Supervision is still around, but not for the reason you stated. An opt out state has no Medicare requirements for supervision, yet as far as I can tell, most major hospitals in these states have anesthesiologist supervision or direction. small hospitals have CRNA independence with little to no anesthesiologist involvement often due to rural pass through laws. Also, as far as I know, private insurers don’t care and aren’t legally obligated to determine whether or not hospitals have a supervision or direction model or independent CRNAs.
Medicare supervision laws have absolutely no bearing on whether or not an anesthesiologist is present only on physician presence (could be a surgeon). What’s keeping real CRNA independence at bay is the local hospital politics because the supervision/direction is usually a medical bylaws thing specific for each hospital. Which is why anesthesiologists need to be involved in their hospital’s committees.
In addition, if the coding for direction/supervision ever went away, well then that’s the real death of ACT or supervision practice models