Any new developments from the ASA legislative conference in Washington, D.C.?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

FollowTheMoney

ASA Member
10+ Year Member
Joined
Apr 7, 2010
Messages
560
Reaction score
278
Any news?

Members don't see this ad.
 
FYI, I just go this in my e-mail from my State Society:


I just played the below video at the ASA Washington Legislative Conference. Each anesthesiologist should see it for themselves. The video may be viewed by clicking the picture below. When you are done, learn how to help ASA increase the strength of our political voice by going to the ASAPAC website.









Having trouble viewing the video? Follow the steps below.

Be a part of the PAC! It's easy:

Go to the ASA website
 
They will say anything to gain power and practice independence even if patients die as a result. What a sham on the American public.
 
Members don't see this ad :)
They are at it again!
233.jpg
 


This is the direct video link on Vimeo for those who have a hard time with the asa website
 
I threw up a little after watching this
 
  • Like
Reactions: 1 users
"best kept secret in healthcare... crnas..." thats a laugh..

their lack of medical knowledge and poor decision making because of it is the best kept secret in healthcare thats for sure...
 
  • Like
Reactions: 2 users
Anyone who after seeing this video is against AAs needs their head examined
 
Last edited:
  • Like
Reactions: 1 users
This is like jr high PTO level. The crowd cheering sounded like a group of half hearted soccer moms. Oh yay..in the background.

Lol.

I'm sure I will sleep well tonight after watching this. I work with a wonderful team of nurse anesthetists. We showed this at work this week and they just put their head down in embarrassment. One commented that CRNAs across the country think the AANA is just a bunch of crazies ruining their job and are so far out of touch with real world medicine. His words. Others sitting there nodded and agreed. I felt embarrassed for them.

I sent him home an hour early for being wise.

CJ
 
  • Like
Reactions: 1 user
The ASA is directly responsible for the bastardization of the Medical specialty of Anesthesiology. When you are being attacked, it is your responsibility to defend your constituents.
 
Members don't see this ad :)
This is like jr high PTO level. The crowd cheering sounded like a group of half hearted soccer moms. Oh yay..in the background.

Lol.

I'm sure I will sleep well tonight after watching this. I work with a wonderful team of nurse anesthetists. We showed this at work this week and they just put their head down in embarrassment. One commented that CRNAs across the country think the AANA is just a bunch of crazies ruining their job and are so far out of touch with real world medicine. His words. Others sitting there nodded and agreed. I felt embarrassed for them.

I sent him home an hour early for being wise.

CJ
stick your head in the sand more why dont you?
 
  • Like
Reactions: 2 users
No one is going to pay these CRNAs any more than what they're getting so why would they want to become independent, become legally responsible for patients, take out malpractice insurance, and take on more demanding hours?


They don't believe that statement. The AANA has convinced its membership the path forward is full independence as providers. This in turn allows CRNAs to bill 100% for their services to insurance companies. The ACA contains language which forces Insurance companies to pay CRNAs fair reimbursement. The ACA combined with new legislation giving CRNAS full autonomy would be a double whammy to the current status quo. Hospitals may abolish the ACT and go with a "collaborative model" as endorsed by the AANA; the same model SDN members like PGG practice in every single day.

In addition, CRNAs want to be viewed as "equivalent providers to Anesthesiologists" in all aspects of care. The only way to accomplish that goal is to push for more autonomy and legal practice rights. The AANA knows that only through Federal legislation can they achieve their goals as local hospitals/medical staff will continue to block CRNA autonomy. We all know that a DNAP CRNA can not be "equivalent" to a Board Certified Anesthesiologist but that won't stop the AANA from achieving through legislation what its membership has failed to earn through education.
 
Last edited:
  • Like
Reactions: 3 users
This is like jr high PTO level. The crowd cheering sounded like a group of half hearted soccer moms. Oh yay..in the background.

Lol.

I'm sure I will sleep well tonight after watching this. I work with a wonderful team of nurse anesthetists. We showed this at work this week and they just put their head down in embarrassment. One commented that CRNAs across the country think the AANA is just a bunch of crazies ruining their job and are so far out of touch with real world medicine. His words. Others sitting there nodded and agreed. I felt embarrassed for them.

I sent him home an hour early for being wise.

