Vote for Angelarosa DiDonato for 2021 AANA Board of Directors

Pictured: Former PANA President Angelarosa DiDonato is running for a seat on the board of directors for the American Association of Nurse Anesthetists (AANA).

Check out the recording of the April 26, 2021 AANA Election and Board of Directors Candidates' Debate:

Visit Angela's AANA Campaign Page for more details.

Medicare payments favor opioids over alternatives, and that’s a problem

By Angelarosa G. DiDonato

Our country in struggling with an opioid epidemic. An estimated two million Americans suffer from opioid use disorder, and opioid overdoses kill more than 130 Americans each day, on average.

Studies show that opioid addiction can occur from the very first exposure --- and sometimes, that first exposure may be during anesthesia for a necessary surgical procedure.

Certified Registered Nurse Anesthetists (CRNAs) operate in every setting where anesthesia is administered: hospital operating and delivery rooms; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, and plastic surgeons; pain management centers and more. With such widespread influence among so many health-care settings, CRNAs play a major role in curtailing the opioid epidemic. We understand the risks and effects of the medications we administer, which is why we’re changing the way we operate. Nurse anesthetists today can manipulate their anesthetic to provide narcotic-sparing and often narcotic-free anesthesia. Our nation’s health programs should be doing the same. Unfortunately, federal regulations from the Centers for Medicare and Medicaid Services (CMS) fail to address a number of outdated regulations that put Pennsylvania’s pain patients in harm’s way. Over the last decade, many non-opioid pain treatment options have been developed, including single-dose injectables that release slowly over the course of up to 90 hours. For many patients, these promising alternative therapies can take the place of traditional more-addictive opioid painkillers. However, CMS rules fail to adequately cover the cost of administering these medications, leaving Pennsylvania’s more than 2.7 million Medicare beneficiaries without the option of affordable, non-addictive pain treatment. In a decade that saw drug overdose deaths skyrocket across the nation, Pennsylvania was among the worst in mortality increases, according to the U.S. Centers for Disease Control and Prevention. Last year, 4,125 Pennsylvanians died, according to the state Department of Health, and two-thirds of those deaths involved opioids. Recently, drug overdoses have spiked in Pennsylvania, with the rise coinciding with stay-at-home orders brought on by COVID-19. Treatment centers closed and counseling and support-group sessions went online. The stress and social isolation of being stuck at home also created a dangerous environment for those suffering from opioid use disorder. Beyond the human toll, the costs of opioid addiction are staggering. The CDC estimates the misuse of opioids costs our nation $78 billion annually in lost productivity, health-care services, addiction treatment, law and justice, and much more. Making alternative treatments more affordable and accessible can make a big difference. National studies suggest a 10 percent reduction in surgery-related opioid prescribing will result in 300,000 fewer people annually developing an opioid addiction, and keep over 330 million opioid pills out of American households, where they are often stolen or abused. These aren’t just numbers on a page --- they speak to lives saved, families preserved, and bright futures kept intact. Given the very real risks of opioid medications and the severity of Pennsylvania’s addiction crisis, we can’t wait to act. Antiquated federal regulations have helped to create our nation’s over-reliance on opioids, which remain the cheapest option for health-care providers because of how insurance payments are administered under the current Medicare reimbursement rule. The federal NOPAIN Act, which has bipartisan congressional support, would change that by requiring Medicare to cover non-opioid treatment alternatives for all Medicare recipients. It’s as simple as that. As a nurse anesthetist who specializes in anesthesiology and non-opioid therapies, I’m worried. I know all too well that legal opioid prescriptions and an over-reliance on pain management with narcotics too often can lead patients down a path of years-long addiction. There is only so much I can do in the operating room. We need help fixing laws that discourage alternatives to have a fighting chance. Passing the NOPAIN Act is a critical step in combatting the addiction epidemic nationwide and deserves our support. Angelarosa DiDonato, DNP, CRNA is president of the Pennsylvania Association of Nurse Anesthetists, online at https://www.pana.org.

Pa. Should Utilize Nurse Anesthetists in COVID-19 Response

Pennsylvania Association of Nurse Anesthetists

FOR IMMEDIATE RELEASE

CONTACT: Kurt Knaus, P: 717-724-2866

E: kurt@ceislermedia.com

Pa. Should Utilize Nurse Anesthetists in COVID-19 Response

Public affairs TV program to spotlight role of nurse anesthetists in pandemic

HARRISBURG (April 17, 2020) --- As the COVID-19 pandemic continues its spread in Pennsylvania, certified registered nurse anesthetists are uniquely qualified to provide care for critically ill patients, according to the Pennsylvania Association of Nurse Anesthetists. Yet, these frontline health-care workers remain an untapped resource for fulfilling critical roles outside the operating room during this crisis.

