CRNA Hires Anesthesiologist

[Lasvegas]

In an ad at www.gaswork .com for a job located in Kennewick Washington, if you look at who is listed as the president of the group it is a CRNA. Has anyone else seen this? This could be our very own ‘inconvenient truth.’

I have posted this before, but I believe a public awareness campaign needs to be started. The AANA already does this in radio spots and billboards. We need to do this ourselves, but for some reason the ASA won’t take this approach.

When a CRNA introduces themselves as the ‘anesthetist’ the average patients thinks ‘doctor’ not ‘nurse’ and this is what needs to change. We need to make the public aware that there is a difference, and outline this in way they can understand. And by looks of this ad, time may be of the essence.

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Members don't see this ad.

 

[amyl]

I am sorry to say that I know of a situation like this in one of the hospitals that we rotate through (I am a third year). The OR is run by a group of CRNAs that employ anesthesiologists to supervise them. The surgeons are pissed and dislike it but haven't done anything about it. You can site all the studies you want to and jump up and down about how CRNAs are as good as anes, but I have never seen so many patients move or cry out before!
And then the surgeon gives the CRNA an annoyed look...and thats it.
(please no discussion on CRNA vs anes -- I am merely citing my admittedly anecdotal experience.)
I know an anes who left the above hospital because of the restructuring-- now his gig is great -- a couple days at another hospital and the other at an outpatient plastic surgery center. I spent a few days with that plastic surgeon and asked him how come he employed this anes when he could hire a crna or a newer grad, etc. His response was, "why? to save a few bucks? its not worth it. this is better for my patients." All the pts are ASA I or II with elective procedures.

Of all the surgeons I have talked to they prefer anes to crna's. some have real reasons, some just have ego trips that they deserve an anes over crna's, most say things just go smoother. It just comes down to the almighty dollar.
In the la-la land of plastic surgery it just doesn't seem to matter -- patient care comes first. when there is more than enough money to go around.

 

[VolatileAgent]

i'm going to play devil's advocate here. lately, i've seen a lot of bitching about the situation on this forum with a lot of "we need to do this" or "someone should". that's all fine and dandy about identifying what you perceive to be the problem, but instead of putting that back on someone else's shoulders to solve, why don't you try to think of some creative ways to address the problem. in that vein, here's my socratic response to your post...

...for a job located in Kennewick Washington, if you look at who is listed as the president of the group it is a CRNA.

big deal. who wants to live in kennewick?

When a CRNA introduces themselves as the ‘anesthetist’ the average patients thinks ‘doctor’ not ‘nurse’ and this is what needs to change.

caveat emptor. how can i control someone implicitly misrepresenting their training? you know, lying by omission?

We need to make the public aware that there is a difference, and outline this in way they can understand.

is there a difference? what kind of cases are we talking here? lap chole? or on-pump bypass? interventional pain? are we comparing apples to apples?

And by looks of this ad, time may be of the essence.

why does it matter if a crna has his/her own group? and, why should i be mad at that crna group (and want legislation, rules, nursing/med board changes, etc.) who's just trying to do business and not the MD/DO who chooses to go work for that group?

 

[Planktonmd]

I would gladly flip burgers at McDonald's before working for a CRNA.

 

[me454555]

Why do you assume that a CRNA is less qualified to run a group than an anesthesiologist? When we're talking about running a group and business, CRNAs are just as qualified as MDAs or any other person w/some business skills. Now, when it comes to providing anesthesia.....well we all know where thats going and I'm not going to get into it.

 

[powermd]

This scenario creates an interesting power relationship. The anesthesiologist must exert some control over the CRNA to maintain patient safety, but not too much... if the CRNAs are unhappy with the way the anesthesiologist wants them to practice, they can just fire him. I would be curious to meet a fellow doctor who would put a nurse that he supervises in charge of his job.

 

[Mman]

Would you object to someone with an MBA running a group that had zero anesthesia experience? It's a business position. Whoever has the best business sense should be running it.

 

[harryh]

I would gladly flip burgers at McDonald's before working for a CRNA.

