ASA to CMS: Don't Gamble with Medicare Patients Lives on Anesthesia Safety

CHICAGO — The American Society of Anesthesiologists (ASA) today urged the Centers for Medicare & Medicaid Services (CMS) to preserve Medicare’s longstanding physician supervision standard for anesthesia care, warning that weakening or eliminating the standard would remove an important Medicare patient-safety safeguard.

Last week, CMS issued its Cutting Administrative Requirements for Excellence in Patient Care (CARE) proposed rule, part of a broader effort to eliminate red tape in Medicare and Medicaid requirements. As part of the rule, CMS is seeking input through a Request for Information (RFI) on the future of Medicare’s physician supervision requirement for certified registered nurse anesthetists (CRNAs), including whether the current policy should be retained, revised or otherwise modified.

“ASA supports eliminating regulations that are outdated or unnecessarily burdensome. But patient-safety protections are not red tape,” said ASA President Jeffrey Mueller, M.D., FASA. “When patient safety is at stake, we will not compromise. We will fight to preserve physician supervision and the protections it provides.”

Independent evidence does not support weakening the physician supervision requirement. In fact, studies examining Medicare’s opt-out policy allowing states to opt out of physician supervision of nurse anesthetists have found no meaningful improvement in access to anesthesia care, and eliminating the supervision requirement would produce no direct Medicare budget savings. At the same time, both the evidence and real-world experience raise serious questions about the wisdom of expanding CRNA-only anesthesia care without physician supervision, particularly when anesthesia emergencies require immediate physician expertise and clear clinical accountability.

Real-life examples from Modesto, California (an opt-out state) illustrate the risks when nurse anesthetists practice without appropriate physician oversight. 2024 California Department of Public Health reports documented the systematic use of a CRNA-only model of anesthesia services — a violation of California law. The reports documented “serious actual harm,” “serious potential harm” and “risk of harm, injury and possibly death.”

“Modesto should be a warning, not a blueprint,” Dr. Mueller said. “Anesthesia can turn from routine to life-threatening in seconds. Patients deserve clear clinical accountability and immediate access to physician expertise. That is not bureaucracy. That is patient safety. Good deregulation removes unnecessary bureaucracy. It should not remove safeguards that protect Medicare patients.”

THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 63,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Follow ASA on Facebook, X, Instagram, Bluesky, and LinkedIn.

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