Defeat House Bill 101!

House Bill 101 needs to be opposed for the safety of Utah’s citizens. Allowing anesthesiologist assistants (AAs) to practice in Utah would be a poor decision for the following reasons:

1.Quality of Care:
a.AAs are not PAs (Alan Bybee, President, Utah PA Assoc., 2009).
b.The only similarity is they are both supervised and they both have “assistant” in their titles (American Academy of PAs, 2005).
c.AAs are not trained to handle anesthesia emergencies independently and without the close supervision of an anesthesiologist.
d.The anesthesiologist must be immediately available.
e.CRNAs are capable of high level independent function without anesthesiologist or physician supervision. AA’s are being introduced to “phase out” nurse anesthetists because they compete directly with anesthesiologists for jobs.

2.Increased Cost of Healthcare:
a.When an AA provides the anesthesia, the anesthesiologist also gets reimbursed.
b.Anesthesiologists receive a portion of every dollar of reimbursement that an AA earns. Two anesthesia providers are ALWAYS necessary when the AA practices.
c.There are no cost savings by utilizing AAs.  Insurance companies and Medicare pay the same amount for an anesthetic that is performed by a CRNA or an AA when being medically directed by an anesthesiologist.  The medically directed CRNA or AA and the anesthesiologist are both paid 50% of the case.  Although a CRNA or AA can be paid 50% of one case, an anesthesiologist can be paid 50% for each concurrent medically directed case up to four cases.  AAs and CRNAs make comparable salaries so where are the cost savings?  Even if the salaries for either AAs or CRNAs were reduced, the cost savings would go to the anesthesiologists not to the patient or insurance company.  No other states that have enacted this legislation have seen cost savings by utilizing AAs.

3.AAs are Unproven and Not Worth the Risk:
a.There are no published studies in peer reviewed journals analyzing AA quality of care. AAs cite only one poorly conducted, biased report from one AA program.
b.AAs can take their certification exam before they have completed their training program. They may take this exam 180 days before they graduate from their program.
85% of Americans would be concerned if they or their family members were having anesthesia provided by an AA (Public Opinion Strategies, Alexandria, VA. 2003).
c.AAs are not required to have any healthcare experience before they begin their training.

4.AAs are NOT PAs
a.The legislation being proposed would have AAs
licensed under the PA State Governing Board.  The Physician Assistant State
Governing Board has voiced concern regarding the governance of AAs under the
PA Board.  In fact, the PA Board in their March 12, 2009 minutes state:
"Board members voiced concern regarding:
1. Keeping a clear distinction that Anesthesiology Assistants are not
PAs.
2.  Presenting AA education and training information for the PA Board to
review is not necessary.
3.  Based on Anesthesiology Assistants having a different scope of
practice than a PA, they should have their own Board."
5.Decreased Access to Care:
a.CRNAs provide the vast majority of rural anesthesia in Utah.
b.AAs cannot practice in rural settings without anesthesiologists.
c.AAs are significantly restricted in their scope of practice. If they have an emergency in the operating room, they are not trained to handle it independently and the healthcare of Utah citizens would suffer.

6.Unnecessary Expense to the State:
a.It is expensive to regulate a new profession and cannot be justified under this state’s budget. (For example, the Florida Board of medicine reportedly estimated that the cost of regulating AAs would be more than $50,000 per year, which would create a deficit of more than $40,000 on an ongoing basis. The deficit would result because the cost of administering AA licensure, including hiring at least two new staff members, would far outstrip the revenue generated from the number of AAs projected to be licensed).

7.Questions to ask yourself:
a.If an anesthesiologist is supervising four AAs and two of them have emergencies at the same time, who decides which patient goes without the life-saving expertise they require?
b.It takes on average 5-7 minutes without oxygen for the brain to suffer irreversible damage. Would you want to waste those precious minutes waiting for an anesthesiologist to arrive and intervene?
c.AAs are not PAs, nor are they the equivalent of a CRNA. And they will place our loved ones in danger with absolutely ZERO added benefit.