Your employment will most likely be temporary since the CRNA's long term plan is to get the Surgeons comfortable with CRNA's practicing independently and then fire or otherwise force the employed anesthesiologist to resign.


I responded to a job posted by a CRNA. The nasty nurse who ran the group was a past president of the state CRNA organization. Just about every thing he told me about the job was a lie. The Gasworks add offered 300K and every other week off. Second call to the CRNAs from home. He failed to mention the reason he was able to get the contract was that the hospital's anesthesiologist who I would be sharing call with and working with had had his license suspended twice for using Fentanyl and abusing Alcohol. The State Medical board's condition of allowing him to practice was that all his colleges that he shared call with were to be informed of his history of drug abuse. The nasty nurse never mention the drug use of this physician whom he employed, despite my asking if their were any employees with any disciplinary or drug dependence issues. He promised to pay travel expenses it took me over 6 month of emails and certified letters to get him to honor that promise. The contract was 22 pages of the most one sided piece of crap that I have ever seen. Every thing the nasty nurse previously promised was not in the contract. He promised to pay for my tail but the contract had two pages of ways he could avoid paying the tail. The 26 weeks of vacation turned into 6 weeks. The contract made call fist call every other day not q4 second call that I was originally promised. The 300K salary dropped to 260K because 40K was to be paid via a retirement plan which had a page of ways which the nasty nurse could keep my retirement money, including a clause that I would forfeit my retirement if I ever acted in a manner that not in the best interest of the nasty nurse‘s group.

The Nasty Nurse long term plan was to get the Surgeons comfortable with CRNAs practicing independently and then fire or otherwise force the employed anesthesiologist to resign. So this would have been a one or two year position at most until I got fired by the CRNA when The CRNA thought the surgeons would tolerate a CRNA only group. The Nasty Nurse would of couse manufacture some incident to keep my 40k per year pension and get out of paying my tail insurance.

 

[Monty Python]

This scenario creates an interesting power relationship. The anesthesiologist must exert some control over the CRNA to maintain patient safety, but not too much... if the CRNAs are unhappy with the way the anesthesiologist wants them to practice, they can just fire him. I would be curious to meet a fellow doctor who would put a nurse that he supervises in charge of his job.

I have licenses in several states and have worked in almost all practice settings (full autonomy, VA, university, military, private sector ACT setting, etc).

I worked one rural locums gig in a state where CRNAs require physician supervision. This particular hospital went further, and its bylaws required anesthesiologist supervision of the CRNAs. An anesthesia practice owned by three CRNAs had the exclusive contract. They employed a retired military anesthesiologist who lived 45 miles away to "supervise" them. This anesthesiologist would come in one day/week to sign charts, and would occasionally take weekend call. Otherwise he was never seen.

The CRNAs were billing privately. They paid the anesthesiologist $200,000/yr for his employee services.

I can't speak to the details of the malpractice insurance or the liability questions this might raise. All I can say is that the surgeons were very nonchalant with me doing cases from start to finish with nary an anesthesiolgist in house.

 

[EtherMD]

Trinity,

Despite the heat you might get for the post I appreciate it. I have been posting for months that CRNA Groups exist and while rare are becoming more common.

 

[harryh]

I worked one rural locums gig in a state where CRNAs require physician supervision. This particular hospital went further, and its bylaws required anesthesiologist supervision of the CRNAs. An anesthesia practice owned by three CRNAs had the exclusive contract. They employed a retired military anesthesiologist who lived 45 miles away to "supervise" them. This anesthesiologist would come in one day/week to sign charts, and would occasionally take weekend call. Otherwise he was never seen.

The CRNAs were billing privately. They paid the anesthesiologist $200,000/yr for his employee services.

I can't speak to the details of the malpractice insurance or the liability questions this might raise. All I can say is that the surgeons were very nonchalant with me doing cases from start to finish with nary an anesthesiolgist in house.