CJ

You are a fool if you think this. A much greater percentage of them contribute to their PAC than we do to ours. They also write more letters. Where are the CRNAs who are willing to stand up and say the AANA doesn't speak for us on this issue?
Why don't you ask your "wonderful group of anesthetists" how they would feel about going on record saying that CRNA only care is second best to an ACT model or MD Anesthesia? See how that one would fly with them.
 
  • Like
Reactions: 4 users
"best kept secret in healthcare... crnas..." thats a laugh..

their lack of medical knowledge and poor decision making because of it is the best kept secret in healthcare thats for sure...

Hilarious and profound. Nice!
 
  • Like
Reactions: 1 users
Yeah Crazy Jake. You actually believe that ****? You are very naive then. They don't want to be supervised. Who the hell does?
I say let them all be independent. No medical direction, no supervision, and hell no to collaboration. I am not interested in discussing your patient and plan. I will take care of my own thank you. Get your own damn insurance and don't ask me for help in any shape or form.
 
  • Like
Reactions: 2 users
Can someone delineate the possible scenarios by which CRNAs practice in the future and what the impact would be on physician anesthesiologists? For example, what would happen in CRNAs actually gain independence in every state? Will it create a 2-tiered system of anesthesia care for all cases? Or will they simply flock to ASCs? Will they drive down physician salaries by flooding the market? Would it be possible for a "senior" CRNA to lead an ACT of other CRNAs? So many questions.
 
You are a fool if you think this. A much greater percentage of them contribute to their PAC than we do to ours. They also write more letters. Where are the CRNAs who are willing to stand up and say the AANA doesn't speak for us on this issue?
Why don't you ask your "wonderful group of anesthetists" how they would feel about going on record saying that CRNA only care is second best to an ACT model or MD Anesthesia? See how that one would fly with them.

Issue is Aana was one payment. Asa has two payment. One to Asa and one to state component b

Get rid of the two payment structure. Lower the dues. Get more membership. It's not rocket scientist here folks.

Paying $1000-1100 a year is a hard pill to swallow unless you got ur group or dept paying for it.

Aana membership dues cover both national and state components. (I think). Correct me if I am wrong.
 
A bill in the TX house to license AAs for practice failed last week both first vote and reconsideration.
 
Can someone delineate the possible scenarios by which CRNAs practice in the future and what the impact would be on physician anesthesiologists? For example, what would happen in CRNAs actually gain independence in every state? Will it create a 2-tiered system of anesthesia care for all cases? Or will they simply flock to ASCs? Will they drive down physician salaries by flooding the market? Would it be possible for a "senior" CRNA to lead an ACT of other CRNAs? So many questions.

Ummmm......that already exists.
 
The old senior CRNAS that walk with a limp are many times scarier than the young newbies. The old ones are the ones who dont call you, who continually treat bp problems with pressors the whole case. I shake my head. There arent many causes of intraop hypotension and they get it wrong each time. When they need to give fluid they give pressors, when they need to give pressors they give albumin when they need to turn down the gas they turn it up. It is astounding to me the HUGE HUGE gaps in knowledge. When there is no indication for deep extubation they want to do it. They give offirmev intra op when there is no need for it. Ketorolac is often given. And dont get me started with how they talk with patients preop. Disgusting. basically the important things they miss by a mile but they are truly worried about if the bair hugger is affixed perfectly... And these folks are going to be independent.. ???? Seriously
 
  • Like
Reactions: 4 users
Cromwell and coauthor Brian Dulisse, a health economist at RTI, analyzed 481,440 hospitalizations covered by Medicare. They found that the frequency of nurse anesthetists’ providing anesthesia without anesthesiologist supervision grew from 1999 to 2005. As of 2005, 21 percent of surgeries in opt-out states and 10 percent in non-opt-out states used nurse anesthetists without anesthesiologists, as opposed to 17.6 percent and 7.0 percent in 1999. The authors speculate that the increase could be due to anesthesiologists’ taking on more privately insured cases and leaving more Medicare cases to certified registered nurse anesthetists.

The researchers also found that although nurse anesthetists are trained to handle very complex cases, anesthesiologists, on average, work on more of these cases, which involve greater risk of death. The authors hypothesize that anesthesiologists, who can choose their cases more often than can certified registered nurse anesthetists, prefer more complex, better-paying, cases. Anesthesiologists also are more prevalent in teaching hospitals that perform more complex surgery.

