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

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BLADEMDA said:
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That's a really sickening video. It's too bad they got a Surgeon to actually buy into that garbage. Once I start receiving an Attending salary I'll definitely start donating to the ASAPAC more often. At least I'm moving to a state with a lot of AAs as the midlevel provider. I do some moonlighting now, and I can't tell you how many arguments I've gotten into with CRNAs ... even dismissing one from a case for incredible insubordination and changing the anesthetic plan without consulting me. This is at an "academic" practice, not private practice. They are horribly misled in their beliefs.
 
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Hold on, isn't the "when seconds count" phrase the crna just used a trademark of the ASA?
 
Carbocation1 said:
Hold on, isn't the "when seconds count" phrase the crna just used a trademark of the ASA?
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It is a not so subtle F.U. to use the slogan of an ASA campaign in a pro CRNA ad. Don't let it get under your skin.
 
Carbocation1 said:
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.
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Not sure if srs. How do you suppose that the demand for surgeries or procedures of the like is unlimited? I would venture that any trend you can see in healthcare in the past few decades is due to demographic and socioeconomic changes, as opposed to demand independent of these factors. I can just as easily say that the beauty of hospital medicine is that there is unlimited demand for hospitalizations, and the data would beautifully support my hypothesis just like surgical data would yours. But, such a statement is disingenuous at best, and the assumption of its veracity does no one any good.

Your assessment of heme/onc makes little to no sense. Why is it going to "fall to the level of Infectious Diseases once therapies start to dramatically improve?" Do you think that ID is where it is because therapies are just too good? And to posture that "better" therapies means a "cure" which ultimately decreases market demand for heme/onc services... well, that's just wishful thinking akin to thinking that AI will replace human intelligence or that machines will replace anesthesiologists.

Why are you singling out allergy/immunology in terms of encroachment. A/I is in trouble for new grads because of the low rate of attrition for older allergists - not exactly from encroachment from third parties. I'm an internist, and I know a lot of allergists as I was previously considering going into A/I. I don't know a single PCP that performs immunotherapy. The ones that do are the exception, and not the rule. The overhead you incur is NOT worth it, unless you have substantial volume. Plus, most PCPs have no desire to deal with possible complications of immunotherapy. The possible advent of sublingual IT is a different matter... maybe that will be the downfall.
 
It's easy to tell the difference, when things go bad, the one who throws up their hands and backs away saying " it's not my fault I'm just a nurse" that's the CRNA. Wants the cash, and title, but not the responsibility.
 
G-Man82 said:
That's a really sickening video. It's too bad they got a Surgeon to actually buy into that garbage.
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It goes like this:

Administration: Hey Joe, want a promotion (and/or raise)?
Surgeon Joe: Sure!
Administration: Okay, they are shooting a video in OR #5 in 10 minutes. Here are your lines.
 
From ASA Washington alerts news feed: the House has passed a bill to repeal the IPAB, and Colorado's Supreme Court has declared independent crnas unconstitutional. Nice!
 
likeaboss said:
California's AA legislation (AB 890) died last week. That's a development :-(
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It went further than we thought it would - we'll be back next year. :)
 
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Yes, I hope so. Apparently it made it thru the business and professions committee but died in appropriations because it would have cost too much to regulate and didn't give any regulatory mechanism to the medical board of CA. Hopefully these issues will be worked out the next time around...
 
Carbocation1 said:
From ASA Washington alerts news feed: the House has passed a bill to repeal the IPAB, and Colorado's Supreme Court has declared independent crnas unconstitutional. Nice!
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The AANA's Press Release is posted and seems to state otherwise.


https://www.courts.state.co.us/user...ation/Supreme_Court/Opinions/2012/12SC671.pdf

The AANA won and the ASA lost no matter how you want to spin this legal opinion. But, CRNAS are limited to the 13-14 hospitals as listed by former Gov. Ritter for Independent Practioce. This means the large cities and towns in Colorado remain as they were before the Opt-Out.
 