I heard of a similar arrangement. The big name chairman of the state's only anesthesia residency gladly lent his name and prestige to any CRNA group that wanted to hire him for "quality" control. He would never actually practice anesthesia or take call, but would help the CRNA's by signing chart and making presentations to the hospital administration in support of the CRNA groups. I suspect he was similarly very well compensated for the amount of time he actually spent working for the various CRNA groups thought the region.

When the state's fifth largest town's Anesthesiologists and CRNA's group split when the CRNA's decided they wanted to get paid more and were tired of being supervised. It was the big name chairman of the states only anesthesia residency who made the presentation to the hospital administration in support of the new CRNA only group. The Chairman of course promised that he would personally oversee the quality of the anesthesia serviced provided by the CRNA group and promised that they would provide much better service than the services previously provided by the Anesthesiologists and CRNA's group.

 

[VolatileAgent]

The Nasty Nurse long term plan was to get the Surgeons comfortable with CRNAs practicing independently and then fire or otherwise force the employed anesthesiologist to resign. So this would have been a one or two year position at most until I got fired by the CRNA when The CRNA thought the surgeons would tolerate a CRNA only group. The Nasty Nurse would of couse manufacture some incident to keep my 40k per year pension and get out of paying my tail insurance.

sad story (if even partly true), but this won't happen on a large scale. if you believe it will, you don't understand demographics.

I can't speak to the details of the malpractice insurance or the liability questions this might raise. All I can say is that the surgeons were very nonchalant with me doing cases from start to finish with nary an anesthesiolgist in house.

why so many states, trinity? locums... or running from the law?

seriously, what you describe is highly illegal, and would result in serious discipline from both the state medical and nursing boards. this is not only gross medical and nursing malpractice, in no uncertain terms, it is also outright fraud. knowingly engaging in such behavior would not be looked favorably upon by the courts. you might permanently lose your license. people have even been jailed for this type of behavior. i'd advise you not to pursue such an employment situation again in the future.

 

[harryh]

sad story (if even partly true), but this won't happen on a large scale. if you believe it will, you don't understand demographics.

VolatileAgent, perhaps you can be kind enough to tell me what demographics have to do with the proliferation of CRNA groups.

This CRNA group owner has been in the business for 20+ years and since he has also been the president of the CRNA society has seen and learned many of the tricks anesthesia groups use to fleece unwary doctors. He show a very strong anti-physician bias so along with his obvious greed and knowledge of the business side of anesthesia which makes him as dangerous or more dangerous than the worst anesthesia management company. I just think he needs to polish his delivery, but that will come with time. Soon, he will have figured out how to con people into working for him before they figure out how dishonest he is.

I am a little more careful than most new graduates, since I check the state license database of all the employees that I will be working with, along with seeking out ex-employees to get the full story about a position. I also have seen a few contract and can tell what is excessive and ridiculous.

 

[amyl]

I was on a triple A repair with the vascular surgeon at the local VA hospital. He found out after the case that there was not an anes in house. Thankfully everything went okay during and post op...but the surgeon threw a total fit anyways (he was the type). he ended up quitting a couple days later and this episode was a big part of it. He was so mad at the VA he even left before all his foreign visa stuff was settled so he would have to start over some place else.
and btw -- the anes that quit the crna group at my local hospital quit for exactly that reason...they were putting pressure on the anes to go with cases he was uncomfortable with. he said: nurses can run the business, why not?, make suggestions about patient care etc but NO final decisions about what happens with a case or a patient -- they didn't fire him but gave him a hard time about it....he left.

 

[foxtrot]

I heard of a similar arrangement. The big name chairman of the state's only anesthesia residency gladly lent his name and prestige to any CRNA group that wanted to hire him for "quality" control. He would never actually practice anesthesia or take call, but would help the CRNA’s by signing chart and making presentations to the hospital administration in support of the CRNA groups. I suspect he was similarly very well compensated for the amount of time he actually spent working for the various CRNA groups thought the region.

When the state's fifth largest town’s Anesthesiologists and CRNA’s group split when the CRNA’s decided they wanted to get paid more and were tired of being supervised. It was the big name chairman of the states only anesthesia residency who made the presentation to the hospital administration in support of the new CRNA only group. The Chairman of course promised that he would personally oversee the quality of the anesthesia serviced provided by the CRNA group and promised that they would provide much better service than the services previously provided by the Anesthesiologists and CRNA’s group.

