AANA Mid Year Assembly 2016

The AANA Mid Year Assembly took place April 2-6 in Washington, DC.

People attending the Mid Year Assembly from NVANA:
Jan Kleinsasser, Robert Erickson, Joanne Heins.

Topics covered:

  1. Essentials of effective CRNA advocacy.
  2. Best practices of individual CRNAs related to the overall AANA advocacy program.
  3. Logistical tasks such as conducting a meeting with legislators & staff to further CRNA policy and practice interests
  4. What our past teaches us about today and tomorrow, an insider’s view.
  5. Practice session.
  6. Board meeting, AANA President, Executive Director, Treasurer’s reports.
  7. CRNA-PAC Report & AANA Foundation Report.
  8. Awards for FPD of the year & state government relations advocacy.
  9. Health care policy changes shaping CRNAs future.
  10. AANA attorney’s report on the top 10 events impacting state regulation of CRNAs
  11. Individual region meetings (we are region 5)
  12. Speeches/presentations by the slate of candidates for region and Board of Directors positions.
  13. Rally on the west lawn of  The Capitol Building (very inspiring, but 30F and very windy…holy cow!)
  14. Visits to the senators and representatives (see below)

Visit report:

Jan, Robert and Joanne were able to visit the following offices on Tuesday, April 5: Senator Reid, Representatives Amodei, Titus & Hardy.  In all these offices we met with staff, we gave them information very well prepared by the AANA.  The biggest current push is the VHA proposal, HR 1247.  Sadly, these meetings are set up a long time in advance, and the House of Representatives was in recess! So, we did not meet with any reps.  Senator Reid also did not see us, but we spoke with an administrative aid.  Jan and Robert had to fly away home, so on Wed., April 6, Joanne Heins met with staff in Rep. Joe Heck’s office and in Senator Heller’s office.  Sen. Heller finished a meeting, and stopped by quickly, but I was able to point out that CRNAs are an excellent solution to rising healthcare costs!  We are safe and affordable.  He indicated interest, and said that he would look at the information I had, and especially the VA issue. (which is S 2279 in the Senate). If you are interested in more information, especially if you would like to see a copy of the information we take to the legislators, please contact Joanne Heins, jkheins57@gmail.com

I cannot stress enough what a good experience this is!  AANA is excellent at clearly stating our issues.  They help set things up, and you really get to see the value of membership!!! Plan to participate next year!

Thank you to Jason Girouard for setting up meetings even though he was unable to join us.

NVANA Annual Meeting – Oct. 17 2015 Las Vegas

Meeting Notes

Thank you to Karen Murphy for hosting at her house!
  1. Introduction of members present. Attendees: Morgan Beeson, Stephen Carrier, Andea Cook, Nancy Yang Digsby, SRNA,  Robert Erickson, Joanne Heins, Jan Kleinsasser, Brenda Koiro, Lauria Mason, Karen Murphy, Steven Sertich, Norma Sorelle, Toni Turner, and Margaret Wilson.
  2. Dr. Annette Teijeiro is running for Congress District 3. She is very pro CRNA (her husband is Steve Sertich, incoming NVANA President). Together, they were instrumental in helping to defeat SB181.  We should lend her our support, whether it is donation of time or money.
  3. NVANA has not been pleased with the performance of our previous lobbyist. We recently learned that this lobbyist currently represents Sunrise Hospital, creating a conflict of interest. NVANA is in current search of a lobbyist to speak for our interests on State and National level. Brenda Koiro, Morgan Beeson, Margaret Wilson and Joanne Heins will try to sort out the lobbyist situation.
  4. The Nevada State Board of Nursing does not currently have a CRNA sitting on the board.  The Board of Nursing advocates for public safety.  Let’s try to get a CRNA on the Nevada Board of Nursing.       
  5. Currently, APRNs has independent practice privileges in Nevada but not CRNAs.  The current Nevada State law states that CRNAs can give anesthesia at the request of a surgeon, podiatrist or dentist (may include gastroenterologist).  We need to have further discussion on whether to pursue “opt-out” legislation or continue supporting the current law, or amending the current law. 
  6.  Joanne Heins encouraged fellow CRNAs to join NAPNA to help develop closer ties with APRNs. They can be helpful if any problems with The Board of Nursing arise.  NAPNA will meet this February. 
  7. Margaret Wilson suggested we send up to four people to the Mid Year Assembly next year to discuss current state issues with state and national politicians.  There are funds available to help defray costs. 
  8. Information is available on the AANA website regarding multiple state initiatives against licensing of AAs: AANA/ My AANA/ Advocacy/ State government affairs/State update November 2015.  Anyone who has been part of the fast action team, please consider that job as ongoing.  And thanks to everyone who rallied to get the AA bill defeated (SB 181). Robert Erickson and Steve Hamilton will be on point for state legislative issues.
  9. Brenda Koiro and Morgan Beeson will help each CRNA in the state to be more organized and informed on who their exact Senator and Legislators are. They will also look at making the web site more useful and interactive.
  10.  NVANA would like to meet more then once a year to keep communication open between members. The next meeting is tentatively scheduled for January or February at the home of Joanne Heins. 
  11. CRNA week January 24-30, 2016.  Jan Kleinsasser is going to try to get something organized for publicity during National Nurse Anesthetist Week in January.
Meeting adjourned. 

Federal Political Director’s Annual Report for 2015

Federal Political Director’s Annual Report 2015

Dear Fellow NVANA Colleagues and Family Members:

Mid-Year Assembly, Washington D.C.

AANA members from across the United Stated attended Mid-Year Assembly (MYA) held at the Crystal Gateway Marriott in Arlington, Virginia from 18-22 April, 2015. Military CRNAs were represented as well. MYA is the annual advocacy conference for CRNA practice on the Federal level, and updates Congress regarding our concerns on legislative and policy issues which will affect delivery Safe and Effective Anesthesia Care. MYA also provides the opportunity to build relationships with members of Congress while we visit Capitol Hill.

