ASA urges CMS to protect Medicare's physician supervision standard for anesthesia care

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ASA supports eliminating regulations that are outdated or unnecessarily burdensome.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. When patient safety is at stake, we will not compromise. We will fight to preserve physician supervision and the protections it provides."

Jeffrey Mueller, M.D., FASA, ASA President

Independent evidence does not support weakening the physician supervision requirement. In fact, studies examining Medicare's opt-out policy 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."