What is the history of CAAs?
During the mid-1960s, in response to a manpower shortage and concerns over the increasing complexity of anesthesia and surgery, Drs. Gravenstein, Steinhaus, and Volpitto created the concept of the Anesthesiologist Assistant. They designed an educational program whereby matriculants would build on an undergraduate premedical education, then obtain a masters degree in anesthesiology. In their white paper, the authors wrote, "Responsibility and immediate care of the patient must remain within the province of the anesthesiologist; consequently, personnel could not work independently but only under the immediate direction of an anesthesiologist. An advantage in manpower for the anesthesiologist would result, as he could provide attention to several patients with the proper employment of the anesthesia team, described above."
References
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Gravenstein JS, Steinhaus JE, Volpitto PP. Analysis of manpower in anesthesiology. Anesthesiology 33(3): 350-7, 1970.
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Steinhaus JE, Evans JA, Frazier WT. The physician assistant in anesthesiology. Anesthesia and Analgesia. 52(5): 7949, 1973.
What is the Anesthesia Care Team (ACT) model, and what role do CAAs serve?
CAAs practice exclusively within the ACT model, which is a team-based approach that emphasizes a system of treatment built around a patient's care. In this model, Physician Anesthesiologists lead the planning and implementation of anesthesia care to maximize patient safety and quality of care. In this model, CAAs serve as supervised physician extenders and work synergistically with said physicians to create and implement the best possible anesthesia care plans for patients.
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Physician-Led Care
The ACT model ensures that each patient is treated directly by a Physician Anesthesiologist. Access to these expert providers is essential to emphasize patient safety during anesthesia care.
Patient Centric Team
The ACT is designed to surround each patient with a team of anesthesia professionals, rather than a sole provider. The approach provides patients with the most thorough care possible.
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The practice of anesthesiology within the ACT includes the delegation of monitoring and appropriate tasks by the physician to non-physicians (CAA or CRNA). Such delegation is defined specifically by the physician anesthesiologist and must be consistent with state law, state regulations, and medical staff policy. Although selected tasks may be delegated to qualified members of the ACT, overall responsibility for the team’s actions and patient safety ultimately rests with the physician anesthesiologist.
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Incorporation of CAAs into the care model in Nevada will allow one Physician Anesthesiologist to medically direct and supervise up to 4 operating rooms at a given time to allow for efficient, yet safe anesthesia services while increasing access to care. The ACT with CAAs is a sustainable revenue model in the ever increasing environment of downward pressures on payment and ever decreasing availability of anesthesia providers.
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Click the buttons below to view an ACT infographic from our parent organization, the AAAA, as well as read about the ACT as described by the American Society of Anesthesiologists™.
What training & qualifications do AAs possess?
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Training: All CAAs possess a premedical background, a baccalaureate degree, and also complete a comprehensive didactic and clinical program at the graduate school level. CAAs are trained extensively in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques.
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All AA training programs are housed within or affiliated with a university with a medical school which either has an anesthesiology residency program in place, or the capability to have one.
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Accreditation: All CAA training programs are accredited by The Commission on Accreditation of Allied Health Education Programs (CAAHEP), which is the largest accreditor in the health sciences field which reviews and accredits over 2000 educational programs in nineteen different health science occupations (i.e. respiratory therapy and emergency medical technician-paramedic). More information can be found on their website: CAAHEP.
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Certification Body: The National Commission for Certification of Anesthesiologist Assistants (NCCAA) was founded in July 1989, to develop and administer the certification process for CAAs in the United States. The NCCAA consists of Commissioners representing ASA, AAAA, and at-large physician and CAA members. NCCAA is responsible for the development and administration of both the initial certification exam and the subsequent demonstration of continuing qualification exams. The NCCAA is also responsible for validation of the continuing medical education hours required to maintain certification. The NCCAA website can be found here.
Where can AAs currently practice?
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Alabama
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Colorado
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District of Columbia
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Florida
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Georgia
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Indiana
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Kansas*
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Kentucky
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Michigan*
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Missouri
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Nevada
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New Mexico
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North Carolina
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Ohio
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Oklahoma
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Pennsylvania*
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South Carolina
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Texas*
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Utah
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U.S. Territory of Guam
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Vermont
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Wisconsin
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* Delegatory Authority
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What are the differences between Certified Anesthesiologist Assistants (CAAs) and Certified Registered Nurse Anesthetists (CRNAs)?
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Schooling: CRNA programs require a nursing degree and 1-2 years of critical care experience, while CAA programs require a bachelor's degree emphasizing pre-medical, science-based coursework as well as a competitive score on either the GRE or MCAT. 2000 clinical hours and 600 anesthesia cases are the minimum graduation requirements for both categories of student anesthetists, as described by the ASA.
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Supervision: CAAs are required to work under the supervision of a physician anesthesiologist within the ACT. CRNAs can also work under the supervision of physician anesthesiologist within the ACT. In some states/circumstances, CRNAs can also work under the operating physician or independently.
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Surgical Outcomes: For decades, the Anesthesia Care Team has safely and effectively delivered anesthesia care with either a CAA or CRNA as the non-physician anesthetist member of the team. Click this link to view one of many reports that concluded there is no difference in surgical outcomes with regards to which type of mid-level anesthesia provider makes up the Anesthesia Care Team. Additionally, per the ASA: "The experience reported by physician anesthesiologists who work simultaneously with CAAs and CRNAs is that there are no significant differences in skills, training, knowledge base, or clinical expertise."
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Reimbursement: CAAs are recognized by the Centers for Medicare and Medicaid Services (CMS), Tricare, and commercial payers. Under physician anesthesiologist medical direction within the Anesthesia Care Team model, CMS makes no distinction between anesthetist type and refers to both professions as "qualified non-physician anesthetists" as a combined group. Therefore, both professions are identically reimbursed within the ACT model.
What is the purpose of legislation and licensure in Nevada and what are some references to past legislative efforts?
The addition of legislation in support of Certified Anesthesiologist Assistant licensure will help correct the shortage of physician anesthesiologists throughout the state of Nevada, allow greater access to care, as well as create an overall safer medical environment for patients and a more efficient/desirable workplace for staff.
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Past Legislative Efforts
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76th Session (2011): S.B. 258 (.pdf)
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78th Session (2015): S.B. 181 (.pdf)
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79th Session (2017): S.B. 210 (.pdf)
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