L to R: Jason Girouard, Steve Hamilton, Rep. Cresent Hardy, Steven Sertich.


NVANA Delegates Attending MYA 2015

Steven Sertich, Pres-Elect, NVANA, former Region 5 director

Steven Hamilton

Jason Girouard


Advocacy Issues for 2015

CRNAs Provide Access to Safe and Affordable Healthcare

Recent studies have led researchers to recommend that supervision for CRNAs to be eliminated (1). The CRNA-model of a full –range anesthesia delivery is at least 25% more cost effective than medical-direction models, with maintaining high standards of quality and patient safety (2).The Institute of Medicine (IOM) recommend all APRNs, including CRNAs, practice to their full extent of their education and training (3). Also noted was frequent lapses in TEFRA requirements with as few as 2 CRNA being medically-directed simultaneously, which creates significant issues in CMS claims compliance (4).

Ensure Veterans Access to High Quality Care

CRNAs have been delivering anesthesia for over 150 years, with documentation of nurse anesthestists dating back to the Civil War. Sponsored by Sen. Mark Kirk (R-IL), SB 297 allows for Full Practice Authority (FPA) for APRNs, but omits CRNAs from this legislation. AANA/NVANA asks that SB 297, The Frontlines to Lifelines Act, be opposed with a “NO’ as it is currently written. If SB 297 is amended to include FPA for CRNAs, then it should be supported with a “YES” vote. It believed this bill will have long-term reverberations for CRNA practice going forward.

Restore Rural Access to Nurse Anesthesia Services

Medicare Part A cost-based pass-through reimbursement has been put at risk. CMS has twice denied rural pass-through funding for CRNA standby and on-call services, thus denying claims for Medicare funding which these hospitals have come to rely upon to keep their doors open and provide rural health services. Legislation reversing these policies must be introduced, while we oppose the Medicare Access to Rural Anesthesiology Act of 2013 (or similar legislation). This legislation will allow for addition funding for anesthesiologist in rural areas, which will in turn increase cost of services by an estimated 300% with no documented alteration in outcome or increase in services provided.

Pass SGR Legislation and Ensure Proper Implementation

On April 14, 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; President Obama signed it shortly thereafter. This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015 for the Medicare Physician Fee Schedule. In addition, provisions allowing for exceptions to the therapy cap, add-on payments for ambulance services, payments for low volume hospitals, and payments for Medicare dependent hospitals that expired on April 1 have been extended. CMS immediately began work to implement these provisions. This was the result of sustained efforts by organization such as AANA, and individual advocacy by CRNA and other practitioners. Good work, and congratulations to everyone involved.

Support Nurse Anesthesia Workforce Development

CRNA education programs collectively received about $3 million annually through the Title VIII Nurse Workforce Development Programs. The Affordable Care Act included a 4-year pilot Graduate Nursing Education (GNE) project to aid in caring for the increased demand of higher coverage rates combined with projected demographic shifts in the future. We ask all CRNAs and APRNs support Title VIII program renewals.

Visits to Elected Official in Washington, D.C.

  • Senator Harry Reid (D-NV). We met with Legislative Correspondent Kimberly Miller-Tolbert. Sen. Reid has recently declared his intention to retire from Congress at the end of his term
  • Senator Dean Heller (R-NV). We met with Ryan McBride, Legislative Assistant.
  • Dina Titus (D-NV-1). We met with Elizabeth Decker, Legislative Assistant.
  • Mark Amodei (R-NV-2). We met with Stephanie Walker.
  • Rep Joe Heck, D.O. (R-NV-3). We met with Michael Lisowski.
  • Cresent Hardy (R-NV-4). We met personally with Rep. Hardy. Mr. Hardy is from the Mesquite area, and this is his first-term in Congress.

Speedy Recovery for Stephen Panter, CRNA

Steve Panter moved to Carson City in the early 1970s. He is NV CRNA #002! When he started practice, there was no CRNA subsection in the Nurse Practice Act. In addition to 40-plus years of practice in Carson City/ Northern Nevada, he co-wrote the CRNA portion of the NPA which took over one-year to get approved. Steve recently had major surgery, and is recovering at home with his wife Marian.


Other Issues

SB 181, which allows the introduction of Anesthesiologist Assistant practice into Nevada, pass without opposition through the State Senate during this period. SB 181 moved into the Assembly Commerce and Labor Committee in May. SB 181 initally failed in Committee, but was resurrected via parliamentary procedure. SB 181 was not voted upon the Assembly floor as it did not have the votes to pass. I want to thank all those involved (albeit, not inclusive, nor in any particular order): Chad Brown, Annette Teijero, Steven Sertich, Steve Panter, Joanne Heins, Norma Sorell, Brenda Koiro, Margaret Wilson, Rand Bracken, Steve Hamilton, Susie West, Art Savignac, Gina Kronenberg, Ed Mohr, Sean Higgins, and Diana Girouard.   Again, this is not meant to be a fully-inclusive list. Thank you for everyone’s input on this; it was crucial in our victory.

Please consider starting and maintaining relationships with our elected official before it becomes critical.   Phone calls are good, letters are appreciated, but meeting in person opens new horizons in these relationships. Whether it is local events, walking the halls of the legislature, meeting locally, or walking with candidates while canvasing districts during the election period, these personal relationships will pay dividends into the future.

Thank you,

Jason Girouard, CRNA, MSN


1) Dulisee B, Cromwell J. No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians. Health Affairs. 2010;29(8): 1469-1475.

