High-quality, affordable CRNA care: Good for hospitals, good for patients
In today’s rapidly changing healthcare environment, there is one constant that healthcare facility administrators can count on: the safe, cost-effective anesthesia care provided by Certified Registered Nurse Anesthetists (CRNAs).
CRNAs are highly qualified anesthesia experts who practice in every hospital and ambulatory surgery center across South Dakota where anesthesia is required for surgery, labor and delivery, trauma care, and pain management. They are the sole anesthesia providers in 100 percent of South Dakota’s rural facilities.
The steady, reliable presence of CRNAs ensures that patients have access to essential anesthesia services and helps facilities deliver exceptional anesthesia and related care efficiently and cost-effectively.
Get to Know South Dakota’s CRNAs
If a healthcare facility in South Dakota provides surgical, labor and delivery, emergency, or pain management services, rest assured that CRNAs are present to provide the anesthesia—every breath, every beat, every second. The hallmarks of CRNAs are providing safe, compassionate hands-on patient care, and staying with their patients throughout their procedure. In a handful of S.D. facilities, CRNAs work collaboratively with physician anesthesiologists; in such instances, CRNAs are always the hands-on caregivers.
In South Dakota as of January of 2020:
- There are 509 licensed CRNAs.
- 41 of 66 counties have anesthesia services, and CRNAs are the sole providers in 34 of the 41 (83%).
- CRNAs provide anesthesia in every county that has anesthesia services; there are no anesthesiologist-only counties.
South Dakota became the 13th state to opt out of the Medicare physician supervision rule for CRNAs in 2005; there are now 17 opt-out states.*
*In 2001, the Centers for Medicare & Medicaid Services (CMS) changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt out of this facility reimbursement requirement (which applies to hospitals and ambulatory surgical centers) by meeting three criteria: 1) consult the state boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state, 2) determine that opting out is consistent with state law, and 3) determine that opting out is in the best interests of the state’s citizens. To date, 17 states have opted out of the federal physician supervision requirement, including: Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, Colorado, and Kentucky. Additional states do not have supervision requirements in state law and are eligible to opt out should the governors elect to do so.
CRNA education, training, and practice are expansive. Enabling these anesthesia experts to provide patient care to the full extent of their education, training, licensure and certification is in the best interests of healthcare facilities and the communities they serve.
In short, CRNAs…
- Practice in collaboration with other qualified healthcare professionals.
- Provide safe, holistic, patient-centered, evidence-based anesthesia and analgesia services.
- Conduct a pre-anesthesia interview with the patient, administer the anesthetic, monitor and interpret the patient’s vital signs, manage the patient throughout surgery, and ensure the patient’s safe transfer to recovery.
- Are well prepared to handle any emergency.
- Provide anesthesia care in every healthcare setting where anesthesia is required for surgical, obstetrical, trauma, diagnostic, therapeutic, and pain management services.
- Care for patients of all ages and at every acuity level.
- Are the primary anesthesia providers for maternity patients, in rural and other medically underserved areas of the United States, and in the U.S. Military.
For a concise summary of the primary elements of nurse anesthesia practice, click here.
In addition to their stellar reputation as exceptional clinicians, many CRNAs also excel as business owners, researchers, educators, facility administrators and in other related roles.
Research Confirms CRNA Safety and Cost-Effectiveness
In 1999, the Institute of Medicine (now the National Academy of Medicine) reported that anesthesia care is nearly 50 times safer than it was in the early 1980s. Since 2000, all significant anesthesia-related research has confirmed the safety and cost-effectiveness of anesthesia care delivered by Certified Registered Nurse Anesthetists.
Must-read research for facility administrators:
- Nursing Economic$ (2010/2016): Cost Effectiveness Analysis of Anesthesia Providers (a CRNA working solo is the most cost-effective anesthesia delivery model, with no reduction in patient safety)
- Health Affairs (2010): No Harm Found When Nurse Anesthetists Work Without Supervision by Physicians (anesthesia care is equally safe when provided by a CRNA working solo, a physician anesthesiologist working solo, or a CRNA and anesthesiologist working together)
In South Dakota, 83 percent of counties with anesthesia services are CRNA-only. Based on the research, patients who undergo surgical and other procedures in hospitals and ambulatory surgery centers in these counties can rest assured that they will receive the safest, most cost-effective anesthesia care available.
Other Noteworthy Research
Nationwide, the average 2018 malpractice liability insurance premium for self-employed CRNAs was 33 percent less than it was in 1988, and 68 percent less when trended for inflation—evidence that CRNA care today is safer than ever.
Case law has repeatedly demonstrated that surgeons are no more liable when working with a CRNA than with an anesthesiologist.
What are the Differences between CRNAs and Anesthesiologists?
It is far more accurate to ask, “What are the similarities?” CRNAs and anesthesiologists provide anesthesia care using the same techniques and medications, to patients of all ages, in every type of healthcare setting, for every type of procedure that requires anesthesia.
Nurse anesthetists were the first recognized anesthesia professionals in the United States and have been providing patients freedom from pain for more than 150 years.
One difference stands out: Anesthesiologist compensation is approximately 2.5 times greater than that of CRNAs. Medicare pays the same fee for anesthesia services regardless of whether they are provided by a CRNA working solo, an anesthesiologist working solo, or a CRNA and anesthesiologist working together. Therefore, the anesthesiologist’s higher compensation is typically covered by the hospital, healthcare facility or the patient.
Did You Know:
CRNAs advocate for and specialize in Enhanced Recovery After Surgery (ERAS®)?
As healthcare professionals, policymakers, and other stakeholders continue to seek effective ways to combat the opioid crisis, CRNAs are doing their share to win the fight.
ERAS is a collaborative approach to pain management which involves the patient, CRNA, and entire care team. This patient-centered strategy relies on robust patient communication and opioid-sparing techniques such as regional anesthesia, peripheral nerve blocks, and non-opioid medications. ERAS reduces the need for opioids, improves patient outcomes, and reduces healthcare costs.
CRNAs are pain management specialists?
Chronic pain afflicts millions of Americans. CRNAs are specifically educated and trained to care for pain patients by delivering anesthetic injections around nerves and other treatments.
CRNAs were the first nursing specialty to be granted direct reimbursement rights under Medicare?
Legislation passed by Congress made it official in 1986.
CRNAs collaborate with all members of the patient care team to ensure the patient’s comfort and safety?
The patient and patient care team count on CRNAs to fulfill many roles and responsibilities that contribute to excellent patient care.
CRNA Education and Training
Total education and training:
- 7-8 ½ years of nursing and anesthesia education and training
- More than 9,000 clinical hours
Prior to entering nurse anesthesia program:
- Attain bachelor’s degree in nursing, RN license, minimum 1 year of critical care experience
- Average critical care experience: 2.9 years (CRNAs are the only anesthesia professionals who start their anesthesia education knowing how to manage critical events)
Prior to becoming a CRNA:
- Graduate with master’s or doctorate degree from accredited nurse anesthesia educational program
- Pass National Certification Exam
CRNAs embrace life-long learning, maintaining their certification through continuing education.
Learn more about CRNAs