The American Society of Anesthesiologists (ASA) warns that removing physician oversight requirements under Medicare could compromise patient safety.
RT’s Three Key Takeaways:
- Supervision Rule Defense: The American Society of Anesthesiologists (ASA) urged the Centers for Medicare & Medicaid Services (CMS) to retain Medicare’s physician supervision requirement for anesthesia care in response to proposed federal regulatory changes.
- Access and Cost Findings: According to the ASA, independent evidence indicates that state opt-outs from supervision rules did not improve patient access to anesthesia care, and ending the federal mandate would not generate direct Medicare budget savings.
- Patient Safety Concerns: Citing state public health findings in California, the association cautioned that removing physician expertise and clear clinical accountability during anesthesia introduces significant hazards for patients.
The American Society of Anesthesiologists (ASA) is urging the Centers for Medicare & Medicaid Services (CMS) to maintain Medicare’s longstanding physician supervision requirement for anesthesia administration, according to an announcement from the association.
The group cautioned federal regulators that weakening or eliminating the mandate would remove a critical patient safety safeguard across healthcare facilities.
The ASA’s statement comes in response to the Cutting Administrative Requirements for Excellence in Patient Care (CARE) proposed rule, an initiative issued by CMS intended to reduce administrative requirements across Medicare and Medicaid programs. Within that proposed rule, CMS published a Request for Information (RFI) seeking input on the future of the federal physician supervision standard for certified registered nurse anesthetists (CRNAs), including whether the current policy should be retained, revised, or modified.
“ASA supports eliminating regulations that are outdated or unnecessarily burdensome. But patient-safety protections are not red tape,” said Jeffrey Mueller, MD, president of the ASA. “When patient safety is at stake, we will not compromise. We will fight to preserve physician supervision and the protections it provides.”
According to the ASA, independent research evaluating Medicare’s state opt-out policy—which allows individual US states to opt out of physician supervision rules for nurse anesthetists—demonstrated no meaningful improvement in patient access to anesthesia care. The association also reported that eliminating the federal supervision standard would yield no direct budget savings for the Medicare program, while questioning the clinical wisdom of expanding nurse-only models without physician oversight.
To highlight the clinical risks of unassisted practice models, the ASA cited regulatory findings from Modesto, California, an opt-out state. According to 2024 California Department of Public Health reports referenced by the society, facility use of a CRNA-only model violated state law and resulted in documented instances of “serious actual harm,” “serious potential harm,” and “risk of harm, injury and possibly death.”
“Modesto should be a warning, not a blueprint,” said Mueller, president of the ASA. “Anesthesia can turn from routine to life-threatening in seconds. Patients deserve clear clinical accountability and immediate access to physician expertise. That is not bureaucracy. That is patient safety. Good deregulation removes unnecessary bureaucracy. It should not remove safeguards that protect Medicare patients.”