Nurse anesthetists get essentially the same training in anesthesia as anesthesiologists. So in this case, a nurse is just about a perfect substitute for the doctor,” says Cromwell. “Eliminating physician supervision will not only allow nurses to do what they are trained and highly qualified to do, but it will encourage hospitals and surgeons to use a more cost-effective mix of anesthetists.”

Using nurse anesthetists more broadly could help save on health care costs because they typically earn less than anesthesiologists.


http://content.healthaffairs.org/content/29/8/1469.full
 
University of Sydney
It is very strange for a surgeon to understand why a nurse would like to pretend to be a doctor and try so hard to bypass the formal training to become a technician in anaesthesia. It looks to me that nurses providing anaesthesia wanted to be doctors as now they are requesting same scope of practise (and pay) but without the same amount of knowledge. This will never happen in surgery, fortunately for the patients. Nursing and medical school have different goals. If you want to provide anesthesia independently, then the way to go is to study medicine followed by the anaesthesia training as per all other medical specialties. Hopefully, I live in a country where medical acts are not seen as purely technical but include medical knowledge. Nurses in anaesthesia provide nursing care to the patient, as it should be. it is a terrible and disappointing way to see how a financial-based health system can deform medical care.

I make a call to my colleague surgeons to support our colleague anaesthesiologists and refuse to operate with purely a nurse, as I'm sure the anesthesiologists would refuse to provide anaesthesia if a nurse wanted to operate.
 
  • Like
Reactions: 5 users
Can someone delineate the possible scenarios by which CRNAs practice in the future and what the impact would be on physician anesthesiologists? For example, what would happen in CRNAs actually gain independence in every state? Will it create a 2-tiered system of anesthesia care for all cases? Or will they simply flock to ASCs? Will they drive down physician salaries by flooding the market? Would it be possible for a "senior" CRNA to lead an ACT of other CRNAs? So many questions.
IF CRNAS could magically gain complete independence tomorrow what would that do to physicians?

Well, it would create a system where we would do our own cases and they would do their own cases and there would be NO overlap. Meaning, I would not confer with, suggest a medical plan or examine their patients. Their complications are their complications. IT actually would improve our job market.
Consider an Operating room with 8 rooms plus endo plus ep. thats ten locations. Currently staffing with 4 mds and ten crnas.. Mds are making 325K crnas making 165 plus ot. total salaries of about 3 million give or take. Switch that over to 5 mds and 5 crnas. MDs are making 325 andcrnas are making 200. You are saving on salaries, 1/2your cases have NO MD input(which you have to explain to the patient, expose the hospital and surgeon to liability),1/2 your call are not covered by a physician which would expose yourself (the hospital) to liability and you have to find 5 experienced crnas to do the job without any supervision.

Its a win win for us. The only people that lose are the docs/ who hate being handcuffed to the anesthesia machine watching paint dry. And believe me depending on the surgeon.. this can be quite painful. It seems complete crna independence does not do anything for the crna demand at all. In fact i think it would decrease the demand.
 
IF CRNAS could magically gain complete independence tomorrow what would that do to physicians?

Well, it would create a system where we would do our own cases and they would do their own cases and there would be NO overlap. Meaning, I would not confer with, suggest a medical plan or examine their patients. Their complications are their complications. IT actually would improve our job market.
Consider an Operating room with 8 rooms plus endo plus ep. thats ten locations. Currently staffing with 4 mds and ten crnas.. Mds are making 325K crnas making 165 plus ot. total salaries of about 3 million give or take. Switch that over to 5 mds and 5 crnas. MDs are making 325 andcrnas are making 200. You are saving on salaries, 1/2your cases have NO MD input(which you have to explain to the patient, expose the hospital and surgeon to liability),1/2 your call are not covered by a physician which would expose yourself (the hospital) to liability and you have to find 5 experienced crnas to do the job without any supervision.

Its a win win for us. The only people that lose are the docs/ who hate being handcuffed to the anesthesia machine watching paint dry. And believe me depending on the surgeon.. this can be quite painful. It seems complete crna independence does not do anything for the crna demand at all. In fact i think it would decrease the demand.


The AANA goal is 1 doctor/MD (Fireman) and 10 CRNAs. The "call" is covered by the CRNA with phone consultation to the MD if needed. If things get real busy the 1 MD has to do his/her own room during the day.