PANA President Angelarosa DiDonato and PANA Federal Political Director Laura Wiggins outlined the work of CRNAs and the challenges they face during a taping of the statewide public affairs TV program, “Pennsylvania Newsmakers,” which is set to begin airing this weekend.

PHYSICIAN SUPERVISION: Pennsylvania still requires physician supervision of a CRNA. However, under the directive of President Donald Trump, the Centers for Medicare and Medicaid Services removed the national physician supervision requirement and encouraged states to allow CRNAs to practice to the fullest extent of their education and training to best care for patients during this crisis.

States like New York, West Virginia, Maine, Michigan, New Jersey, Arizona and others already have acted to remove barriers, allowing them to better utilize all available health-care providers without risking patient safety. PANA has been urging Gov. Tom Wolf and his administration to lift the requirement in the commonwealth.

“This is a respiratory pandemic,” DiDonato said. “CRNAs often work with patients’ airways and perform intubations and other procedures. Our education and clinical experience make us central to any response. We want to do all we can to help.”

Removing the supervision requirement of CRNAs in Pennsylvania will avail more physicians to provide hands-on care, expand the capacity of both CRNA and physician providers, and augment the state’s health-care system to meet the growing demands of this pandemic.

PERSONAL PROTECTIVE EQUIPMENT: Like other frontline health-care workers, personal protective equipment (PPE) is crucial for CRNAs, and the shortage of some material has been alarming --- especially after guidance came from the federal government that during shortages, any facial covering, even a bandanna, would be better than nothing.

To help protect its members, PANA, which represents more than 3,700 CRNAs and students in Pennsylvania, invested $40,000 to purchase 1,000 masks for CRNAs who need them, or for those who may have been working in facilities where PPE was limited or quantities were diminishing, especially in high-need areas.

The masks, which are being sourced and manufactured in part through Ifft Enterprises in Evans City in western Pennsylvania, have been innovatively designed after extensive review of a variety of mask prototypes used by health- care professionals. The masks are reusable and feature a filter, with three replacements.

Each CRNA must request the mask individually. The manufacturer then ships the masks directly to the CRNA. But PANA is underwriting the full cost --- both manufacturing and shipping.

“We are proud of the work CRNAs are doing to respond to this crisis and remain committed to doing all we can as an association to keep CRNAs healthy and safe so they in turn can keep patients healthy and safe,” Wiggins said.

PROFESSIONAL DESIGNATION: Pennsylvania is one of just two states that fails to formally recognize CRNAs in some form. Because there is no definition for “certified registered nurse anesthetist” under the state’s Professional Nursing Law, CRNAs are recognized only as registered nurses, not as CRNAs. That brings logistical and financial burdens, and it continues to inhibit our full response to this health-care pandemic.

In response to COVID-19, many CRNAs want to contribute more in the facilities where they work but can’t. Likewise, hospitals and other health-care institutions want to use CRNAs to their fullest capacity but can’t. Many of these facilities feel restricted by the way the state licenses CRNAs and will not allow nurse anesthetists to provide advanced, critical care services, even though it is within their education, training, clinical experience and scope of practice --- meaning this valuable health-care resource remains untapped during a time of crisis.

There are other challenges as well. Pennsylvania nurse anesthetists who serve in the military must secure designation in another state to provide anesthesia in the armed services. They cannot assist on rapid response teams in states affected by natural disasters because they lack formal credentials. And, after receiving training in Pennsylvania, many nurse anesthetists relocate to states with full credentialing, contributing to the state’s “brain drain.”

Bipartisan measures have been introduced in both chambers to recognize nurse anesthetists as “CRNAs” under Pennsylvania statute, with one bill (S.B. 325), sponsored by Sen. John R. Gordner (R-Columbia), receiving Senate approval last year. The legislation remains under consideration in the House Professional Licensure Committee.

Results of a recent statewide public opinion poll shows that two-thirds (67%) of Pennsylvania voters support professional designation for certified registered nurse anesthetists, including those who identify as Republican (59%), Democrat (75%) and Independent (62%).

“Broad support like this should give lawmakers the confidence they need to advance this measure and finally provide CRNAs with professional designation,” DiDonato said.

“Pennsylvania Newsmakers” is one of the state’s premier politics and public policy television talk shows. The program runs statewide. For more information or to view the program, visit: www.newsmakerstv.com.

For more information about CRNAs in Pennsylvania, visit www.PANAforQualityCare.com or follow along on social media via Twitter at @PANACRNA or on Facebook at www.facebook.com/PANACRNA.

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