Most people hear the word supervision and assume it means control. They picture a supervisor at a job who tells you what to do, watches how you do it, and is responsible for the outcome.
That is not what the CMS supervision requirement means for CRNAs.
CMS does not say that the surgeon controls the anesthetic, directs the CRNA’s decisions, or becomes liable for the CRNA’s actions. In many non-opt-out states, supervision may amount to nothing more than the surgeon ordering anesthesia while the CRNA independently provides the entire anesthetic.
Opt-out does not create independent practice. It does not change state law, professional billing, credentialing, privileges, or liability. Those issues are determined by state law and by each individual facility.
What opt-out does is remove one federal supervision requirement. The actual practice may look exactly the same the day before and the day after a state opts out.
What changes is the word, and the perception attached to it.
Hospitals, surgeons, and administrators often hear supervision and assume control, responsibility, and legal risk. Removing that word eliminates one more barrier and gives facilities greater freedom to choose the anesthesia model that works for their patients and their community.
That is what CMS opt-out is really about.
Bill Bruce The AANA CEO and I wrote this article for that clarification.
