Expert Corner — Nurse Anesthetists at Forefront of Evolving Healthcare Delivery Models

Several factors in recent years have greatly accelerated the adoption rate among novel healthcare delivery trends.  Most notably, the COVID-19 pandemic resulted in numerous factors, including early physician retirement, the implementation of telemedicine, and the role of advanced practice providers (“APPs”) that escalated new developments.  In fact, certain types of APPs are permitted to provide patient care outside the historical restrictions of immediate physician supervision.  One type of APP provider making a notable difference in patient access to necessary care are certified registered nurse anesthetists (“CRNAs”). 

Currently, more than 20 states allow CRNAs to provide anesthesia in surgical and other settings without physician supervision. In most of these states, CRNAs are the exclusive provider of anesthesia-related care in rural communities.  These markets have been impacted the most by workforce reduction due to physician shortages and/or retirement.  Particularly with the rebound in surgical volumes following the pandemic, CRNAs have been stepping in to help meet demand and fill gaps in patient care coverage.  In fact, Medicare continues to report that the number of claims processed with the QZ modifier (CRNA service without medical direction of a physician) has increased as a percent of overall anesthesia cases on an annual basis. Currently, almost 55 percent of all anesthesia providers are CRNAs.  In addition to the traditional surgical setting, CRNAs are allowed to provide services through telehealth and can also provide pain management.

As a result, the compensation for CRNAs continues to increase faster than the data reported in benchmark surveys.  In large part due to increased demand and lessened physician supervision requirements, the job market for CRNAs has expanded since the pandemic and these providers are arguably more valuable than ever.  High demand and increased compensation rates amongst CRNAs are trends being experienced across the country and within various types of markets.  For instance, employed CRNAs are not only earning a base salary but also additional compensation in the form of incentive bonuses for services over a certain threshold and, in some cases, unrestricted emergency call coverage.  While CRNA compensation is on the rise, their overall compensation packages are generally 50% to 75% of what a medical doctor would earn, and reimbursement for anesthesia services is generally on par regardless of the level of degree of the provider.

While the significant shortage of anesthesiologists continues to plague the American healthcare system, CRNAs aim to fill gaps in care.  However, certain states still restrict CRNAs’ scope of practice.  For instance, CRNAs in certain states are not allowed to provide services for complex cases without physician supervision. As certain complex cases move to outpatient settings, this fact creates complexities in moving cases to a more cost-effective setting unless the facility can secure both the appropriate level of anesthesia coverage and have the coverage available during the necessary shifts.  These types of shortfalls will undoubtedly require resolution as CRNAs are becoming an increasingly necessary piece in providing patient care and for keeping operating rooms in rural communities running.  In fact, in some rural communities where CRNA(s) may often serve as the primary anesthesia provider, demand for CRNAs continues to escalate.  As such, the trends in demand and higher compensation will likely not abate soon.  CRNAs have undoubtedly landed themselves in the intersection of post-pandemic advancements in telemedicine, rural coverage, and the role of APPs.