Basic Opt Out Information

This is a basic information page only. Although AZANA has always had opt out as a goal, it is not formally asking the Governor for action at this time.

CRNAs are one of the two main types of anesthesia providers in Arizona.  CRNAs often care for rural and medically underserved patients. Despite favorable state law for CRNAs, federal regulations still impact CRNAs, and thus surgeons and facilities. While any false perception of liability was removed from state law in 2017 (it is illegal for surgeons to be liable for CRNA actions), CMS supervision from surgeons for CRNAs is now non-compliant with state law, which CMS is supposed to defer to. CMS supervision also inhibits healthcare facilities’ ability to choose and have access to anesthesia coverage.

Background: Currently, the Centers for Medicare and Medicaid Services (CMS) requires that a surgeon “supervise” CRNAs in non-opt-out states, including Arizona, despite CRNAs operating independently without

Problem: CMS “supervision” is undefined but creates obvious problems for surgeons and CRNAs working together; in this case, it hurts the healthcare system and limits economic opportunity.  It does not increase quality or access to care but does increase cost, while hindering competition and choice.  Further, CMS supervision is no longer compliant with Arizona law as according to Arizona state law, which CMS is supposed to defer to according to CMS policy, surgeons cannot be responsible or liable for anesthesia when delivered by a CRNA.

Why it matters:  CMS supervision ends up increasing costs for facilities, and ultimately, the taxpayer.  The barrier to competition impairs the ability for facilities to freely choose their anesthesia group.  If facilities cannot choose their anesthesia group without a burden from CMS, they often must pay subsidies to MD anesthesia groups due to market demands.  These subsidies are paid by federally funded facilities – meaning the taxpayer ultimately shoulders the burden. 

Solution: Governors are explicitly authorized to “Opt-out” of CMS Supervision, and Arizona can join the 18 states and territories that have already done so.  The regulation is optional.

Bottom line: Opting-out of supervision is a position supported by healthcare experts and increases competition by placing the two fully trained anesthesia providers (CRNAs and MDs) on an equal playing field, in regard to anesthesia services, while maintaining quality, increasing access to care and decreasing health care costs. 

Opt-out accomplishes the following:

 ·      For patients, Opt-out creates a more efficient, and more accessible system that maintains safety and delivers high-quality outcomes.

·      For surgeons, Opt-out removes a false-but-present perception of liablity from federal regulation when working with a CRNA putting federal rule in compliance with state law, and preserves a team-based model of care.

·      For healthcare facilities, Opt-out increases choice and competition, with corresponding reductions in overall anesthesia costs. 

·      For the taxpayer, Opt-out reduces costs ultimately paid by taxpayers.

·      For physician anesthesiologists, Opt-out has no appreciable impact on their profession and increases the competitiveness of physician-owned groups who contract with CRNAs.

·      For CRNAs, Opt-out allows for a fairer, more competitive environment, and promotes a team-based model of care where CRNAs are recognized as full members by the federal government.

·      For policymakers, Opt-out is an opportunity to improve the healthcare system while maintaining safety and improving cost-effectiveness.