2) Hogan, P., Seifert, R., Moore, C., and Simonson, B. Cost Effectiveness Analysis of Anesthesia Providers. Nursing Economic$, 2010:28(3): 159-169.
3) Institute of Medicine (IOM). The future of nursing: leading change, advancing health. Washington, DC: The National Academies Press, p3-13 (pdfp.108) 2011
4) Epstein R, Dexter F. Influence of Supervision Ratios by Anesthesiologists on First-case Starts and Critical Portions of Anesthetics. Anesthesiology. 2012;116(3): 683-691.

NVANA 2014 Annual Meeting – Las Vegas

NVAVA 2014 Annual Meeting – Las Vegas

In attendance:

  • Joanne Heins, CRNA President
  • Steven Sertich, CRNA President –Elect, former AANA Region 5 Director
  • Toni Turner, CRNA
  • Brenda Koiro, CRNA
  • Karen Murphy, CRNA
  • Margaret Wilson, CRNA
  • Morgan Beeson, CRNA
  • Suk Hi Ross, CRNA
  • Jennifer Brown, CRNA
  1. The NBCRNA CPC Program was the first topic discussed. Joanne and Steve provided an overview of the history and future of the NBCRNA. Kate Jansky CRNA, Region 5 Director sent the following email to the Region 5 State Presidents. The email is being reproduced with the consent of Joanne Heins and Kate Jansky.

Subject: NBCRNA Update

Hello State Presidents:

As a follow up to the AANA Annual Congress, the AANA President and President elect met with the NBCRNA Executive Committee on October 21st in Chicago to discuss the Continued Professional Certification (CPC) Program, resolution 2014-2, and the Recognition Agreement.

NBCRNA has agreed to 2 elected AANA members on their BOD, for which they will rewrite their bylaws. There will be an NBCRNA liason directly to the Continuing Education Committee, to ensure work is collaborative. NBCRNA assures us they have no plans to certify any other professionals.

In the past, the NBCRNA has made significant changes to the CPC Program and are now considering more changes to the future program addressing members’ requests.

Both AANA and NBCRNA leadership are working on a communication plan to provide transparency of the CPC Program and our relationship.

For the future of our great profession, the AANA and the NBCRNA are working together to address the member’s concerns in a positive manner. The strength of our profession has been the working relationship that we have with each other. As we speak to legislators, healthcare policy makers, and facility administrators, we show strength in unity while delivering the same message

Both organizations appreciate the time allowed to define and operationalize the process. There will be a major announcement of the full negotiations at Fall Leadership Academy.

Kate Jansky, CRNA, MS Ltc USA (Retired)
Director, Region 5 

  1. Steve Hamilton, CRNA State Government Relations Chair, wrote in to Joanne Heins regarding the national efforts that are being made on behalf of the Veterans Health Administration (VHA) Access to Care through ARRN Full Practice Authority. For additional information visit AANA/ Advocacy/ Federal Government Affairs. A sample CRNA letter in support for the VA proposal to recognize CRNAs and other APRNs as Full Practice Providers (FPP) is available online using the Take Action tool at www.crna-pac.com.
  1. The Nevada State AA proposal, SB 181, Provides for the licensure of certified anesthesiology assistants (BDR 54-240). The Feb 2015 session will hear strong support from the American Society of Anesthesiologists and the American Medical Association. Additional information for opposition to the bill can be found at AANA/ Advocacy/ stategovaffairs/documents/AA fact sheet.
  1. Margaret Wilson, CRNA nominated Dan Simonson CRNA, MHPA for VP of AANA with a second nomination from Steve Sertich, CRNA. The vote was unanimous in favor for the nomination.

    Margaret Wilson, CRNA nominated Kate Janski, CRNA for treasurer of AANA with a second nomination from Toni Turner, CRNA. The vote was unanimous in favor for the nomination.

  1. Treasury Report and Budget

Federal Political Director’s Annual Report for 2014

To My Fellow NVANA Colleagues:

CRNAs visit Capitol Hill – Mid-Year Assembly 2014

Over 900 AANA members traveled from all fifty States and Puerto Rico to advocate for CRNA practice and access to care with the elected members of the United States Congress in Washington, D.C. April 5-9, 2014. The AANA Washington DC office confirmed this was a record attendance for Mid-Year Assembly.

NVANA Delegates Attending 2014 MYA

Joanne Heins, President-NVANA
Jason Girouard, FPD-NVANA
Steven Sertich, current AANA treasurer candidate, former Region 5 director

AANA Business

AANA Board of Director’s meeting on April 5 was well attended. AANA President Dennis C. Bless and AANA Treasurer Cheryl L. Nimmo gave their respective association updates April 6 to the general audience of conference attendees. Leah Binder, President and CEO of Leapfrog Group was the keynote speaker, and her focus was on how to provide best “value” during her review of the current healthcare environment. Various regional updates were conducted as breakout session, as well as various PAC fundraisers. Candidates for AANA office were afforded time for speeches, including NVANA’s own Steven Sertich, CRNA, J.D.

Issues Addressed

CRNAs Provide Access to Safe and Affordable Healthcare

Through all anesthesia delivery models, care by CRNAs is extremely safe and 25% more cost-effective than the next less-costly model. (1). The Future of Nursing report by the Institute of Medicine (IOM) recommends “Nurses should be able to practice to the full extent of their education and training” and should be “full partners with physicians and other health care professionals. . .” in efforts to ensure patient access to high –quality care. (2) A study published in Anesthesiology discussed frequent supervision lapses by anesthesiologists using TEFRA definitions, even during low levels of supervision (3). Results of these reports had led to calls for elimination of supervision requirements.

