Few have the skills and ability just out of training. They really a need a year or more of working past training.


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