Carmel, CA Nurses Looking To Expand Their Roles In Pain Management, Could Impact Hospice Services

There is no question that the demand for private duty caregivers, home health aides and nurses is going to expand at a blistering pace with about 10,000 baby boomers retiring per day.  And with doctors becoming increasingly stretched thin, nurses are now attempting to expand their roles.  The Centers for Medicare and Medicaid Services is expected to weigh in by November 1 on whether or not they will reimburse nurses for evaluating, diagnosing and treating pain with epidural injections or prescription painkillers.  The current guidelines aren't clear on whether nurse anesthetists may only treat pain while they are in the operating room or whether they can do things like manage chronic pain in patients, including those on hospice.  This will be a big decision.  There are currently 45,000 nurse anesthetists in the U.S., but they work almost exclusively in hospitals and surgical centers.  If Medicare and Medi-Cal will reimburse them for working in other locations, it could vastly expand this career opportunity.  The move is already taking place.  In 24 states (although not in California) nurse anesthetists can write prescriptions for controlled substances like oxycodone.  If the rules were rewritten, which seems likely, this would expand to all 50 states and could increase the ease of hospice administrations, since Doctors would not have to be involved in all aspects of care.  The American Medical Association is opposing the proposal, saying the move could lead to an increase in painkiller prescriptions, but with enough training and oversight, this shouldn't be the case.  Controlled substances are monitored closely by the DEA, and any abusive prescription writing will likely result in a quick license revocation.