Repeal SGR (Sustainable Growth Rate) Cuts and Reform Medicare Payment

AANA has requested members petition Congress to enact legislation to permanently repeal SGR cuts and reform Medicare’s reimbursement system. The Medicare Payment Advisory Commission (MedPAC) proposed to “fix SGR” by cutting anesthesia payments by 17% over 3 years. Medicare reimburses physician services at 80% of market rates, but reimburses Part B at approximately 45% of market rates. A permanent SGR “fix” was delayed for another year, and will be under review again in 2015. AANA stressed that Medicare payment reforms should recognize CRNAs the same as physicians as anesthesia standards are the same regardless of type of practitioner.

Ensuring Veteran Access to High Quality Care

Approximately 700 AANA members serve with the Veterans Health Administration (VHA). CRNAs are the oldest nursing specialty, and have been providing all types of anesthesia services for over 150 years. CRNAs have been providing the majority of the anesthesia services for the military, both in peace and combat, since World War I. VHA Nursing Handbook modernization which designates CRNAs and APRNs as Full Practice Providers (FPP) with Full Practice Authority (FPA) is supported by the AANA. VHA does not require physician supervision, and CRNAs are the sole anesthesia provider in some VHA facilities. Safety records of CRNAs have been demonstrated through the waiver of supervision requirement in the seventeen states which have exercised the opt-out process required by Medicare. It is recommended that you contact the VA and your congressional members to support the modernization of the VHA Nursing Handbook, support CRNAs/APRNs Full Practice Providers, and oppose the “Grimm-Kirkpatrick Letter”.

Provider Nondiscrimination

Provider nondiscrimination was enacted into law in 2010 to promote access to healthcare and patient choice of healthcare professionals in an attempt to reduce costs and foster competition. If health insurance plans are able to exercise the type and location of healthcare professionals they agree to reimburse, the law will allow them to discriminate among entire classes of licensed professionals. This not only creates a difficult situation for the licensed professional discriminated against, but also places the patient in financial jeopardy due to a higher out-of-pocket bill due to refusal of reimbursement. Rep. Andy Harris (R-MD) has introduced legislation, HR 2817, to repeal provider nondiscrimination. AANA requests ask that your congressional delegates oppose HR 2817.

Support Nurse Anesthesia Workforce Development

Title VIII Nursing Workforce Development for FY2014 is approximately $233 million. Nurse anesthesia educational programs receive approximately $3 million of these aggregate assets. Title VIII funding fell below the level of inflation in 2005, and has not kept up since. Graduate nursing education is supported in recent health policy decisions with the intention of APRNs providing clinical care for the ever-increasing demands in the healthcare arena. These developments are supported by organizations such as AARP and governmental agencies such as CMS. Demand for CRNA service is projected to continue to increase due to an increasing and aging population.

Other Issues

Other issues included opposition to the 96-hour rule for Critical-Access Hospitals, opposition to the CMS Two-Midnight Rule for hospital inpatient admission, continued support of CRNA interventional pain management, “meaningful use” of EMR, delay of ICD-10 implementation, and continued updates on medication shortages.

Visits to Congressional Delegation of Nevada on Capitol Hill

  • Senate Majority Leader Harry Reid (D-NV). This year we met with assistant for health affairs McKenzie Bennett.
  • Senator Dean Heller (R-NV). NVANA met with Ryan McBride, assistant for health affairs.
  • Representative Dina Titus (D-NV-1). We met with Katherine Cassling, assistant for health affairs.
  • Representative Mark Amodei (R-NV-2). We personally met with Congressman Amodei and his aide Anna Leieritz. We talked at length about implementation of the Affordable Care Act (ACA), and access to anesthesia care. Congressman Amodei personally requested to keep his office update about legislation regarding CRNAs. Anna Leieritz has since resigned her position at Congressman Amodei’s office- Stephanie Walker is the new assistant for health affairs.
  • Representative Joe Heck, D.O. (R-NV-3). We were unable to meet with Congressman Heck’s office due to scheduling conflicts. The following link is Dr.
  • Heck’s response to SGR debate. http://thehill.com/blogs/congress-blog/healthcare/202221-a-missed-opportunity-to-fix-the-sgr
  • Representative Steven Horsford (D-NV-4). District 4 is Nevada’s newest district since the 2010 census reapportioning, and Congressman Horsford became District 4’s first Congressman in 2012. NVANA delegates were unable to meet with the Congressman as he was in committee, but we did meet with his assistant, Nancy Juarez.

I want to thank those who took the time and effort to travel across the nation and attend this event. Joanne Heins and Steven Sertich were instrumental in helping with the Capitol Hill visits. I also want to thank Gina Kronenberg for her assistance and work as NVANA Treasurer. This is where your annual dues go: to protect CRNA practice and ensure access to “Safe and Effective Anesthesia Care” with the best value. It was a wonderful learning experience, and I encourage you to take the time to go next year. I also want to thank the Washington, D.C. office, including (but not limited to) Frank Purcell and Kate Fry, for their tireless efforts in both the year-round advocacy efforts and for the conference.

We are continuing to work on policy issues throughout year-round, so please feel free to keep the NVANA leadership informed of practice issues. Also, please contact your elected representative, as they do want to hear from you.
Jason Girouard, CRNA, MS


1) Dulisee B, Cromwell J. No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians. Health Affairs. 2010;29(8): 1469-1475.
2) Institute of Medicine (IOM). The future of nursing: leading change, advancing health. Washington, DC: The National Academies Press, p3-13 (pdfp.108) 2011
3) Epstein R, Dexter F. Influence of Supervision Ratios by Anesthesiologists on First-case Starts and Critical Portions of Anesthetics. Anesth. 2012;116(3): 683-691.


L to R: Jason Girouard, Steven Sertich, Congressman Amodei, Joanne Heins.

L to R: Jason Girouard, Steven Sertich, Congressman Amodei, Joanne Heins.


Joanne Heins & Jason Girouard in front of US Capitol between visits.

Joanne Heins & Jason Girouard in front of US Capitol between visits.

