Doctors will call on President George W. Bush to reverse a new federal rule that will allow certified nurse anesthetists to practice without physician supervision. The HCFA regulation change is expected to give hospitals greater staffing flexibility.
Neil Swissman, M.D., president of the American Society for Anesthesiologists, called the rule change an "outrageous action" and said the Clinton administration was removing "the safety net that has protected millions of seniors" just before leaving town.
HCFA issued final regulations last week that will allow certified nurse anesthetists to practice without supervision of a physician where state law permits. Twenty-nine states permit certified registered nurse anesthetists to practice without physician oversight, according to the American Association of Nurse Anesthetists.
"This issue has never been about quality of care but about access to care," said AANA President Larry Hornsby. "AANA applauds HCFA for staying the course and ultimately carrying through with its initial plan." HCFA first proposed the new rule in 1997.
The American Hospital Association supported the change. "It is an important provision, especially for rural hospitals that need the provision to have flexibility in staffing," said AHA spokeswoman Anne Berdahl.
The existing Medicare rule mandated physician supervision of every case of anesthesia administration by a nurse anesthetist. It was the only case in which Medicare mandated physician supervision of the practice of other state-licensed independent practitioners.
The new rule, which was published in the Jan. 18 Federal Register and will be effective in 60 days, applies to hospitals, critical-access hospitals and ambulatory-surgery centers.
The American Medical Association also blasted the new rule. "This disturbing decision-made contrary to medical and scientific evidence-compromises quality just when the medical community is working hard to make surgery the safest it has ever been," said AMA President Randolph Smoak Jr., M.D.