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Colorado Supreme Court Affirms That Nurse Anesthetists Can Provide Anesthesia Care Without Physician Supervision in State Critical Care and Rural Hospitals
For Immediate Release
June 1, 2015 For more information, contact Lisa Pearson
Phone: (970) 823-2762
Email: [email protected]

Denver, Colorado—In a victory for state nurse anesthetists, the Colorado Supreme Court has upheld the legality of Colorado’s 2010 opt-out from Medicare’s facility reimbursement rule requiring physician supervision of Certified Registered Nurse Anesthetists (CRNAs), effectively ending the legal challenges by the Colorado Society of Anesthesiologists (CSA) and Colorado Medical Society (CMS).

The Supreme Court upheld former Gov. Bill Ritter’s opt-out from the Medicare reimbursement requirement, ruling that the challenge by the CSA and CMS was not predicated on the appropriate grounds to make the governor’s decision reviewable. CRNAs will therefore continue to provide anesthesia care without physician supervision in state critical care and rural hospitals per the opt-out.

“Colorado's scope of practice has always allowed for the independent administration of anesthesia by CRNAs,” said Sarah Fredrikkson, CRNA, DNAP, president of the Colorado Association of Nurse Anesthetists. “We are pleased that the continued independent practice of CRNAs will not be disrupted by the legal challenge of these physician groups,” Fredrikkson said, emphasizing that the opt-out ensures patient access to safe, cost-effective anesthesia care for all Coloradoans, especially in rural and other medically underserved communities.

The opt-out was strongly supported by the Colorado Hospital Association and the Colorado Nurses Association. It is consistent with a 2010 Institute of Medicine report recommending the removal of scope of practice barriers so that advanced practice nurses can practice to the full extent of their education and training. The opt-out also alleviates the misperception held by some physicians that their liability is increased when working with CRNAs.
 
BLADEMDA said:
Colorado Supreme Court Affirms That Nurse Anesthetists Can Provide Anesthesia Care Without Physician Supervision in State Critical Care and Rural Hospitals
For Immediate Release
June 1, 2015 For more information, contact Lisa Pearson
Phone: (970) 823-2762
Email: [email protected]

Denver, Colorado—In a victory for state nurse anesthetists, the Colorado Supreme Court has upheld the legality of Colorado’s 2010 opt-out from Medicare’s facility reimbursement rule requiring physician supervision of Certified Registered Nurse Anesthetists (CRNAs), effectively ending the legal challenges by the Colorado Society of Anesthesiologists (CSA) and Colorado Medical Society (CMS).

The Supreme Court upheld former Gov. Bill Ritter’s opt-out from the Medicare reimbursement requirement, ruling that the challenge by the CSA and CMS was not predicated on the appropriate grounds to make the governor’s decision reviewable. CRNAs will therefore continue to provide anesthesia care without physician supervision in state critical care and rural hospitals per the opt-out.

“Colorado's scope of practice has always allowed for the independent administration of anesthesia by CRNAs,” said Sarah Fredrikkson, CRNA, DNAP, president of the Colorado Association of Nurse Anesthetists. “We are pleased that the continued independent practice of CRNAs will not be disrupted by the legal challenge of these physician groups,” Fredrikkson said, emphasizing that the opt-out ensures patient access to safe, cost-effective anesthesia care for all Coloradoans, especially in rural and other medically underserved communities.

The opt-out was strongly supported by the Colorado Hospital Association and the Colorado Nurses Association. It is consistent with a 2010 Institute of Medicine report recommending the removal of scope of practice barriers so that advanced practice nurses can practice to the full extent of their education and training. The opt-out also alleviates the misperception held by some physicians that their liability is increased when working with CRNAs.
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I'm confused. The ASA post clearly states "Very importantly, the ruling also overturned a lower court’s decision that Colorado nurse anesthetists may administer anesthesia without physician supervision." Additionally, it is accompanied by a press release entitled:

"Colorado Society of Anesthesiologists Pleased Colorado Supreme Court Ruling on Physician Supervision of Anesthesia Care Corrects Lower Court Errors".

http://newswise.com/articles/colora...f-anesthesia-care-corrects-lower-court-errors
 
The above posts have confused me to no end.

o_O
 
Spinach Dip said:
The above posts have confused me to no end.

o_O
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Each side "spins" the facts to show they are winning the war. If you actually read the Court's ruling on that matter then it is clear the AANA won and the ASA lost. Former Gov. Ritter's "opt-out" stands as written but only applies to the 13-14 hospitals specified by him. The rest of Colorado remains under Physician Supervision requirements for CRNAs.

