Guest column: Eliminate barriers to crisis-ready health care

An emergency is no time to trifle with bureaucratic red tape. At the outset of the COVID-19 crisis, many feared a surge of patients would overwhelm hospital capacity. Health officials sounded the alarm and identified policy changes that would enable them to meet the coronavirus challenge. And, in many cases, government responded.

In March, Gov. Tom Wolf issued executive orders designed to expand the state’s health care capacity, including temporarily suspending regulations that restricted where and how nurses and other health care professionals could practice.

For those aiming to ensure our health care system is always prepared, this raises an important question: If we cut the red tape during times of crisis, why not cut it permanently?

The fact is, before these regulations were suspended, our health system was suffering serious consequences. In April, PennLive reported that thousands of medical professionals across the country were getting furloughed or laid off. Though postponed elective procedures were partially responsible, another major factor was licensing requirements that made it difficult for medical staff to transition from their previous roles to help care for those suffering due to COVID-19.

Jess Poole, who previously worked out of Greensburg, is one such medical professional. Despite being a licensed nurse anesthetist with the training to intubate and manage patients, Pennsylvania wouldn’t recognize her specialty. Licensing restrictions made it impossible for her to contribute.

Health care heroes like Jess were forced to sit on the sidelines just when they were needed most. Thankfully, some state lawmakers are determined to keep this from happening again.

State Rep. Christopher Quinn (R-Delaware County) recently introduced legislation, HB 2779, that everyone concerned about conquering the virus should care about. Rep. Quinn’s bill would extend the suspension of certain bureaucratic regulations holding back our health system for one year — and establish a panel to determine which of those counterproductive regulations should be done away with for good.

Telehealth, or remote medical appointments often conducted via video calls, is a great example of a health care innovation that would have been limited under prior overly-restrictive regulations. The contagious nature of COVID-19 made telehealth an essential service in 2020, and utilization skyrocketed by 50 to 175 percent. This expanded use was made possible because Pennsylvania took steps to guarantee provider reimbursements by insurance companies and relaxed licensing restrictions that prevented providers from serving patients across state lines.

Even after the crisis subsides, telehealth promises increased access to care and reduced patient costs. For example, a Vermont Veterans Association saved almost $19,000 a year from reduced travel costs after offering telehealth options. A 2017 study found that patients experienced a cost savings of $156 per consultation due to reduced time and travel burden.

The removal of antiquated barriers to telehealth and the lifting other unnecessary regulations should be made permanent to expand access to care. For example, maintaining newly-increased practice flexibility for Advanced Practice Registered Nurse Practitioners would empower over 7,000 nurse practitioners in Pennsylvania to care for more patients.

Rep. Quinn isn’t alone in seeing an opportunity to improve health care access and reduce cost for all Pennsylvanians. Senate Bill 25 and HB 100, together sponsored by over 70 lawmakers, create a path for nurse practitioners to practice independently after a minimum of 3 years and 3,600 hours under the supervision of a physician. Empowering them to provide primary care could bring down the patient load per primary care provider from almost 1,000 patients per provider to 667 patients per provider.

Two other proposals, HB 1997 and HB 1998, would give doctors more flexibility over how to work with physician assistants. The result? Greater access by patients to customized care.

Another bill would allow pharmacists to offer flu shots to individuals 9 years of age or older, creating an additional 9,000 access points for flu vaccinations across the state. Empowering pharmacists to provide vaccinations to a wider age range can free up physicians to focus on their most urgent cases.

It is impossible to predict what the future holds for COVID-19. But by repealing unneeded health care regulations that are barriers to patient care, lawmakers can ensure Pennsylvania’s health system is always prepared for crisis.

Stephen Bloom is vice president for the CommonwealthFoundation, Pennsylvania’s free market think tank.

Published in The Pottstown Mercury

PANA Members Recount How Patients and Facilities Benefit from Waiver Removing Physician Supervision

Health-care facilities, patients benefit from waiver removing physician supervision during pandemic

We shared with you previously stories from the frontline among certified registered nurse anesthetists who are experiencing firsthand the effects of the state’s temporary blanket waiver removing the physician supervision requirement for CRNAs.

The waiver was included in an executive order that the governor signed to protect health-care practitioners for good-faith actions taken in response to this crisis, and it remains in effect for the duration of the governor’s disaster proclamation.

As you know, Pennsylvania regulations still require physician supervision of CRNAs in a hospital setting. The temporary suspension gives health-care facilities more flexibility to tap into the unique skillset of CRNAs to fulfill critical roles outside the operating room during this crisis. After all, CRNAs possess a skillset uniquely suited to aid during a respiratory pandemic.

Without a doubt, the waiver has made a real difference. Here are some more voices from the frontline. (Please note that the names of the CRNAs and their facilities have been removed to ensure their anonymity and protection in the workplace.)

