How new legislation can help address the health care workforce shortage
Posted: September 22, 2023 | Word Count: 769
If you've recently scheduled medical appointments or procedures, you may have noticed longer wait times than you expected. There's a reason for that: The U.S. currently needs more than 17,000 additional healthcare practitioners to keep up with demand, according to the Health Resources and Services Administration. Although healthcare provider shortages are occurring across the country, the problem is particularly acute in underserved rural and urban areas.
One specific area of need is anesthesia care. Certified Registered Nurse Anesthetists (CRNAs) are often the only anesthesiology providers in rural hospitals and are the predominant providers in underserved communities, yet current regulations regarding how these highly qualified healthcare professionals can practice limit the ability of CRNAs to care for patients to the full extent of their training and experience.
To address this issue, the Improving Care and Access to Nurses (ICAN) Act introduced in Congress with bipartisan support will help eliminate unnecessary barriers to practice, so patients and healthcare facilities can fully benefit from the expertise of CRNAs for anesthesia care.
Senators Jeff Merkley (D-OR) and Cynthia Lummis (R-WY) introduced the ICAN Act (Senate Bill 2418) in the Senate, joining more than a dozen representatives from both parties sponsoring the House version of the bill. The ICAN Act would remove barriers for advanced practice registered nurses (APRNs) such as CRNAs, allowing them to provide more comprehensive healthcare services to patients nationwide. The American Association of Nurse Anesthesiology (AANA), plus over 200 other nursing and healthcare organizations, support the legislation, which will remove unnecessary supervision of CRNAs and provide access to CRNA services in Medicaid.
"CRNAs play a vital role in maintaining critical access in communities across the country," said AANA President Dru Riddle, PhD, DNP, CRNA, FAAN. "However, superfluous regulations serve as barriers to expanding care, especially when those same communities face a shortage of providers. This critical legislation helps ensure everyone who needs access to high-quality care provided by advanced practice registered nurses such as CRNAs can have it."
CRNA training and experience
CRNAs and other APRNs are trained at the master's or doctoral level to provide anesthesia and pain management services, treat and diagnose illnesses, advise the public on health issues, manage chronic disease, provide care during pregnancy, childbirth and the postpartum period, order and interpret diagnostic tests and prescribe medication and non-pharmacologic treatments.
Despite the critical role APRNs such as CRNAs serve in the U.S. healthcare system, some federal statutes and regulations as well as institutional rules currently limit their practice, preventing them from practicing to the full extent of their education and clinical training.
CRNAs currently represent over 80% of anesthesia providers in rural counties. Rural hospitals and critical access hospitals often rely on independently practicing CRNAs for anesthesia care so the facilities can provide a wide range of surgical care, including obstetrics and pain management, close to home, when and where patients need it most. Even with CRNAs' vital role in maintaining critical access in communities nationwide, current Medicare restrictions require physician supervision of CRNAs. However, in many cases, there are no physician anesthesia providers available in a rural hospital to offer this unnecessary supervision, so the federal requirement creates a barrier to expanding care and worsens the current provider shortage, especially in underserved communities — without improving patient outcomes.
Additional support for the ICAN Act
Removing barriers to practice for CRNAs and other APRNs has widespread support. The National Academies of Science, Engineering and Medicine recommended in "The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity" that "all relevant state, federal and private organizations enable nurses to practice to the full extent of their education and training by removing practice barriers that prevent them from more fully addressing social needs and social determinants of health and improve health care access, quality and value."
These recommendations are echoed by multiple bipartisan stakeholders including the American Enterprise Institute, Brookings Institution, the Bipartisan Policy Center and AARP.
Improving access to care
Passing the ICAN Act will mean removing many barriers between patients and nurses in Medicare and increasing access to care for all Americans. Removing redundant supervision requirements for CRNAs will help lower costs in Medicare and Medicaid programs — and ensure proper reimbursement for services to maintain the highest standard and quality of care.
"We've seen how much nurses can do when they're allowed to reach the full potential of their education and scope of practice," added Riddle. "Removing barriers between nurses and patients is critical for achieving a more compassionate, efficient, affordable and equitable healthcare system for all Americans."
Learn more about the ICAN Act and how you can support this life-saving legislation at AnesthesiaFacts.com.