This kind of thing is exactly what EtherMD and many others have posted about. Why are big name chairman selling their residents out? I know that money is the top reason but this is sickening. In my opinion, you need to post what state this is coming from so that maybe this chairman may catch some heat from this. Or maybe so future applicants can know what type of person is running this program and not apply there.

 

[toughlife]

This kind of thing is exactly what EtherMD and many others have posted about. Why are big name chairman selling their residents out? I know that money is the top reason but this is sickening. In my opinion, you need to post what state this is coming from so that maybe this chairman may catch some heat from this. Or maybe so future applicants can know what type of person is running this program and not apply there.

Behavior like this should be reprimanded by the ASA and this 'leader' should have his license/board certification suspended.

The more I learn about stories like this, the more I am realizing the ASA is not on the ball. They are allowing this crap to occur without doing anything about it.

As long as the 'leaders' are lining their pockets by selling out the specialty, nothing is going to change. Things will just get worse.

 

[Noyac]

Yes, The ASA drops the ball again.

 

[VolatileAgent]

VolatileAgent, perhaps you can be kind enough to tell me what demographics have to do with the proliferation of CRNA groups.

This CRNA group owner has been in the business for 20+ years and since he has also been the president of the CRNA society has seen and learned many of the tricks anesthesia groups use to fleece unwary doctors. He show a very strong anti-physician bias so along with his obvious greed and knowledge of the business side of anesthesia which makes him as dangerous or more dangerous than the worst anesthesia management company. I just think he needs to polish his delivery, but that will come with time. Soon, he will have figured out how to con people into working for him before they figure out how dishonest he is.

I am a little more careful than most new graduates, since I check the state license database of all the employees that I will be working with, along with seeking out ex-employees to get the full story about a position. I also have seen a few contract and can tell what is excessive and ridiculous.

well, the first problem happens just right there with your first statement. i take objection to the perception that there has been a "proliferation of crna groups", and i'm waiting (and will continue to wait) for someone to prove to me that this is actually occurring.

the facts are that there are roughly 80,000 anesthesia "providers" in the U.S. these are made up by anesthesiologists, crna's, aa's, csn's, and a small host of other people who are providing anesthesia without formal training (i specificlally and personally know of a FP doc in maine who is doing this right now). out of those 80K providers, roughly 60% are anesthesiologists - that is, md's or do's who've completed an acgme/aoa boardable anesthesiology residency program.

in order for the crna groups to be "proliferating" or, even worse, taking over there would have to occur several things. first, they'd have to grossly outnumber us (which they don't). secondly, the political and practice management climate would have to be favorable in all venues for them to take the upper hand (which it isn't). and, lastly, patients would suddenly have to have no say in where they electively seek their care (which they, in the majority of cases, still do). if all those things happened, forget just about anesthesia - the entire system would melt down.

on this forum, we are subjected to a few anecdotal examples and suddenly everyone starts to believe this is "the norm". it's a chicken little phenomenon. i'm not saying don't be vigilant, don't bury your head in the sand and ignore such examples, or not that we should even talk about them. what i am saying is try not to characterize this as what's inevitably going to happen. it can't. we are not outnumbered, and we won't be. more crna's going into the field creates more competition for jobs on their end, not ours.

you yourself say this particular crna has been in the business for 20+ years. and, he hasn't taken over the whole system, has he? again, i'd say caveat emptor to any anesthesiologist who even remotely entertains entering into such an agreement. in no other words, some individual didn't properly do their homework. how is the whole system to blame for that?

i think, after seeing a huge trend on this forum over the past few months, that people need to realize that their individual choices are as important as what the ASA can or should be doing for them. you all can start by educating your colleagues, many of whom (i'm finding in the real world) are blissfully uninformed about what it means to the entire profession when they consider a job, say, in a practice management company.

that's where change starts. talking and discussing, not complaining that someone else isn't doing enough. and, right now, believe it or not, we still do have the upper hand.