Federal Political Director’s Annual Report for 2013

Hey CRNA Colleagues across Nevada….

Issues addressed on Capitol Hill for Mid-Year Assembly 2013

This year CRNAs across the nation, and members of the AANA lobbied elected officials of the U.S. House and Senate in Washington, DC during April 14-17. This is our opportunity to voice our concerns as part of our yearly federal policy education conference on Capitol Hill.

Issues addressed included:

1. Promoting Competition, Choice and Cost Savings in Patients’ Healthcare by Protecting Provider Nondiscrimination:

The provider nondiscrimination law taking effect January 2014 protects patients and employers from out-of-control healthcare cost growth and promotes access to care by prohibiting health plans from discriminating against qualified licensed healthcare providers (such as CRNAs) solely on the basis of the providers’ licensure (P.L. 111-148, Sec. 1201). This law, subject to a federal regulatory notice-and-comment rulemaking process, supports the pro-consumer, pro-market principle of nondiscrimination and should be protected against attempts to weaken it.

2. Protecting Patient Access to Safe Care of Pain:

After two Medicare carriers threatened patient access to chronic pain management services by CRNAs, the Medicare agency acted in 2012 with support from many members of Congress, hospital, rural health and consumer groups to protect patient access to care by clarifying that it covers all Medicare CRNA services within CRNA scope of practice in the state that the service was provided. The need for these services is great: the 2011 Institute of Medicine study Relieving Pain in America found that 100 million Americans suffer from chronic intractable pain at an annual U.S. economic cost approaching two-thirds of a trillion dollars.

3. Combat Dangerous Shortages of Anesthesia Drugs:

With AANA’s support, Congress in 2012 enacted legislation to combat drug shortages by requiring manufacturers to provide more advance notice of conditions that may give rise to shortages (FDA Safety and Innovation Act or FDASIA, P.L. 112-144, Title X). Unfortunately, persistent shortages of anesthesia drugs are affecting patient care and increasing healthcare costs – a fact that America’s CRNAs want to keep before Congress as it oversees implementation of FDASIA.

4. Support Patient Access to Quality Care through Nurse Workforce Development Funding:

Though the rising number of retiring baby boomers increases patient demand for healthcare, patient access to care is put at risk when there is not a sufficient supply of nurses, APRNs, and CRNAs to provide it. The Medicare Graduate Nursing Education demonstration project must continue being implemented, and funding for the Title 8 Nurse Workforce Development program in Labor-HHS-Education appropriations legislation must be preserved, to ensure patient access to quality care now and in the future.

Evidence shows CRNAs help make healthcare more accessible, work better, and cost less based on several studies, including:

  • Health Affairs in August 2010,” found there is “No Harm Found when Nurse Anesthetists Work without Supervision by Physicians.”
  • The Lewin Group study published May-June 2010 in the “Journal Nursing Economic$,” found that Nurse Anesthesia care is the most cost-effective model of anesthesia delivery.
  • The Institute of Medicine (IOM), “The Future of Nursing: Leading Change, Advancing Health.”
  • The newest Study: “Influence of Supervision Ratios by Anesthesiologists on First case Starts and Critical Portions of Anesthetics.” First-case Starts and Critical Portions of Anesthetics Lapses in Anesthesiologist Supervision of CRNAs.

NVANA Advocacy leadership attending the 2013 MYA:

Phyllis Kantor, FPD of NVANA
Joanne Heins, President-Elect of NVANA
Steve Sertich, AANA 5 Director
Susanna Bean West, NVANA CRNA
Art Savignac, NVANA CRNA
Emily Bean, Student Nurse Anesthetist – Sister of Susanna

I want to reach out and thank all those who participated at this years MYA. This is an extremely important endeavor where we strive to educate our legislators to further CRNA concerns, practice issues and patients access to anesthesia services. I’ve included a map of Nevada that delineates anesthesia services across the State of Nevada according to anesthesia providers. The white out areas indicate significant access barriers to anesthesia services. The NVANA leadership distributes these maps to your legislators on Capitol Hill to make our case for supporting CRNA practice where CRNAs provide the majority of anesthesia services in rural America.

All appointments with Nevada’s Legislators for 2013:

  • U. S. Senate Majority Leader Harry Reid (D-NV). This year we met with the Senator’s Health Care Consultant Kate Leone. Frank Purcell, AANA Senior Director, Federal Government Affairs joined us.
  • U. S. Senator Dean Heller (R-NV-2nd district): We were fortunate to meet Mrs. Heller on the way out – Susanna West & Emily Bean grew up with the Heller family.
  • U. S. House Representative Joe Heck (R-NV-3rd district): This year we met with the Congressman’s assistant Mr. McBride the son of Dr. McBride who supports CRNA independent practice in Nevada.
  • U. S. House Representative Mark Amodei ((R-NV-2nd district):
  • U. S. House Representative Dina Titus (D-NV-1st district)

Doctorate in Nursing Practice Capstone Project

I want to take this opportunity to thank all my colleagues in Nevada who returned my DNP Capstone questionnaire. At our AANA Annual Meeting several colleagues asked me about the findings. Here are the results:

The findings of the study were quite significant indicating that 94% of Nevada’s CRNAs feel qualified to practice without the CMS supervision requirement. Furthermore, 80% of Nevada’s CRNAs indicate that if barriers to practice were removed they would support an Opt Out policy and 63% of Nevada’s CRNAs feel Nevada is ready for an Opt Out policy. Based on our CRNA membership list as of 2012 we had 72 practicing CRNAs. There are 58 urban CRNAs practicing in Nevada or 81%, and 14 rural CRNAs practicing in Nevada or 19%. The level of satisfaction to practice was 57% – satisfactory, fair or poor while 46% reported excellent.

