Addressing Provider Shortages in Rural America: The Role of State Opt‐Out Policy Adoptions in Promoting Hospital Anesthesia Provision

Abstract

Background: Shortages of anesthesia providers in rural areas have long resulted in access limitations in many US states. This situation prompted federal legislation designed to promote increased usage of certified registered nurse anesthetists (CRNAs) in hospitals. Starting in 2001, state governors were afforded the option to adopt "opt-out" provisions, giving facilities in their states flexibility in utilizing CRNAs; specifically, adopting the opt-out policy removes physician oversight requirements for Medicare billing purposes. Methods:We used mixed effects generalized linear models to identify predictors of CRNA service provision in hospitals from 2011-2015. Results:We found that being located in an opt-out state does not result in increased odds of CRNA service provision in US hospitals. Higher levels of deprivation in counties, being located in rural geographic areas, and being a teaching hospital all influenced CRNA service provision. Conclusions:Given that we found no evidence that being in an opt-out state increases the odds of using CRNAs in hospitals, we contribute to the growing literature suggesting that states adopting the opt-out policy have not realized increased health care access or reduced health care costs. As a result of other contextual restrictions on hospitals' decision-making, simply adopting the optout policy has not been enough to address anesthesia provider shortages.

Physician dominance in the 21st century: Examining the rise of non‐physician autonomy through prevailing theoretical lenses

“…higher unemployment, poverty and rurality) result in fewer opportunities for APNs to make professional inroads. These findings run counter to prevailing wisdom that APNs should be able to make more headway in rural and impoverished areas due to increased need for health‐care services (Feyereisen et al, 2020).…”

Is Rural Kansas Prepared? An Assessment of Resources Related to the COVID-19 Pandemic

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