Guest Essays, Opinion

Guest essay: 1,013 days: What have we learned over the last several years?Guest essay:

by Kellon Smith

To say that the health care landscape has changed over the last several years would be the understatement of the century. Looking back at, let’s say, the last 1,013 days, the health care industry was challenged to unprecedented levels due to the COVID pandemic. During this period, health care professionals, especially those on the front lines of patient care, got beat up and knocked down as they struggled to keep up with demands. Numerous changes were needed in order to care for the influx of the ill and dying and the massive health care crisis that would ensue.

West Virginia, much like other areas of the country, is faced with health care disparities and access to quality care issues. Rural Americans rely on highly educated, trained and licensed providers to meet their health care needs. In response to the COVID pandemic, in early 2020,

President Trump issued an executive order that removed outdated practice restrictions that limited many of these providers from practicing to the full extent of their capabilities and made it difficult for many patients to access desperately needed health care services in a timely manner, if at all.

Soon after, in March 2020, Gov. Jim Justice followed suit and issued an executive order empowering every licensed provider in our state to answer the call unencumbered. A perfect example of the positive impact of Justice’s order is the effect it had on certified registered nurse anesthetists (CRNAs) and the hospitals and other health care facilities across West Virginia that utilize them.

By way of the order, an outdated and unnecessary anesthesia billing requirement known as physician supervision was suspended. The removal of this antiquated billing requirement, which has nothing to do with physician oversight of a CRNA’s work and which research has proven does not improve patient safety, enabled CRNAs to efficiently and effectively provide high-quality patient care in a timely manner, which is exactly what fighting the pandemic called for. Gone were the needless distractions and restrictions of the supervision rule — for both CRNAs and their physician colleagues alike.

From the stroke of the governor’s pen on the executive order to the present, CRNAs have been health care stalwarts on the pandemic’s frontlines — intubating patients and managing their airways, operating ventilators, overseeing intensive care units and providing anesthesia care for surgical, obstetrical, trauma and pain management services. So the question must be asked: If CRNAs provided this level of patient care during the worst of times, without any change in safety and patient outcomes, shouldn’t they be trusted to perform the same during normal health care times? Must we wait until the next pandemic or health care crisis to empower our providers after the proverbial horse has left the barn?

West Virginia is well-positioned with its 2023 legislative session to follow Justice’s example — but take it one step further by permanently removing the physician supervision requirement for CRNAs. Our state lawmakers only need to examine the last 1,013 days to understand what was achieved by CRNAs under the governor’s executive order. It is extremely rare to be able to evaluate, in real time, the beneficial changes brought about by governmental action. Our state leaders need to take advantage of this unique situation to affect change that would permanently benefit patients and health systems across West Virginia.

Now is the time for West Virginia to put its best foot forward by bringing forth much-needed change for the new year. Access to care is essential in our great state. The post-pandemic future is promising, but only if we step forward regarding health care policy, especially the removal of needless physician supervision of CRNAs.

Kellon Smith serves as the current president of the West Virginia Association of Nurse Anesthetists, which represents 556 CRNAs and 127 student nurse anesthetists throughout the state of West Virginia. He’s been a practicing certified registered nurse anesthetist for over 10 years.