As reported by the two other cohorts in the study (the seventeen State Association Presidents before they became an Opt Out state and the seventeen State Association Presidents after they became an Opt Out state), 68% of CRNA presidents identified Opt Out as their solution to barriers to practice before Opt Out was sought. In addition, 45% reported that barriers to practice after Opt Out was instituted were resolved. Moreover, once Opt Out was established in their state it created a 64% increase in practice opportunities with a surge in practice satisfaction of 91%. The most common recommendations from the State Association presidents were: Educate all stakeholders at every level about the role CRNAs play in health care delivery; educate and lobby your legislators and disseminate smart politics utilizing strategic politicking; relationships formed through grassroots networking are key factors essential to the procurement of one’s goal. The most common concern echoed among Nevada CRNAs was lack of funds to support a political process leading to an Opt Out policy. I addressed those concerns in the questionnaire to the 34 State Presidents: Did available funds needed for legal costs prevent you from seeking an Opt Out in your state? 91% said NO. Was the legal cost to obtain an Opt Out worth the fight to gain full scope of practice? 91% said YES.

Thank you so much…. Phyllis Kantor, CRNA

Clear distinction between rural and urban communities in Nevada (American Association of Nurse Anesthetists, 2012)

Map of Nevada: Delineated According to Anesthesia Access.
Clear distinction between rural and urban communities in Nevada (American Association of Nurse Anesthetists, 2012)


MYA 2013: Senator Dean Heller, Phyllis Kantor, FPD; Joanne Heins President-Elect; Steve Sertich Region 5 Director; Susanna Bean West; Art Savignac; Emily Bean, SRNA

MYA 2013: Senator Dean Heller, Phyllis Kantor, FPD; Joanne Heins President-Elect; Steve Sertich Region 5 Director; Susanna Bean West; Art Savignac; Emily Bean, SRNA


MYA 2013: Mrs. Dean Heller; Phyllis Kantor, FPD; Joanne Heins, President-Elect; Susanna Bean West; Emily Bean, SRNA

MYA 2013: Mrs. Dean Heller; Phyllis Kantor, FPD; Joanne Heins, President-Elect; Susanna Bean West; Emily Bean, SRNA


MYA 2013: Congresswoman Dina Titus; Phyllis Kantor, FPD; Joanne Heins, President-Elect; Susanna Bean West; Steve Sertich, Region 5 Director

MYA 2013: Congresswoman Dina Titus; Phyllis Kantor, FPD; Joanne Heins, President-Elect; Susanna Bean West; Steve Sertich, Region 5 Director


MYA 2013: Congressman Mark Amodei with Phyllis Kantor, FPD; Joanne Heins President-Elect; Steve Sertich Region 5 Director; Susanna Bean West; Art Savignac

MYA 2013: Congressman Mark Amodei with Phyllis Kantor, FPD; Joanne Heins President-Elect; Steve Sertich Region 5 Director; Susanna Bean West; Art Savignac


MYA 2013: Phyllis Kantor, FPD; Joanne Heins President-Elect; Steve Sertich Region 5 Director; Susanna Bean West; Art Savignac

MYA 2013: Phyllis Kantor, FPD; Joanne Heins President-Elect; Steve Sertich Region 5 Director; Susanna Bean West; Art Savignac

Certified Registered Nurse Anesthetists (CRNAs) at a Glance

Certified Registered Nurse Anesthetists (CRNAs) at a Glance

Nurse anesthetists have been providing anesthesia care to patients in the United States for 150 years.

The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. CRNAs are anesthesia professionals who safely administer more than 34 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2012 Practice Profile Survey.

CRNAs are the primary providers of anesthesia care in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, pain management and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100% of the rural hospitals.

According to a 1999 report from the Institute of Medicine, anesthesia care is nearly 50 times safer than it was in the early 1980s. Numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts.*

CRNAs provide anesthesia in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way.

As advanced practice registered nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.

CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities.

Nurse anesthetists have been the main providers of anesthesia care to U.S. military personnel on the front lines since WWI, including current conflicts in the Middle East. Nurses first provided anesthesia to wounded soldiers during the Civil War.

Managed care plans recognize CRNAs for providing high-quality anesthesia care with reduced expense to patients and insurance companies. The cost-efficiency of CRNAs helps control escalating healthcare costs.

In 2001, the Centers for Medicare & Medicaid Services (CMS) changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt out of this facility reimbursement requirement (which applies to hospitals and ambulatory surgical centers) by meeting three criteria: 1) consult the state boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state, 2) determine that opting out is consistent with state law, and 3) determine that opting out is in the best interests of the state’s citizens. To date, 17 states have opted out of the federal supervision requirement, most recently Kentucky (April 2012). Additional states do not have supervision requirements in state law and are eligible to opt out should the governors elect to do so.

Nationally, the average 2012 malpractice premium for self-employed CRNAs was 33% lower than in 1988 (65% lower when adjusted for inflation).

Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program.

Nearly 47,000 of the nation’s nurse anesthetists (including CRNAs and student registered nurse anesthetists) are members of the AANA (or, greater than 90% of all U.S. nurse anesthetists). More than 40% of nurse anesthetists are men, compared with less than 10% of nursing as a whole.

Education and experience required to become a CRNA include:

  • A Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree.
  • A current license as a registered nurse.
  • At least one year of experience as a registered nurse in an acute care setting.
  • Graduation with a minimum of a master’s degree from an accredited nurse anesthesia educational program.  As of Aug. 1, 2013 there were 113 accredited nurse anesthesia programs in the United States utilizing more than 2,200 active clinical sites; 16 of these programs award a doctoral degree for entry into practice. Nurse anesthesia programs range from 24-36 months, depending upon university requirements.  All programs include clinical training in university-based or large community hospitals.
  • Pass the national certification examination following graduation.

In order to be recertified, CRNAs must obtain a minimum of 40 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure, and certify that they have not developed any conditions that could adversely affect their ability to practice anesthesia.