Under the AANA scenario 3 MDs get fired or have to work for CRNA wages. In 20 years the AANA goal is DNAP CRNA= MD Anesthesiologist for salary and privileges. A SENIOR crna will provide backup to all the anesthesia providers (MD and CRNA).
 
  • Like
Reactions: 1 user
Cromwell and coauthor Brian Dulisse, a health economist at RTI, analyzed 481,440 hospitalizations covered by Medicare. They found that the frequency of nurse anesthetists’ providing anesthesia without anesthesiologist supervision grew from 1999 to 2005. As of 2005, 21 percent of surgeries in opt-out states and 10 percent in non-opt-out states used nurse anesthetists without anesthesiologists, as opposed to 17.6 percent and 7.0 percent in 1999. The authors speculate that the increase could be due to anesthesiologists’ taking on more privately insured cases and leaving more Medicare cases to certified registered nurse anesthetists...

I find it very hard to believe that those numbers are accurate.
 
The AANA goal is 1 doctor/MD (Fireman) and 10 CRNAs. The "call" is covered by the CRNA with phone consultation to the MD if needed. If things get real busy the 1 MD has to do his/her own room during the day.

Under the AANA scenario 3 MDs get fired or have to work for CRNA wages. In 20 years the AANA goal is DNAP CRNA= MD Anesthesiologist for salary and privileges. A SENIOR crna will provide backup to all the anesthesia providers (MD and CRNA).
Blade
IF they have equal parity why would they need a md "fireman"? There would be zero need for a fireman!

Does this said "fireman" sign all charts? Does this firemanhave liability if he/she is tied in another FIRE?

serious question because someone above posed it. What happens to us? with all of our training? Do we just disappear? OR as technological advances happen do the CRNAS disappear and we can do the cases with a technician (one year training).
 
  • Like
Reactions: 1 user
100% guarantee of failure.

It has to start somewhere, and we've already passed our first hurdle, so it's already gotten further than it ever has in the past.
 
  • Like
Reactions: 1 user
I find it very hard to believe that those numbers are accurate.

Many of the CMS numbers make the assumption that QZ billing = independent practice, even if the care was actually supervised or directed. Maybe that's in play in that statistic.
 
  • Like
Reactions: 1 user
U


You know what Blade... I've thought about this a lot and I actually think even if CRNAs become independent in all 50 states with the rollout of Obamacare and zealous hospital execs as well as insurance companies looking to cut costs I think a 2 tier system will develop in anesthesia. MD provided anesthesia and midlevel provided anesthesia with no overlap or collaboration that would 1. Finally allow the official objective comparison to be made and we know how that will turn out and 2. anesthesiologists will naturally attract more keen patients that have good health insurance or are wealthy and want MD anesthesia because they know better. I think all the **** insurance will naturally get filtered out and it may benefit anesthesiologists while proving to the public that doctors are superior. Just like in real life you have the choice of shopping at Walmart or Bloomingdales for your clothes.

Exactly, I completely agree.
 
I don't. Patients will have no choice about who provides their anesthesia. Just like they don't about who reads their X-rays or MRIs

This is only true because of the current way that networks contract with anesthesia groups. This could well change if the above scenario came to pass.
 
I don't. Patients will have no choice about who provides their anesthesia. Just like they don't about who reads their X-rays or MRIs
Hospitals like to advertise things, ours sure does. Anesthesiologists supervising care could be a safety talking point for advertising and implied superiority over other area hospitals. Patients do have a say in where their surgery is done. Now the hospital across town has to compete. They're not going to put up a sign that says CRNAs are equal to MDs and not to worry.
PS Toronto's Hospital for Sick Children looks better and better every year. If there was a real children's hospital in Vancouver, I'd be living there already in my bay view cottage.
 
Last edited:
  • Like
Reactions: 1 user
May 2014 National Occupational Employment and Wage Estimates

http://www.bls.gov/oes/current/oes_nat.htm

Anesthesiologists are #1 in mean hourly wage and annual wage.


What matters to you is the FUTURE of Anesthesiology and not its past. A post about 2014 hourly wage is about as relevant to you as posting my 2010 salary income: they are both in the past.

Like the stock of a company you need to be concerned about LONG TERM growth prospects for your specialty. If Anesthesiology was a stock would you be a buyer at today's prices? I'm sure it would be a Large Value stock in 2015 but the question remains is the current PE ratio justified and will the "E" be shrinking for the Physician Anesthesiologists as the "E" for CRNAs increases over time.
 
