Government to Decide if Nurse Anesthetists Can be Reimbursed for Treating Pain

The federal government will decide within the next month whether nurse anesthetists can be reimbursed by Medicare for treating chronic pain, The Wall Street Journal reports. Some doctors say such a move could complicate the fight against prescription drug abuse.

The Centers for Medicare and Medicaid Services (CMS) is expected to decide by November 1 whether nurse anesthetists can be reimbursed directly for evaluating, diagnosing and treating pain with epidural injections or opioids.

Current guidelines are unclear about whether nurse anesthetists only can treat pain in the operating room, or whether they also can help treat chronic pain, such as back or neck pain. There are about 45,000 such nurses in the United States. Most of them work in hospitals and surgery centers.

The proposed CMS rule change would allow nurse anesthetists to be reimbursed on the same level as doctors. In most states, they can provide some chronic pain treatment, such as injecting steroids or refilling implanted pumps with pain medication. In 24 states, they also can write prescriptions for controlled substances. The new rule would allow many more nurse anesthetists to write these prescriptions.

The American Medical Association and other doctors groups say the change could lead to a jump in prescriptions for painkillers, providing the drugs to more patients who do not need them. They argue nurse anesthetists do not have adequate training. “This proposal is turning nurse anesthetists into doctors,” Laxmaiah Manchikanti, Chief Executive of the American Society of Interventional Pain Physicians, told the newspaper.

Groups that support the proposal include AARP and the National Rural Health Association. According to the American Association of Nurse Anesthetists, there are not enough board-certified pain doctors to meet demand.