{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T11:15:11Z","timestamp":1790248511793,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T00:00:00Z","timestamp":1727654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Rural hospitals in the United States often rely on nonphysician providers such as advanced practice nurses to care for their patients. One important role that is served by advanced practice nurses is that of anesthesia provider (certified registered nurse anesthetist or CRNA). In 2001, Centers for Medicare &amp; Medicaid Services (CMS) passed an opt\u2010out law affording state governors the right to loosen physician supervision requirements on CRNAs in their respective states, thus potentially improving access in targeted areas. Since then, 24 states have adopted these opt\u2010out provisions. We aim to understand the extent to which the CMS opt\u2010out law has resulted in increased CRNA service provision in hospitals, especially in rural areas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>The study used a longitudinal design. We compiled 2010\u20102021 American Hospital Association data, which includes 4,464 unique U.S. hospitals observed an average of 8 times annually (35,863 total hospital\u2010year observations).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We model CRNA services provision at the hospital level using longitudinal mixed effects generalized linear models that incorporate state, county, and hospital control variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Using descriptive statistics and mixed effects generalized linear models, we discovered that adopting opt\u2010out provisions does not universally result in increased CRNA service provision in U.S. hospitals. Notably, opt\u2010out provisions do not improve access in rural counties. However, in supplemental analysis, we discover some of the conditions under which the likelihood of CRNA service provision is influenced.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Hospitals often utilize CRNAs to staff their hospitals. However, many hospitals use both CRNAs and physician anesthesiologists; this can be a potential source of contention and confusion, given the lack of uniformity in the\u00a0scope of practice policies. We offer some suggestions with regard to the effects of state interventions into the field, and how they might impact this dispute. Lastly, policymakers should consider additional measures to address rural access limitations, as the opt\u2010out policy does not seem to be working as intended.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12879","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T04:38:11Z","timestamp":1727757491000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Revisiting the effects of state anesthesia policy interventions: A comprehensive look at certified registered nurse anesthetist service provision in U.S. hospitals from 2010 to 2021"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8327-3749","authenticated-orcid":false,"given":"Scott","family":"Feyereisen","sequence":"first","affiliation":[{"name":"Department of Management Programs College of Business Florida Atlantic University  Boca Raton Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"McConnell","sequence":"additional","affiliation":[{"name":"Department of Sociology Schmidt College of Arts &amp; Letters Florida Atlantic University  Boca Raton Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8893-2317","authenticated-orcid":false,"given":"Neeraj","family":"Puro","sequence":"additional","affiliation":[{"name":"Department of Management Programs College of Business Florida Atlantic University  Boca Raton Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.17944"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpubeco.2022.104812"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1527154419874410"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12487"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000554"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nurpra.2015.03.004"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001106"},{"key":"e_1_2_9_9_1","unstructured":"ASA.Opt\u2010Outs. 2023. Accessed May 5 2023.https:\/\/www.asahq.org\/advocacy\u2010and\u2010asapac\/advocacy\u2010topics\/opt\u2010outs"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1213\/XAA.0000000000000293"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001504"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.10.001"},{"key":"e_1_2_9_13_1","unstructured":"American Hospital Associatiion.In. Vol 2023.2023."},{"key":"e_1_2_9_14_1","unstructured":"CDC.CDC\/ATSDR Social Vulnerability Index. 2000. Accessed June 1 2023.https:\/\/www.atsdr.cdc.gov\/placeandhealth\/svi\/index.html"},{"key":"e_1_2_9_15_1","unstructured":"USDo.A. Rural\u2010Urban Continuum Codes. 2023. Accessed June 1 2023.https:\/\/www.ers.usda.gov\/data\u2010products\/rural\u2010urban\u2010continuum\u2010codes\/"},{"key":"e_1_2_9_16_1","unstructured":"HRSA.Defining Rural Population. 2013. 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