OR OVERSEER Seventeen states let CRNAs anesthetize patients without supervision.

Letting CRNAs deliver anesthesia without physician supervision doesn't improve patients' access to anesthesia care, according to a recent study.

Since 2001, 17 states have opted out of a federal requirement that physicians oversee nurse anesthetists' work. State lawmakers often explain that opting out will increase surgical facilities' anesthesia capabilities.

In a study funded by the American Society of Anesthesiologists and published online by Anesthesia & Analgesia Case Reports, however, researchers found that most "opt-out" states have actually seen a slower growth in anesthesia utilization rates than states which hadn't opted out of the Medicare regulation.

"The decision over whether to 'opt out' remains contentious in many states," says co-author Eric Sun, MD, PhD, an anesthesiology instructor at Stanford University's School of Medicine in California. "This study shows that 'opt-out' alone is not the silver bullet to improving access."

Jay Horowitz, CRNA, of Quality Anesthesia Care in Sarasota, Fla., sees the study as a lobbying effort rather than a substantial finding, especially since, in his view, the issue of physician supervision is more about longstanding reimbursement rules than patient safety, access to care, economic benefits or streamlined efficiency.

"The bottom line here is, this is more of the same tit-for-tat, paid-for science that has been going on for decades. It's politics masquerading as science, a continuous turf battle, and ASA (American Society of Anesthesiologists) and AANA (American Association of Nurse Anesthetists) are both guilty of it," he says, noting that the study seemed to respond to another, published last year in the journal Nursing Economic$, about the patient populations that CRNAs serve.

"Let's do something meaningful, instead of battling each other," says Mr. Horowitz, who recommends an end to government reimbursement of medical direction by anesthesiologists.

David Bernard