How reimbursement policies can affect patient access to anesthesia care

Hospitals nationwide — especially those in rural or other underserved areas where staffing is challenging — count on the skills and talents of every single member of a healthcare team to provide the best possible patient care. Crucial members of that team include Certified Registered Nurse Anesthetists (CRNAs) — who are highly skilled, well trained, and licensed to deliver anesthesia care for a wide variety of cases including surgical, obstetrical, trauma stabilization, and pain management. Due to their exceptional training and experience, CRNAs practice with a high degree of autonomy, and in some states CRNAs are the sole anesthesia providers in nearly 100% of rural hospitals. Recently, one insurance company announced that CRNAs will receive 15% less compensation than other anesthesia providers for delivering the same services. It is likely that other companies may follow that same practice.

In 2010, a provider nondiscrimination provision in the Affordable Care Act was enacted. This law prohibits health insurance companies from setting different reimbursement rates for providers who are delivering the same high-quality healthcare services. Unfortunately, there is no regulation or rule currently in place issued by the agencies that oversee its implementation so there has been no enforcement of this law.

Due to the lack of enforcement of this nondiscrimination provision, some healthcare plans are reimbursing CRNAs at lower rates than other anesthesia providers for giving the same types of services. This is especially problematic at a time when healthcare staffing is a major concern, and particularly in rural areas that have a smaller provider pool.

What are the consequences of discriminatory CRNA reimbursement?

Discriminating against fully trained, educated and qualified CRNAs delivering the same anesthesia services as other providers can lead to multiple negative impacts on the healthcare industry overall, including:

  • Higher healthcare costs. Policies of unequal payment rates lead to higher cost healthcare delivery, without improving quality. Inconsistent insurance rates can pass the responsibility to facilities such as hospitals and off-site ambulatory surgery centers (ASCs) to make up the difference in the reduced payments which will increase costs and reduce access for patients. This can drive harmful cost-shifting in healthcare delivery that puts patient access to care at risk, especially among the most vulnerable populations in rural and underserved areas.
  • Increased staff shortages. Unchecked rate setting practices can cause CRNAs to leave an insurance network employing discriminatory reimbursement policies or to move to a different state — or even leave the healthcare field altogether, exacerbating current nationwide staffing shortages.
  • Limited patient access to care. Especially in rural areas where a CRNA may have been the only option for anesthesia care, patients may have few or no options available for anesthesia care at their local hospital.
  • Increased burden on hospitals. Many hospitals are being forced to make tough decisions around cutting much-needed services — such as obstetrics — due to massive financial losses, and reduced reimbursement for CRNAs will only increase these difficulties.

Promoting nondiscrimination in how healthcare providers are reimbursed allows consumers to be able to choose their anesthesia care from among highly skilled, well-trained licensed healthcare professionals such as CRNAs who perform the same services to the same high level of quality as other qualified providers.

“It’s critical to ensure that healthcare providers, including CRNAs and other nurses, are treated fairly,” says Angela Mund, DNP, CRNA and 2022-2023 president of the American Association of Nurse Anesthesiology (AANA). “A strong and enforceable provider nondiscrimination rule is vital to ensuring that everyone has access to life saving care from the provider of their choice.”

Learn more about how CRNAs help provide needed care to patients and how you can support them at

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