The “Save America’s Rural Hospitals Act” (H.R. 833) was reintroduced by Congress in late February. Along with providing enhanced payments to rural healthcare providers to help ensure the viability of these important local healthcare facilities, this legislation also includes a provision to permanently remove physician supervision of Certified Registered Nurse Anesthetists (CRNAs) under Medicare Part A conditions of participation and a provision to include non-medically directed CRNA services as a mandatory benefit under the Medicaid program.
CRNAs have practiced without this regulation for nearly three years under healthcare flexibilities issued during the public health emergency.
Today more than ever, rural communities must address accessibility issues, including a lack of healthcare providers, the needs of an aging population suffering from more chronic conditions, access to healthcare, and larger percentages of uninsured and underinsured citizens,” says AANA President Angela Mund, DNP, CRNA. “As a CRNA who grew up in a small town in far northwestern Minnesota, I know firsthand the challenges of recruiting healthcare providers and how important the solo CRNA was to ensure that we could provide surgical services to our community. The ‘Save America’s Rural Hospitals Act’ comes at a time when rural hospitals and health centers face unprecedented challenges and struggle to keep their lights on and serve their communities.”
According to the National Rural Health Association, more than 170 rural hospitals across the country have closed their doors since 2005, and 453 rural hospitals are currently operating at levels similar to those that have shut down during the last decade, meaning they are vulnerable to closure. This forces patients to travel further to get the care they need and leaves others to put off necessary healthcare.
In November 2020, during the surge of COVID-19 in rural America, AANA joined several other healthcare organizations to bring equitable access to care in rural America and bridge the rural divide. The Rural Health Action Alliance (RHAA), a coalition of healthcare providers and facilities that provide high-quality, evidence-based care to millions of Americans, seeks to advance federal policies to improve rural health outcomes.
“CRNAs are the primary providers of anesthesia care in rural settings and have been instrumental in delivering care during the pandemic to patients where they live and when they need it,” says Mund. “Often, CRNAs serve as the sole anesthesia provider in rural hospitals, affording these facilities the capability to provide many necessary procedures.”
The importance of CRNA services in rural areas was highlighted in a recent survey that examined the relationship between socioeconomic factors related to geography and insurance type and the distribution of anesthesia provider type.
The study correlated CRNA services with lower-income populations and correlated anesthesiologist services with higher-income populations. Of importance to implementing public benefit programs in the U.S., the study also showed that compared with anesthesiologists, CRNAs are more likely to work in areas with lower median incomes and larger populations of citizens who are unemployed, uninsured and/or Medicaid beneficiaries.
More information and the opportunity to contact your local U.S. Representative on this issue are available here.
