What Does “Opt-Out” Mean Regarding Anesthesiologists and Nurse Anesthetists?

by | Nov 2, 2016

The term “Opt-Out” refers to the 2001 decision made by the Centers for Medicare & Medicaid (CMS) to allow states to opt out of the Federal Supervision requirement for Certified Registered Nurse Anesthetists (CRNAs).  As of 2013, there are 17 states that have exercised their right to opt out.

CMS does recognize the differences in state law and allows states to make decisions based upon their unique needs and specifications.  However, according to the American Association of Nurse Anesthetists (AANA) regarding the November 13, 2001 rule requirement, an opt-out must be “consistent” with state law, which CMS states in the November 13 rule comments that CMS wants to leave it up to governors to determine what constitutes “consistency” with state law. CMS rejected the idea of mandating a particular process or mechanisms for determining consistency.

For states that do “opt-out,” there is no longer a requirement for the supervising physician to sign the anesthesia preoperative evaluation.  With that, there is a perceived notion of lesser liability for the supervising physician.  The fact is, the liability is no different.

The AANA website lists the federal requirements for the “opt-out” supervision:
• CRNAs must be supervised by a physician. The November 13, 2001 rule allows states to “opt-out” or be “exempted” (the terms are used synonymously in the November 13 rule) from the federal supervision requirement.
• For a state to “opt-out” of the federal supervision requirement, the state’s governor must send a letter of attestation to CMS. The letter must attest that:
1. The state’s governor has consulted with the state’s boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state; and
2. That it is in the best interests of the state’s citizens to opt-out of the current federal physician supervision requirement; and
3. That the opt-out is consistent with state law.

According to the AANA, anesthesia outcomes are affected by factors such as provider vigilance, attention, concentration, and organization, not whether the anesthesia professional is an anesthesiologist or a CRNA, or whether the CRNA is supervised.

For our readers who have heard of the term “opt-out” but weren’t exactly sure what it referred to, we hope this article has been informative. The “opt-out” presents a variety of anesthesia department staffing options, and DPI can help you understand these options and make recommendations that could potentially decrease costs without jeopardizing patient safety or surgeon satisfaction. DPI is here to provide the ideal staffing personnel that will help your facility accomplish its own unique goals. Whether you are in an “opt-out” state or not, DPI’s expertise in managing efficient anesthesia departments—whether they are staffed by CRNAs, anesthesiologists, or a mixture of the two—can be put to work for you. For facilities seeking to optimize services, increase patient satisfaction, and streamline patient flow while keeping costs under control, DPI can create a customized solution for success.