I'm still not worried. I think I'll have a job for my career. Again, my crew is very good but I have to intervene daily with both the new grads and old alike. They get into trouble, often.

My sister in law works in an opt out state. When they renewed their contract this pass fall the hospitals (granted its a large, very nice hospital) sole request was please stop hiring so many CRNAs.

CRNA schools have become total mills. Just like lawyers, just like pharmacy, and now nurse anesthesia. Almost anyone can go be a CRNA. I worked with a new grad (working on year 1 post training) Friday and she's super nice, but I'm not sure she ever had a clue. I rested well again.
 
What matters to you is the FUTURE of Anesthesiology and not its past. A post about 2014 hourly wage is about as relevant to you as posting my 2010 salary income: they are both in the past.

Like the stock of a company you need to be concerned about LONG TERM growth prospects for your specialty. If Anesthesiology was a stock would you be a buyer at today's prices? I'm sure it would be a Large Value stock in 2015 but the question remains is the current PE ratio justified and will the "E" be shrinking for the Physician Anesthesiologists as the "E" for CRNAs increases over time.
What non-surgical specialties are good investments nowadays other than Derm?
 
I'm still not worried. I think I'll have a job for my career. Again, my crew is very good but I have to intervene daily with both the new grads and old alike. They get into trouble, often.

My sister in law works in an opt out state. When they renewed their contract this pass fall the hospitals (granted its a large, very nice hospital) sole request was please stop hiring so many CRNAs.

CRNA schools have become total mills. Just like lawyers, just like pharmacy, and now nurse anesthesia. Almost anyone can go be a CRNA. I worked with a new grad (working on year 1 post training) Friday and she's super nice, but I'm not sure she ever had a clue. I rested well again.


I don't disagree with you about the reality vs the propaganda on the AANA. The quality of the average CRNA graduate has gone down not up since that group decided to flood the market. Still, every newly minted CRNA has found employment with 40 hour weeks or less at over $125K in my area with bigger hospitals paying over $140K. With overtime a CRNA can easily clear $180-$200K W-2 per year.

The question isn't whether you will have a job in the future but rather will the AANA campaign to stain our profession take its toll. The constant propaganda that an anesthesia nurse is equal to a Physician Anesthesiologist demeans the profession and the value of our education not to mention the impact on patient care.
 
What non-surgical specialties are good investments nowadays other than Derm?


Please don't misunderstand my posts. Anesthesiology is a reasonable choice for Med Students who understand all the issues and problems facing the specialty.
A realistic view of expected income, job tasks and hours are all very important for Anesthesiology.


1. $250 (low) vs $325 (median) salary
2. 50 hour work weeks with lots of night/weekend work
3. 75% chance or more you will supervising CRNAS/AAs
4. AANA will continue its assault on the medical specialty (demeaning and dishonest)
5. 75% you will be an employee of a hospital or AMC


Other choices (non surgical) include Oncology vs Allergy/Immunology.
 
  • Like
Reactions: 2 users
The question isn't whether you will have a job in the future but rather will the AANA campaign to stain our profession take its toll. The constant propaganda that an anesthesia nurse is equal to a Physician Anesthesiologist demeans the profession and the value of our education not to mention the impact on patient care.

Exactly. I believe folks will still have a job. But for how much and what will you be required to do for that salary ANd where is it? Anyone can find a job but if your wife wants to be in xx city... it probably wont happen unless you want to make serious concessions.
 
  • Like
Reactions: 1 user
The beauty of Anesthesiology is that you are investing in a field of unlimited demand: surgery. This remains true even if the types of surgeries/procedures change, because the Anesthesia component is always a constant.

Two fields I would not want to invest in long term include Heme-Onc and Allergy-Immunology. The former will fall the level of Infectious Disease once therapies start to dramatically improve (5-10 years?), and the latter is highly prone to encroachment by mid-levels and Family Practitioners.
 
The beauty of Anesthesiology is that you are investing in a field of unlimited demand: surgery. This remains true even if the types of surgeries/procedures change, because the Anesthesia component is always a constant.

Two fields I would not want to invest in long term include Heme-Onc and Allergy-Immunology. The former will fall the level of Infectious Disease once therapies start to dramatically improve (5-10 years?), and the latter is highly prone to encroachment by mid-levels and Family Practitioners.


 
Top