Anesthesia staffing models and geographic prevalence post-medicare CRNA/physician exemption policy

Abstract

Three common staffing models for delivering anesthesia exist in the United States: services delivered by anesthesiologists only, services delivered by certified registered nurse anesthetists (CRNAs) only, and services delivered by anesthesiologists and CRNA teams. Given the opt-out policy enacted by the Centers for Medicare & Medicaid Services in 2001, it is reasonable to expect the use of CRNAs would vary by state opt-out status. Using 2014 Medicare claims data, we examine hospital and ambulatory surgical center use of three facility anesthesia staffing models and conduct a visual exploration of the geographic variation in the prevalence of these models. We find that rather than state opt-out status, individual facility characteristics and rural/urban considerations play a significant role in facilities’ use of anesthesia service delivery models. Allowing CRNAs to provide anesthesia services independently may help alleviate perceived anesthesiology provider shortages, particularly in rural locations without adversely affecting patient quality of care while reducing total anesthesia delivery costs.