Although access to high-quality health care is a critical issue for our entire state, the problem is most acute in Colorado’s rural communities.
Rural health care facilities have a harder time attracting and retaining physicians than urban facilities, and the prospect of attracting surgeons, anesthesiologists and specialists to these parts of our state is dire.
As the CEO of Yuma District Hospital, I have a deep understanding of the unique workforce challenges faced by rural hospitals and the potential impact on the quality and safety of care provided to patients in rural communities.
In Yuma, the closest hospital with regular anesthesiologist coverage is two and a half hours away. Many of our doctors live far away from the hospital, and we have been unable to recruit any anesthesiologists to come to our community. This means that patients with emergent surgical needs often need to be transferred to other facilities, wasting precious time and putting patients at unneeded risk.
In August, Governor Bill Ritter submitted a letter to the Colorado Medical Board (CMB) and Colorado Board of Nursing (BON) regarding access to anesthesia services. Specifically, he sought the Boards’ recommendation on opting out of a burdensome federal rule that requires physician supervision of Certified Registered Nurse Anesthetists (CRNA) when sedating Medicare patients.
After hearing from physicians, hospitals, nurses and CRNAs, both boards determined that the opt-out would be consistent with state law and in the best interest of Colorado residents.
The opt-out would preserve access to high-quality, safe and affordable health care for rural communities without putting patients at any additional risk. It would also allow each hospital to determine the anesthesia arrangement that best meets the needs of the individual facility and its patients, adding needed flexibility for hospitals around the state.
Nurses have administered anesthesia for over 100 years and now provide 70 percent of anesthesia services in rural Colorado. In my experience, I have known CRNAs to be highly trained professionals who provide quality anesthesia services in communities that would otherwise lack access to surgical services.
I also know first-hand just how challenging it is for my hospital, and so many others, to comply with the federal CRNA supervision requirement. Physicians, many of whom have no training in anesthesia, are often either unavailable or unwilling to provide the required supervision of CRNAs.
When rural facilities cannot find physicians to supervise CRNAs, they cannot provide emergency or elective surgical procedures. This means that patients may be sent hundreds of miles away to receive critical care – a costly and physically burdensome prospect.
And most importantly, studies suggest that opting out of the federal requirement will not affect patient safety or the quality of care we provide.
In the spirit of maintaining the highest patient safety standards and increasing access to care, I am recommending that governor opt-out of the burdensome requirement. The Colorado Hospital Association, Colorado Rural Health Center, Colorado Nurses Association, Colorado Association of Nurse Anesthetists, and many of Colorado’s rural hospitals join me in this position.
With roots in rural Colorado, Gov. Ritter understands the diverse health care challenges of communities like mine. His awareness of rural hospitals’ increasing struggle to provide surgical services for their communities led him to consider opting out of the federal requirement, as 15 other states have already done.
Gov. Ritter’s consideration of the issue began in 2008 when he established the Collaborative Scopes of Care Study, which reviewed the quality, safety and effectiveness of CRNAs in anesthesia settings. The final report concluded that CRNAs are the primary providers of anesthesia in rural areas, permitting these otherwise medically underserved areas to offer critical obstetrical, surgical, pain management and trauma stabilization services.
In addition to the compelling evidence presented by the Collaborative Scopes of Care Study, the Governor now has the recommendation of both the CMB and the Colorado BON.
With this knowledge in mind, Colorado’s nurses, rural providers and hospitals have joined in support of the opt-out. Opting out will ensure access to high-quality care for the communities that need it most and remind Colorado residents that Gov. Ritter is a true champion for rural health care.
John Gardner is chief executive officer of Yuma District Hospital and secretary and treasurer of the Colorado Hospital Association Board of Trustees. He lives in Yuma. EDITOR’S NOTE: This is an online-only column and has not been edited.
