Senate Committee on Commerce, Labor and Energy
Written Testimony on SB 210
Submitted by Jerry Matsumura, M.D.
Past- President, Nevada State Society of Anesthesiologists
March 8, 2017
On behalf of the Nevada State Society of Anesthesiologists, I would like to thank Senator
Kieckhefer for sponsoring this important bill. I wish to thank Chairman Atkinson and the
Senate committee members for their time to receive this written testimony. SB 210
creates licensure in Nevada for Anesthesiologists Assistants by the Nevada State Board
of Medical Examiners. Anesthesiologist Assistants are highly trained and qualified
anesthesia providers that work under the medical direction of an anesthesiologist in an
anesthesia care team model. They work as a specialized physician assistant to physician
anesthesiologists.
Reasons to create the category for Anesthesiologist Assistants in Nevada:
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Access to anesthesia services:
In 2013, the Rand Study executive summary page xv states “The overall conclusion is
that the shortage of Anesthesiologists and CRNAs is highly likely at the national level,
with the survey approach providing hints of such a shortage and the economic analysis
providing stronger confirmation.” Page 79 states, “However, by 2018, as retirements
increase, demand will surpass supply and the workforce will be in shortage. By 2025,
projections indicate that there will be a shortage of approximately 3,000
anesthesiologists.” On page 81, it states, “A few plausible scenarios could lead to greater
shortage than the situation considered above…. As the population ages and becomes less
healthy, the number of needed medical procedures will increase. In addition, the
expansion of insurance under recent health care reforms is likely to increase health care
consumption among the previously uninsured.” We have seen both of these scenarios
come into play.
In the 2010 Nevada Special session, anesthesia was singled out as the only specialty
imposed with a 50% decrease in Medicaid payment. Nevada anesthesiologists did not
refuse to see Medicaid patients as a result of the cut. However, as predicted, there was
still a reduction in access to care for anesthesia services for Medicaid patients.
To exacerbate the situation, a few years ago Nevada expanded Medicaid coverage
pursuant to the Affordable Care Act. The national average for states opting for expansion
was roughly 15%. Nevada increased Medicaid enrollees by just over 60%. It was not fair
to ask a highly specialized group of physicians to carry the larger work load while not
increasing payments. An economic solution exists by expansion of the anesthesia care
team model via Anesthesiologist Assistants.
These are cities of comparable size to Las Vegas, with the number of anesthesia
providers per 1 million population. This does not take into account the number of tourists
that are in Las Vegas at any given time.
1. Nashville area has a population of roughly 1.826M and has 521 anesthesia providers/1
million people.
2. Tampa Bay Area: 2.957M with 369 providers/1M people 3. Kansas City: 2.086M with
340 providers/1M people.
4. Charlotte area: 2.423M with 339 providers/1M people.
5. Columbus: 2.020M with 271 providers/1M people.
6. Orlando area: 2.371M with 260 providers/1M people.
7. Austin: 2.001M with 259 providers/1M people.
8. Portland area: 2.382M with 258 providers/1M people.
9. Denver: 2.808M with 254 providers/1M people.
10. San Antonio: 2.375M with 237 providers/1M people.
11. Salt Lake City: 2.388M with 210 providers/1M people.
12. Sacramento area: 2.271M with 220 providers/1M people.
13. Las Vegas: 2.109M with 159 providers/1M people.
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Options for working with ancillary healthcare providers
Anesthesiologists in 17 states have the option of working with anesthesiology residents in
training, nurse anesthetists and Anesthesiologist Assistants as anesthesia care team
members. Nevada anesthesiologists have only one option, nurse anesthetists. On the
average, physicians in other specialties have a choice of 6.5 allied health care professions
to use as extenders of their practices. Again, anesthesiologists in Nevada have one option.
We are just asking for the choice of two.
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Safety
An analysis of over 50,000 anesthesia cases by the University Hospital of Cleveland did
not find a difference in patient outcomes between nurse anesthetists and anesthesiologist
assistants. No state has amended its state law to limit the scope of practice of an
anesthesiologist assistant due to safety concerns. In fact, states have increased the
physician anesthesiologist/anesthesiologist assistant supervision ratio as they have proven
to be highly qualified anesthesia providers. Because anesthesiologist assistants work
under the medical direction of a physician anesthesiologist, patients will always have a
physician anesthesiologist involved in their care and as such, a physician anesthesiologist
will be immediately available to respond to any complication that may arise.
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SB 210 will not displace anesthesiologists
This is the data over a 10 year period. The first number is the number of members
of the American Society of Anesthesiologists (ASA) in that state when legislation was
passed allowing for the licensure of anesthesiologist assistants. For Florida, Ohio and
Georgia, the second number reflects the increase in anesthesiologists in the state
compared to the population growth over 10 years. For Wisconsin and Indiana, the
numbers reflect the number of ASA members in the respective states compared to the
population growth up to 2016. Ten year data does not exist for Wisconsin and Indiana
because AAs were licensed in 2012 and 2014.
1. Fla: 1299 ASA members up to 1643 members currently. State population changed
from 16.69M up to 19.89.
2. OH: 929 to 1185. Population changed from 11.41M to 11.59.
3. GA: 568 to 760. Population changed from 8.51M to 10.1.
4. WI: 501 to 647. Population changed from 5.45M when AA bill passed to 5.67 in 2016.
5. IN: 648 to 751. Population changed from 6.2M to 6.6.
Source on membership is ASA. Population data is from US census bureau.