“My hospital may not financially survive since elective procedures have been canceled. Our anesthesia team staffing had to change to preserve costs and the governor’s order helped us accomplish that.”

“Our role has been authorized for this expansion of function outside the operating room. The plan is to utilize CRNAs to run overflow ICU beds in our PACU and pre-op areas. CRNAs would manage patient care, manage ventilators, order labs, medications and appropriate radiology studies, and insert central and arterial lines as needed.”

“In our facility, CRNAs served in the OR, in labor and delivery, and on the intubation team for the ED and COVID/PUI patients; we also had a portion of our team train to perform supportive roles in our critical care units and also make the PACU into a makeshift ICU if the need arose but that has not been necessary as of this point.”

“Hospital administration along with the support of our MD Anesthesiologist (MDA) counterparts also suspended MDA supervision at the hospital, allowing the CRNAs to practice to the full extent of our knowledge and training. The CRNAs performed advanced practice skills and critical care decisions independent of the anesthesiologists. CRNAs were also the sole advanced practice provider at night during the first two weeks of the COVID crisis. For five weeks, the CRNAs put into practice the skills and knowledge to assist the ICU physicians, nurse practitioners, and nurses. The CRNAs knowingly put themselves literally face to face with COVID patients, intubating and securing the airways, and placing lines to insure vascular access. Our hospital was the hardest hit in central Pennsylvania by the COVID crisis, and had one of the lowest mortality rates. CRNAs were the keystone in the successful treatment and management of these patients.”

This waiver truly has given CRNAs the chance to showcase the value they bring not only to the state’s pandemic response and recovery efforts, but also to the safe, efficient, affordable delivery of quality health care generally. Stories like these and from our earlier post prove why physician supervision should finally be removed permanently in Pennsylvania.

PANA Members Discuss What Blanket Waiver During Pandemic Really Means

Blanket waiver removing physician supervision requirement benefits health-care facilities, patients during pandemic

The Pennsylvania Association of Nurse Anesthetists achieved a significant victory for the profession in May when Gov. Tom Wolf announced a temporary blanket waiver removing the physician supervision requirement for certified registered nurse anesthetists (CRNAs).

The waiver has been hugely important as part of the state’s response to the health-care crisis caused by COVID-19. Advanced practice nurses like CRNAs can finally practice to the fullest extent of their education and training.

That avails more physicians to provide hands-on care. It expands the capacity of both CRNAs and physician providers. It augments the state’s health-care system to continue to meet growing demands during this pandemic. And it ensures patients get the best care.

But what has this waiver really meant for CRNAs, health-care facilities and the patients we serve? Here are some firsthand accounts from CRNAs on the frontline. (Please note that the names of the CRNAs and their facilities have been removed to ensure their anonymity and protection in the workplace.)

“I work in a critical access hospital and since the governor removed the supervision requirement, the anesthesiologists are now running their own room and I’m working in another room with my surgeon --- which means we are able to provide two times the services!”

“We at our local Hospital started a COVID response team in conjunction with the ER and ICU. We responded to all COVID intubations, put in an arterial line, a central line, and intubated the patients. We also helped manage vent settings/unstable patients as needed.”

“My hospital told our anesthesiologists that they will be taking their own assignment and that the CRNAs will work alone until we get caught up on elective surgeries. Many of our anesthesiologists resigned because they don’t want to give anesthesia.”

“Yes, we have provided a CRNA from our department for 24-hour coverage of the COVID units to act as an NP to help assess patients, place lines, and act as extenders for the critical care intensivists in our county. The chief in my group was able to use the supervision waiver for us to work outside of the OR and in the OR without supervising anesthesiologists.”

“The orthopedic surgeons at my hospital have always wanted an ologist available. That has all changed. The CRNAs are working alone and our ologist was given the option of working in a room or taking time off unpaid.”

It’s clear: Gov. Wolf’s decision to issue that temporary blanket waiver and remove the physician supervision requirement for certified registered nurse anesthetists is making a real difference.

The waiver was included in an executive order that the governor signed to protect health-care practitioners for good-faith actions taken in response to this crisis, and it remains in effect for the duration of the governor’s disaster proclamation, which gives him broad powers to manage this public health emergency.

The proclamation was renewed for 90 days in early June. Lawmakers challenged the extension. But state judges sided with the governor. That means the proclamation remains in place for at least two more months. As long as the governor’s disaster proclamation remains in place, so does his blanket waiver removing the physician supervision requirement for CRNAs.

Stories like these from our CRNAs prove that this policy shouldn’t just be implemented during a pandemic, but instead be permanent to ensure patient health and safely and to give greater options to health-care facilities to provide the best care to those in need.