Association for Public Policy Analysis & Management

In the United States, anesthesia can be delivered by either physician anesthesiologists or certified registered nurse anesthetists (CRNA). Anesthesiologists can deliver anesthesia independently or CRNAs can deliver anesthesia independently or under the direction or supervision of an anesthesiologist. The anesthesia delivery mode is determined by a mix of state, federal, health insurer, and health care organization policies and regulations. Each state establishes a scope of practice regulations that govern the care that CRNAs can provide without the direction or supervision of an anesthesiologist. We use two surveys of anesthesiologists in the United States (first in 2007 and then in 2013) about their work patterns and employ a coarsened exact matching difference-in-difference estimator to examine the impact of states' opting out of a Medicaid requirement wherein CRNAs are not allowed to bill Medicare directly without the direct supervision by an anesthesiologist. We examine several work habits, including the types of cases the anesthesiologists work on. Among other things, we find that opting out is associated with anesthesiologists spending more time in surgery and less in post-op care, pain management care, and monitored anesthesia. In addition, their typical workload decreases as well. The opting-out and potentially increased scope of practice of CRNA's thus adjusts how anesthesiologists work in important ways.