Impact of Scope of Practice Laws for Certified Registered Nurse Anesthetists on the Utilization of Anesthesia Services

Abstract

Objective: To assess the impact of pandemic-related changes in state scope of practice law (SOPL) for certified registered nurse anesthetists (CRNAs) on the utilization of anesthesia services during the COVID-19 pandemic, which served as a natural experiment. Study Setting and Design: We used a difference-in-differences approach to compare changes in the utilization of anesthesia services during the COVID-19 pandemic in areas that expanded SOPL (removed requirements for supervision or direction) to those that did not. Additionally, we examined if the impact of changes in SOPL on patient access differed by underserved status. Data Sources and Analytic Sample: To understand patient access to anesthesia care, we used a large, national administrative claims database of privately insured and Medicare Advantage enrollees to measure utilization rates per 1000 members from 2018 through 2022. We used the county-level density of anesthesia providers to identify underserved areas. We used data on the changes in SOPL at the state level and assessed changes in utilization prior to and during COVID-19. Principal Findings: In the areas that changed SOPL, removing requirements for supervision or direction, utilization of anesthesia procedures increased by 18 procedures per 1000 members over the study period (17% increase; p-value 0.066) compared with an increase of 9 procedures per 1000 members (7% increase; p-value 0.031) in areas that maintained SOPL requiring supervision. However, increases in utilization in underserved and not underserved areas were similar across SOPL statuses. Conclusions: This study provides evidence that the SOPL that allows CRNAs to practice without the requirement of supervision or direction results in greater access to anesthesia services compared with a more restrictive SOPL requiring supervision.