Recent modifications to the Oklahoma Nursing Practice Act, along with actions taken by the governor, have resulted in Oklahoma hospitals being exempt from federal Certified Registered Nurse Anesthetist physician supervision requirements. Oklahoma joins 18 other states in adopting this exemption.
While the more burdensome supervision requirements have been removed, CRNAs are still required to “collaborate” with a physician on the administration of anesthesia.
Federal Medicare Conditions of Participation provide that CRNAs may only administer anesthesia if under the supervision of a physician who is immediately available; meaning the physician and the CRNA must either be in the same operating suite or same unit. However, a hospital may be exempted from this requirement if the state in which it operates submits a letter to the U.S. Department of Health and Human Services, signed by the governor, providing that such exemption is in the best interest of the state’s citizens and is consistent with state law requirements.
Until recently, Oklahoma law also required physician supervision of CRNAs administering anesthesia. In May, the Legislature removed this requirement to allow CRNAs to provide anesthesia services “in collaboration with” a provider. This change was the prerequisite needed in order for the state to request an exemption from the CoP requirements. Gov. Kevin Stitt in July sent a letter to Centers for Medicare & Medicaid Services Administrator Seema Verma requesting the exemption, stating that the exemption is “consistent with Oklahoma law and in the best interests of all Oklahomans, rural communities and our hospitals statewide.”
The phrase “in collaboration with” means to establish an agreement between the provider performing or directly involved with the procedure and the CRNA who are jointly working toward a common goal of providing services to the same patient.
As part of the collaboration, the provider and the CRNA must work together to formulate, discuss and agree upon an anesthesia plan for the patient. The modifications do not state whether this anesthesia plan should be in writing; however, it is recommended that the details of such plan, at a minimum, be documented in the patient’s medical record with some indication the provider and CRNA have agreed upon the plan.
This can be accomplished by either documenting approval in a physician note in the medical record, along with details of the plan, or signing a separate written plan to be scanned into the medical record. Any such anesthesia plan should be discussed with the patient as part of the informed consent process and documentation of such process should also be included in the patient’s medical record.
Further, the provider must remain available for timely onsite consultation during the delivery of anesthesia. The collaborating provider does not have to necessarily be on-site to be available for a timely on-site consultation, but must “be available to provide a consultation that is both timely and on-site.”
Whether the provider should be on-site during the entire procedure or merely available to be on-site in a timely manner is a decision left to the provider’s sound judgment. The facts and circumstances of the particular medical situation will warrant whether the provider should be on-site or off-site.
* This article first appeared in The Journal Record on November 6, 2020, and is reproduced with permission from the publisher.