The Colorado Court ruled that former Gov. Ritter did not have the authority to decide whether CRNAs can practice independently; but, he did have the authority to "opt-out" of CMS supervision requirements for CRNAs.

https://www.courts.state.co.us/user...ation/Supreme_Court/Opinions/2012/12SC671.pdf
 
  1. The physician, dentist, or podiatrist who is performing the procedure requiring anesthesia services does have the responsibility to make sure that the patient is an appropriate risk for the procedure. It is his/her responsibility to make sure the patient has been appropriately evaluated as to health status and is in the best possible condition prior to the procedural intervention. Typically, the physician, dentist, or podiatrist is expected to examine the patient within twenty-four hours prior to the procedure to make sure the patient has not had any changes in status that would make him or her a bad candidate for surgery. These responsibilities of the operating practitioner occur whether the anesthesia is provided by a CRNA or by an anesthesiologist. The approach to anesthetizing the patient is decided based on consultation by the operating practitioner with the CRNA or anesthesiologist, taking into account the patient’s preferences for the type of anesthesia. These activities do not comprise physician supervision of the anesthesia provider – whether a CRNA or an anesthesiologist. Rather, these are the responsibilities of the operating practitioner based on his or her own commitment to doing the best by the patient.

http://coana.org/overview/
 
BLADEMDA said:
  1. The physician, dentist, or podiatrist who is performing the procedure requiring anesthesia services does have the responsibility to make sure that the patient is an appropriate risk for the procedure. It is his/her responsibility to make sure the patient has been appropriately evaluated as to health status and is in the best possible condition prior to the procedural intervention. Typically, the physician, dentist, or podiatrist is expected to examine the patient within twenty-four hours prior to the procedure to make sure the patient has not had any changes in status that would make him or her a bad candidate for surgery. These responsibilities of the operating practitioner occur whether the anesthesia is provided by a CRNA or by an anesthesiologist. The approach to anesthetizing the patient is decided based on consultation by the operating practitioner with the CRNA or anesthesiologist, taking into account the patient’s preferences for the type of anesthesia. These activities do not comprise physician supervision of the anesthesia provider – whether a CRNA or an anesthesiologist. Rather, these are the responsibilities of the operating practitioner based on his or her own commitment to doing the best by the patient.
http://coana.org/overview/
Click to expand...


The typical CRNA is unprepared for the role of Medical Physician/Perioperative Physician the vast majority of time. He/She lacks the education to make the decision to cancel a case, proceed with a case or modify the procedure to minimize risk to the patient. These judgments are outside the scope of practice for an Anesthesia Nurse. As for "patient's preference for type of anesthesia" that too should be tailored to the patient's underlying Physiology and overall health status so that a truly informed decision can be made by the patient.
 
http://lawmedconsultant.com/1305/anesthesiologist-misinformation-rampant-in-medicare-crna-opt-out/



"3rd year anesthesia residents are NOT permitted to supervise nurse anesthetists (not by any insurance company or state law anyway!). After their 3 years of actual anesthesia training during which they obtain similar clinical experience compared to the CRNA, the physician anesthesiologist does evaluate patients pre-operatively and also care for them post-operatively…and so does the CRNA. At no time before during or after the delivery of an anesthetic is the clinical practice of a CRNA different from a physician anesthesiologist, unless the particular institution dictates that it is." - See more at: http://lawmedconsultant.com/1305/an...n-medicare-crna-opt-out/#sthash.lU42COgX.dpuf


The writer is a Lawyer and a Militant CRNA. I wanted the Med Students and residents to see what they are up against for their careers.
 
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