Medicare reimbursements, prescribing authority proposed for nurse anesthetists

The debate over nonphysician providers is heating up as the Centers for Medicare & Medicaid Services decides whether nurse anesthetists should get Medicare reimbursements for delivering chronic-pain treatment.

The CMS decision, expected by Nov. 1, would allow nurse anesthetists to directly bill Medicare at rates on par with doctors, suggesting that nurse anesthetists are just as qualified to treat chronic pain, The Wall Street Journal reported.

The new rule also would allow many more nurse anesthetists to write prescriptions if they choose to treat chronic pain.

However, the proposal to pay nurse anesthetists for chronic pain management has roused opposition from the American Society of Anesthesiologists (ASA), which says nurses don't have the proper education and training to ensure patient safety, according to the organization.

Moreover, 13 U.S. House Representatives from the GOP Doctors Caucus urged CMS to reconsider the rule, claiming it goes against goals of improving access to quality care and is "not in the best interest of patients," they wrote in a Sept. 24 letter to CMS Acting Administrator Marilyn Tavenner.

Allowing nurse anesthetists to write painkiller prescriptions also has raised concerns about unnecessary chronic pain procedures driving up healthcare costs and boosting prescription painkiller abuse, the WSJ noted.

Meanwhile, supporters of the new payment rule--including AARP, the National Rural Health Association and the American Association of Nurse Anesthetists--cite a shortage of board-certified pain doctors to meet demand, according to the article.

The agency's decision will come only a few months after Colorado and California reaffirmed their decisions to allow certified registered nurse anesthetists to work without physician supervision.

For more:
- read the WSJ article (registration required)
- learn about the ASA's opposition
- read the GOP Doctors Caucus letter (.pdf)