Factors Influencing Choice of Anesthesia Staffing Models


Anesthesia Conversion Factors to Improve Revenue & Other Healthcare News

Certified registered nurse anesthetists (CRNAs) can practice independently or with varying degrees of supervision by physicians or anesthesiologists. Before 2001, the Centers for Medicare & Medicaid Services (CMS) conditions of participation required CRNAs to be supervised by a physician. Starting in November 2001, CMS implemented an opt-out policy to give states greater autonomy in determining how anesthesia services are delivered. The policy also provided a mechanism to increase access to anesthesia services.

We sought to understand and describe surgical facility leaders’ perceptions of CRNA quality, safety, and cost-effectiveness; the motivation and rationale for using different anesthesia staffing models; and facilitators and barriers to using CRNAs. We applied a mixed-methods approach to understand surgical facility leadership decision-making for staffing arrangements.

The use of anesthesia staffing models differed by location and surgical facility type. For example, the predominantly CRNA model was used in only 10% of large urban hospitals but in 61% of rural ambulatory surgical centers.

Interviews with surgical facility leaders revealed that geographic location, surgeon preference, and organizational inertia were powerful contributors to a facility’s choice of staffing model. Other factors included the Medicare opt-out provision, facility experience, and cost considerations. Differences in quality and safety between models were not contributing factors for most facilities.


Mills, Amy; Sorensen, Asta; Gillen, Emily PhD; Coomer, Nicole M. PhD; Theis, Elysha; Scope, Stephanie; Beadles, Christopher MD, PhD; Quraishi, Jihan RN, AE-C, CCRC
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Journal of Healthcare Management: January-February 2020 – Volume 65 – Issue 1 – p 45-60
doi: 10.1097/JHM-D-18-00186