For More Information:
PR Dept., 222 South Prospect Avenue, Park Ridge, IL 60068-4001
(847) 692-7050  ▪  pr@aana.com  ▪  www.aana.com

A copy of Quality of Care in Anesthesia is availalbe from www.aana.com.

FPD Message MYA 2012 – Washington, DC

August 11, 2012


2012 Capitol Hill. Steve Sertich, Joanne Heins, Phyllis Kantor, Steve Hamilton. AANA-Region-5

Hey all my CRNA Colleagues and Constituency across Nevada… at this year’s MYA…

AANA Mid-Year Assembly CRNA Federal Government Issues for 2012 on Capitol Hill

The AANA’s Mid-Year Assembly is our chance to voice our concerns to our elected U.S. Senators and Representatives in the Nation’s Capital. During this time our goal is to establish valuable relationships in Congress to promote awareness about quality of care and cost-effectiveness of CRNAs and provide input on legislative and other policy issues crucial to the nurse anesthesia profession. We prepare for these appointments, first by attending three days of educational sessions. These sessions provide a review of CRNA issues that affects our practice and provides us with training on effective personal professional advocacy before Congress. This was our opportunity to canvas on Capitol Hill on core issues that affect all citizens across our nation.

This year’s priorities focused on:

  • Ensuring Patient Access to Safe Care of Pain (Pain Management)

A critical aspect of the anesthesia care continuum is pain management, and providing acute and chronic pain management services is within CRNA professional scope of practice. A recent Institute of Medicine analysis of pain in the U.S. found that 116 million Americans suffer from chronic intractable pain at an annual healthcare and economic cost near two thirds of a trillion dollars, and that not nearly enough healthcare professionals are available to assess and care for those patients effectively.

  • Saving our Seniors’ Medicare and Stabilize Medicare Part B

Dramatic Medicare cuts threaten patient access to care and healthcare financing; our request was to enact long-term relief.

  • Supporting Patient Access to Quality Care through Nurse Workforce Development Funding

Promoting support for FY 2013 appropriations for Nurse Anesthesia Education requesting an increase from $3 million to $4 million as a result of an increase in demand for CRNAs as the U.S. population ages (baby boomers).

  • Congress should Promote Competition, Choice and Cost Savings in Patient’s Healthcare by Protecting Provider Nondiscrimination.

While healthcare costs continue growing unsustainably, healthcare policymakers continue to seek ways to make healthcare work better, cost less, more accessible to patients, and higher quality. Landmark research published in the last three years underscores the value of CRNAs in advancing toward these crucial objectives. This year we add another Significant Study to our already impressive list:

  • “No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians” by Dulisse & Cromwell.
  • “Cost Effectiveness Analysis of Anesthesia Providers” by Hogan, Moore, Seifert & Simonson
  • “The Future of Nursing: Leading Change, Advancing Health” by the IOM.
  • “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research” by the IOM.

This additional Significant Study is:

“Influence of Supervision Ratios by Anesthesiologists on First-case Starts and Critical Portions of Anesthetics” by Epstein & Dexter. This study shows First-case Starts and Critical Portions of Anesthetics Lapses in anesthesiologist supervision of CRNAs and is common even when an anesthesiologist is medically directing as few as two CRNAs.

This study looks at over 15,000 anesthesia records in one leading U.S. hospital and raises critical issues about propriety and compliance in, what we know, is the most common and costly model of anesthesia delivery at a time when quality and cost-effectiveness are white-hot healthcare issues at every level.

As our President of the AANA, Debra Malina stated, “…Such a striking conclusion confirms the evidence and our view that supervision ratios do not benefit patient outcomes, and that medical direction costs tremendous sums of money needlessly.”

All appointments with Legislators and Representatives took place on April 17-18, 2012:

Advocacy Leadership: Steve Hamilton-President, Phyllis Kantor-Federal Political Director, and Joanne Heins: We met with the following Congressional Leaders on Capitol Hill: Addressing all issues as stated above…

    • U. S. House of Representative Shelley Berkley (D-NV-1st District), now running for the Senate.
    • U. S. House of Representative Mark Amodei (R-NV-2nd District). His daughter is entering a nurse anesthesia program…We had his attention!!
    • U.S. House of Representative Joe Heck (R-NV-3rd District), this year only passed in the Capitol Tunnel-not an actual meeting, but he did recognize our group from last year.

This year we had the added opportunity and pleasure of meeting with:


MYA 2012: Senate Majority Leader Harry Reid

  • Senator Harry Reid (D-NV-Senate Majority Leader) in the Capitol. Attending this appointment was as follows: Our AANA leadership, Frank Purcell, AANA Senior Director of Federal Government Affairs, Christine Zambricki, AANA Senior Director, Federal Affairs Strategies, and Steve Sertich, AANA Region 5 Director.

**Thursday morning we again met with Senator Harry Reid at a breakfast meeting that he holds every Thursday morning for all Nevada constituencies. He recognized us with acknowledgement, as he regaled us with the facts of the past years accomplishments for Nevada and America.

See you soon,

Phyllis Kantor, CRNA, MSN, Federal Political Director of NVANA



MYA-2012: Phyllis Kantor and Steve Hamilton


MYA-2012: Steve Hamilton, Joanne Heins, Phyllis Kantor


MYA-2012: Congresswoman Shelley Berkeley


MYA-2012: Congressman Mark Amodei (R NV 2nd district)

NVANA 2012 Annual Meeting – Las Vegas

Mark your calendars for the 2012 Annual Meeting in Las Vegas on 10/27/2012!

This year, the annual meeting will be held at the end of the Institute for Post-Graduate Education, Inc. (IPGE) Las Vegas Seminar, held at NEW YORK NEW YORK.  IPGE will be providing a meeting room for the annual business session to be conducted on Saturday, October 27th at 11:30 AM. More details about courses offered by IPGE are available at http://www.ipge.com/.

