Elon Musk’s brand as a bureaucracy-slashing enthusiast has found a seemingly unlikely advocate: the largest organization for nurse anesthesiologists in the United States.
The American Association of Nurse Anesthesiology is eying Musk’s Department of Government Efficiency as a model to remove red tape the group says nurse anesthesiologists regularly encounter as they care for patients. The organization boasts over 65,000 members, representing certified registered nurse anesthetists and nurse anesthesia residents across the country.
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Certified Registered Nurse Anesthetists nationwide deliver anesthesia to patients every day — with a catch, the AANA says. Under the Centers for Medicare & Medicaid Services’ current policy, a CRNA must be overseen by a physician anesthesiologist unless the practice has been waived by the state. And a physician anesthesiologist can oversee up to four nurse anesthesiologists administering anesthesia at a time, a policy the AANA argues adds to healthcare costs without increasing the quality of care.
AANA president Jan Setnor wants to end the practice, and she views CMS administrator Dr. Mehmet Oz as the easiest pathway to do so. He can “DOGE” CMS, cut the regulation, and end the practice once and for all, she said during an interview with the Washington Examiner. Doing so, Setnor said, aligns with the administration’s pre-existing goals “of reducing unnecessary regulation and making healthcare more efficient.”
“It doesn’t need legislation to do this. He [Oz] has the power to eliminate the supervision requirement and the opt-out process,” she said. “We currently have 25 states that have opted out. But if you look at the bigger picture, in a majority of the states, 43 of the states, there is no requirement for supervision at all. It is purely CMS red tape.”
“It seems that DOGE is more of a triggering mechanism, and I look at it that we’re looking at efficiency. We’re looking at saving the government and taxpayers dollars,” Setnor continued. “ It just seems so inefficient to have two people coming in to do the same job. And so I know that this is a great way to save taxpayers money and to improve access.”
Setnor argued that cutting the regulation follows through on an executive order President Donald Trump issued during his first term in office. The October 2019 directive called on the Health and Human Services secretary to propose a regulation that would remove costly and needless physician supervision requirements, a move the AANA hailed at the time as a step that would remove the CMS anesthesiologist policy.
“We just need to ask Administrator Oz to follow up through the goals of the past executive orders,” Setnor said. “President Trump has supported this in the past, and it would be great if Administrator Oz would continue this work.”
Following the DOGE model seeking to slash unnecessary costs, the AANA president said there’s rampant financial waste being fueled by the “outdated” CRNA anesthetist policy.
“A big area of waste and abuse where you have one physician anesthesiologist supervising four CRNAs, and the reimbursement for a physician to a CRNA is 50/50,” she explained. “However, if a physician anesthesiologist is supervising four CR days … that means that this physician makes 200% reimbursement watching four people do anesthesia.”
“And I think that is really a huge area of waste and lack of efficiency, when instead — that position — if we didn’t have the supervision requirements, could open up another room and actually do anesthesia, and that alone would improve access to care,” she continued.
Changing the policy would also cut costs as it allows healthcare facilities the option of “picking anesthesia practice based on need” instead of having “a medically directed system, which is way more expensive,” Setnor added.
The AANA president said the main criticism regarding the proposal to change the policy is from physician anesthesiologists, including from the American Society of Anesthesiologists. Nurse anesthetists are being met with accusations that they haven’t met the same standards of care or training that physician anesthesiologists have, leading critics such as the ASA to argue it wouldn’t be safe to change the policy.
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“It’s absolutely not true,” Setnor denied, arguing that their stalling isn’t helping to alleviate “significant” national anesthesia workforce shortages she projected are only expected to increase.
“If you look at the military, all branches of the military … CRNAs provide care independently. We have been deployed into the war zone. We have been deployed as the sole anesthesia providers at Forward Operating Bases deep in the mountains of Afghanistan, deep into the war zones of Iraq, and they have done excellent work,” she said.
“The CRNAs that provide care in the military receive the exact same training that CRNAs across the nation receive, and so you are not receiving lesser care,” she added. “You are not receiving a lower standard of care, but you will be eliminating a lot of broad waste and abuse and the cost that is going to taxpayers when you have two people charging for one job.”
ASA President Dr. Donald Arnold pushed back on Setnor’s argument during an interview with the Washington Examiner.
“Physician-led care teams, are important and efficient way to deliver health care,” he said. “The physician who is overseeing those two or three or four anesthetists isn’t redundant, but does provide an important safety resource, not only in terms of assessing the patient prior to the procedure and confirming the plan of care, but being present for key moments during the procedure because surgery or a course of anesthesia can have complications that require medical decision-making and then following care as well.”
“So there are clear reasons to have a physician involved,” he continued. “We recognize Dr. Oz as a distinguished board-certified cardiothoracic surgeon and a professor of surgery. We would hope that he would fully support the retention of this important patient safety standard.”
In addition to administering anesthesia, anesthesiologists are responsible for monitoring patients’ vital signs during surgeries and looking for adverse changes in factors such as heart rate and breathing. They are also trained to manage any medical emergencies that may arise during surgery, such as cardiac arrest.
Many hospitals work in team models with CRNAs where a lead anesthesiologist (a supervising physician anesthesiologist in states that have not waived the CMS policy) supervises up to four anesthetists across multiple operating rooms at once, staying linked to those anesthetists as a team throughout the shift.
Arnold said he believes the CMS policy of having a physician lead overseeing potentially multiple anesthetists allows for greater flexibility in the event of an emergency occurring with patients during operations, allowing the physician anesthesiologist to pivot to crisis management using different tools than a CRNA holds. He personally utilizes the physician-led team model in his practice, typically overseeing two to four anesthetists during his shift.
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“Now, from a math point of view, you might look at that and say, Dr. Arnold, was it necessary? You know, could it have been less expensive, or could you have used less resources?” he reflected. “[But] if that’s what the patient needed in a life-saving moment, we want to be able to provide that care.”
“There are opportunities to make sure that… care is done efficiently and thoughtfully, but that doesn’t reduce to a simple headcount, because the inputs that the physician makes are different than the inputs that the nurse anesthetists makes into the care of a patient,” Arnold added.
If Oz listens to Arnold, the AANA has a backup plan: Congress.
Earlier this year, a bipartisan, bicameral group of lawmakers reintroduced the Improving Care and Access to Nurses, which would remove the regulation from nurse anesthesiologists.
The I CAN Act is led by Reps. Dave Joyce (R-OH), Suzanne Bonamici (D-OR), Jen Kiggans (R-VA), Lauren Underwood (D-IL), as well as Sens. Jeff Merkley (D-OR) and Cynthia Lummis (R-WY).
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“Currently, there are unnecessary federal barriers in place that limit the patient care our nurses can provide,” Joyce said in a statement to the Washington Examiner.
“Enacting a bill, like the I CAN Act, will cut red tape and save taxpayer dollars by streamlining these outdated regulations to allow nurses to deliver the quality care they have been educated and trained to provide. This bill will increase access to care, lower patient costs, and strengthen patient choice,” he continued.
