In the past month, three states have decided to drop a federal requirement that physicians supervise nurse anesthetists, and two more states are considering doing so, according to the American Association of Nurse Anesthetists.
That means that 10 states now have dropped the supervision requirement since federal authorities gave governors the option to do so two years ago, the association reports.
The three additions are Alaska, North Dakota and Washington, and they join Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico and Kansas, the AANA says.
Meanwhile, the governors of Colorado and Montana are exploring the possibility of dropping the requirement, says Mitch Tobin, spokesperson for the association.
The American Society of Anesthesiologists defends the supervision requirement, saying nurse anesthetists do not have the training to work alone. But the American Association of Nurse Anesthetists asserts that nurse anesthetists' record of adverse events is no different from that of anesthesiologists.
State governors, meanwhile, are worried about the effects of a growing nationwide shortage of anesthesiologists.
In his letter informing CMS of his decision to drop the supervision requirement, Alaska Gov. Frank Murkowski wrote that there is a shortage of anesthesiologists in rural areas of the state, the association reports.
"I believe not exercising this exemption may severely limit the ability of rural hospitals to treat emergencies and provide other services requiring anesthesia care to Medicare patients," Murkowski writes in the letter.
The association reports that states that have dropped the requirement are taking full advantage of their new status.
In Iowa, for example, 91 of 118 hospitals in the state rely solely on nurse anesthetists to provide anesthesia care, AANA reports, citing a letter this July from Iowa Gov. Thomas Vilsack to the governor of an unnamed state.
"Iowa has proven the intent of the opt-out change is a complete success in practice," Vilsack adds in the letter.