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reports

CRNA Pain Management Case Studies

August 2012

American Association of Nurse Anesthetists
Lewin contact: Paul Hogan

 Certified Registered Nurse Anesthetists (CRNAs), educated with specialized training, skill, and expertise in pain management, provide chronic pain management in rural areas, underserved by physicians and healthcare facilities. CRNA services are often the sole source of chronic pain management services in these areas. If the patients are not able to access care from the local CRNAS, the alternatives are to travel great distances for care from physicians, to have expensive and invasive surgery, or to be institutionalized as a result of untreated pain.

The report discusses four case studies about four Medicare beneficiaries who are currently receiving pain treatment from their local (rural) CRNA. Each case discusses the costs – medical and indirect (non-medical and opportunity cost) – of the current treatment pathway, and alternative pathways that do not include access to a CRNA for chronic pain treatment.

Analysis of costs associated with pain management in these geographically diverse cases shows that total costs of pain care alternatives range between 1.4 to 128 times the costs of a CRNA providing these services in the community. Cost of treatment by physician anesthesiologist in a large city is between 1.4 to 3.3 times higher, cost of surgery and alternative pain treatment procedure is between 4 to 57 times higher, and cost of untreated care and resultant nursing home stay is between 76 times to 128 times higher than pain total cost of pain treatment by the local CRNA. Indirect costs include cost of travel, opportunity cost of travel companion, and cost of home health care for family member. From this analysis of four cases across the United States, it is clear that, care by the local CRNA is the most efficient and effective means of chronic pain management in rural areas. 

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