While the number of Medicare “opt-outs” increased during 2022, care led and delivered by anesthesiologists remains the overwhelmingly dominant model of anesthesia care in the United States. Notwithstanding what nursing advocates may argue, an “opt-out” is not synonymous with so-called “independent” nurse practice. The nurse-only model of practice is only permitted in states that have opted out and that have a permissive state law. An opt-out does not invalidate, in any way, a state's law. In fact, the overwhelming majority of opt-out states maintain state laws that require a physician-led or physician-involved model of anesthesia care.
In 2001, the federal government amended the Medicare and Medicaid Anesthesia Services Condition of Participation for hospitals, critical access hospitals, and ambulatory surgical centers. The amendment upheld the previous standard of physician supervision for nurse anesthetists but authorized state governors to “opt out” of this supervision requirement if certain criteria were met. Since 2001,...
