Download AANA: Letter to the Editor, New York Times, June 5, 2013

 June 5, 2013
Letters to the Editor
The New York Times
620 Eighth Ave.
New York, NY 10018
Re:
VIA EMAIL
[email protected]
“The $2.1 Trillion Bill,” June 2, 2013
Dear Editor:
Healthcare costs in America are too high and often result in poor quality of care, but the Times
article on colonoscopies (“The $2.1 Trillion Bill”) misdiagnoses the problem and thus the cure.
Instead, the Institute of Medicine (IOM) recommends solutions from the world of nursing.
The best science points to colonoscopy as the standard for early detection and treatment of
colorectal cancers. Patients still demand, and health plans should still cover, medically necessary
anesthesia care for this uncomfortable procedure. When the anesthesia drug propofol is involved,
the FDA requires that it be administered by professionals expert in general anesthesia for a
reason: to protect patient safety. Qualified professionals include Certified Registered Nurse
Anesthetists (CRNAs), who are more cost-effective than and just as safe as physician
anesthesiologists, and a much safer alternative to untrained healthcare providers using a machine
to administer the drug. Propofol administered incorrectly or to the wrong patient can lead to
general anesthesia, which requires an anesthesia professional to manage the patient’s airway.
Trusting untrained healthcare providers and/or machines to do the job poses unacceptable risks.
(The RAND study cited in the Times article was funded by the manufacturer of such a machine.)
So why are healthcare costs so high in the United States? A big reason is because ossified
healthcare policy impairs competition, access and choice. Barriers to the use of CRNAs as well
as other advanced practice registered nurses (APRNs) include unnecessary “physician
supervision” requirements, prohibitions against delivery of services they are educated to provide,
and reimbursement rules that hinder cost- and life-saving care coordination. Noting that the
safety and everyday excellence of CRNAs and other APRNs is well established, the Federal
Trade Commission has red-flagged several state legislative and regulatory attempts to protect
physician guilds at the expense of patients and the public. Yet, such barriers contribute to the
huge overcharges the Times described. Anesthesiologist charges exceeded $1,000 for a 20minute procedure in part because anesthesiologist labor costs are three times those of CRNAs for
providing the same service. As recently as April 30, the anesthesiologist society was asking
Congress to consider doubling – yes, doubling – Medicare payments to these physicians.
To ensure access to high-quality, cost-effective care for patients, particularly the growing
number of baby boomers reaching retirement age, the IOM recommends authorizing all APRNs
American Association of Nurse Anesthetists
222 S. Prospect Ave., Park Ridge, IL 60068-4001 www.aana.com
American Association of Nurse Anesthetists
AANA - 2
to practice to the fullest extent of their scope and skills. Anything less sidelines a great underused
nursing resource, and relegates patients to high costs attributable to old-fashioned guild
protections. With regard to colonoscopy procedures, CRNAs offer a solution that ensures patient
access to safe, affordable healthcare.
Sincerely,
Janice Izlar, CRNA, DNAP
President
[email protected]
American Association of Nurse Anesthetists
222 S. Prospect Ave., Park Ridge, IL 60068-4001 www.aana.com