Many important issues for the membership will be discussed including recertification, CMS pain management proposal, treasurers report, and AA’s being reintroduced to the State Legislature.

Come participate in the future direction of Nurse Anesthesia care in Nevada.

Looking for some CE hours? NVANA members will have an opportunity to register for the 20 credit IPGE meeting at a discount.

In the mean time, please send nominations for President Elect, Board Members, Federal Political Director, and Treasurer to our Secretary at jkheins at aol.com. Voting will take place in September.

In relationship to these positions, NVANA needs to send at least 5 individuals to The Fall Leadersip Academy Training Nov 16-18th in Colorado Springs.  This will include the President Elect, the State Government Relations Chair, the Federal Political Director, and Nevada AANA Foundation Advocate.

FPD Message MYA 2011 – Washington, DC

September 6, 2011

Hey all my CRNA Colleagues and Constituency across Nevada,

This is an exciting time for our Nevada Association of Nurse Anesthetists, which has been quite a year for your elected and appointed officers who are working hard in re-establishing a viable Association with definitive goals.  We have many issues NVANA is tackling; one major challenge was defeating Bill SB258, thanks to our former President Steve Sertich who fought hard for our cause. Steve’s emails called us to take action by contacting our legislature to vote against this Bill. Steve has been on top of this subject, which effectively blocked the AA program from going any further, for now. But, we must be prepared to revisit the debate in two years, doing our homework to bring this Bill (SB258) to defeat, definitively. As always, we must continue to be diligent in our efforts to protect our practice in Nevada. Thank you Steve Sertich…!!!

AANA Mid-Year Assembly CRNA Federal Government Issues for 2011 on Capitol Hill

I have the pleasure of representing our Nevada Association of Nurse Anesthetists by serving as your Federal Political Director. In April, past President, Steve Sertich, President-Elect, Steve Hamilton (now President), and I, had the opportunity to canvas on Capitol Hill on core issues that affect all citizens across our nation. Nurse Anesthesia Care Is Critical to our Community to Promote Competition, Choice, and Cost Savings in Patients’ Healthcare.

The 43,000 members of the AANA represent over 90 percent of all CRNAs, who safely administer some 32 million anesthetics to patients each year in the United States, which predominates in rural and medically underserved America, as well as, in our Veterans and Military HealthCare Systems.

Evidence Shows CRNAs Help Make Healthcare More Accessible, Work Better, and Cost Less. CRNAs Provide Access to Safe and Affordable HealthCare. We are the backbone of our HealthCare system and play a major role in HealthCare delivery. We must be an active part of the discussion to come up with smart strategies in solving our HealthCare crises to ensure that all CRNAs are full partners in redesigning HealthCare.  As evidenced by the following:

  1. Research published in Health Affairs in August 2010, which concluded that there is “No Harm Found when Nurse Anesthetists Work without Supervision by Physicians.”
  2. A Lewin Group study published May-June 2010 in the journal Nursing Economic$, which found that Nurse Anesthesia care is the most cost effective model of anesthesia delivery.
  3. Outcome of the newest major study, The Institute of Medicine (IOM), “The Future of Nursing: Leading Change, Advancing Health,” who recommend that advanced practice registered nurses (CRNAs) should be able to practice to the full extent of their education and training.

Protecting Provider Nondiscrimination:

HealthCare Plans shouldn’t be able to discriminate against a whole class of Healthcare Providers solely on the basis of licensure of anesthesia providers; we must prevent others from defining our practice and promote patient access to HealthCare.

Support Patient Access to Quality Care through Nurse Workforce Development Funding:

Legislation Congress enacted providing $200 million over four years through a Graduate Nursing Education demonstration project.

  1. It must be implemented with funding for the Title 8 Nurse Workforce Development program, so it’s preserved to ensure patient access to quality care now, and in the future.
  2. Reverse 21.2% Medicare CRNA and Physician Payment Cuts.

All appointments with Legislator’s and Representative’s took place on Wednesday April 13, 2011: Addressing all issues as stated above…

Steve Sertich, Steve Hamilton, and I (Phyllis Kantor, FPD), met with the following Congressional Leaders on Capitol Hill:

  • U. S. House of Representative Dean Heller (R-NV-2nd district), now Senator, replacing John Ensign in U.S. Senate.
  •  U. S. House of Representative Shelley Berkley (D-NV-1st district), now running for Senate in 2012.
  •  U. S. House of Representative Joe Heck (R-NV-3rd district).
  •  Assistant Griffin Doherty to Senator Harry Reid (D-NV).

The conversation is ongoing… Please give suggestions and ideas to your leadership; be part of the solution of CRNA practice by preventing others from defining our constituency. As we go forward, we will continue to be the backbone of our HealthCare system, which enables us to practice to the full extent of our education and training.

I look forward to meeting all those CRNAs attending our NVANA meeting in Mesquite on Sept. 17, 2011. Be sure to check out our new and improved NVANA website often: www.nvana.org

See you soon,

Phyllis Kantor, CRNA, MSN

Federal Political Director NVANA

 Steve Hamilton, President; Steven Sertich, Region 5 Director; and Phyllis Kantor, FPD

Pictured with Congressman Dean Heller

Steven Sertich, Phyllis Kantor, and Steve Hamilton

Pictured with Congressman Joe Heck

Steve Hamilton, Phyllis Kantor, and Steven Sertich

Pictured with Congresswoman Shelley Berkley

Phyllis Kantor pictured with Frank J. Purcell, Senior Director Federal Government Affairs American Association of Nurse Anesthetists

 Steven Sertich, Region 5 Director; Phyllis Kantor, FPD; and Steve Hamilton, President