 

[EtherMD]

What the ASA needs is a good advertisement campaign like the Geico Insurance company's Caveman spots. Perhaps, we need a "monkey" instead of the caveman at the head of the table.

"Your Anesthesia is not monkey business." Make sure you have a Board Certified Anesthesiologist involved with your care. Don't bet your life on a monkey."

This would get the ASA's point across without bashing the CRNA's. We are the best and most qualified provider in the USA. It is time to get the message out to the public load and clear. We need to stop monkeying around and raise money for the T.V. spots after the movie AWAKE hits the theaters.

 

[Monty Python]

Trinity,

Despite the heat you might get for the post I appreciate it. I have been posting for months that CRNA Groups exist and while rare are becoming more common.

As always, just trying to add non-judgemental facts and perspectives to the conversation without meaning to rain on anyone's parade.

 

[Monty Python]

why so many states, trinity? locums... or running from the law?

The locums market, especially in the Texas boonies, is very lucrative especially if you're free to work holidays and/or weekends and are proficient with OB epidurals. I'm registered with several PRN agencies who constantly call me. What's becoming a royal pain is JCAHO requirements for granting privileges. Each new hospital where I moonlight (perhaps for only one weekend out of an entire year) requires a telephone book sized application with a zillion attachments.

seriously, what you describe is highly illegal, and would result in serious discipline from both the state medical and nursing boards. this is not only gross medical and nursing malpractice, in no uncertain terms, it is also outright fraud. knowingly engaging in such behavior would not be looked favorably upon by the courts. you might permanently lose your license. people have even been jailed for this type of behavior. i'd advise you not to pursue such an employment situation again in the future.

I'd say the above is probably more true for the supervising anesthesiologist than for me. I was in compliance with state law and BON rules. As to the hospital bylaw requirement for anesthesiologist-specific supervision .... one surgeon was Chief of Staff who never said word one about where the anesthesiologist was. Probably the person with the biggest unrealized liability was the surgeon if operating without the anesthesiologist in-house. Was he then by default supervising me? Or was the anesthesiologist of record still supervising me from afar? I don't know. To my knowledge, this private hospital was all private pay and that freed us from TEFRA requirements of the anesthesiologist, from the perspective of Medicare billing fraud.

I'm guessing TEFRA is what you're referring to, above. Yes, there are people in the slammer for intentionally defrauding Medicare with shady supervision/billing arrangements. Whistle-blowers stand to collect a pretty penny from Uncle Sam if their allegations are proven in court.

 

[Monty Python]

This kind of thing is exactly what EtherMD and many others have posted about. Why are big name chairman selling their residents out? I know that money is the top reason but this is sickening. In my opinion, you need to post what state this is coming from so that maybe this chairman may catch some heat from this. Or maybe so future applicants can know what type of person is running this program and not apply there.

Underlying the debates of ASA/anesthesiologist/AANA/CRNA/AA/AAAA/AARP/Holiday Inn Express is one cold, hard truth: money makes the world go round, and is the primary motivator for a certain percentage of any profession. Sad but true. While there are other aspects of any job from which to receive personal satisfaction (mental stimulation, doing a good job taking care of a fellow human being, enjoyment of the technical hands-on, etc.) some people just follow the money instead.

You can't buy happiness.

 

[Planktonmd]

What the ASA needs is a good advertisement campaign like the Geico Insurance company's Caveman spots. Perhaps, we need a "monkey" instead of the caveman at the head of the table.

"Your Anesthesia is not monkey business." Make sure you have a Board Certified Anesthesiologist involved with your care. Don't bet your life on a monkey."

This would get the ASA's point across without bashing the CRNA's. We are the best and most qualified provider in the USA. It is time to get the message out to the public load and clear. We need to stop monkeying around and raise money for the T.V. spots after the movie AWAKE hits the theaters.

Brilliant!

 

[dogbone65]

I have licenses in several states and have worked in almost all practice settings (full autonomy, VA, university, military, private sector ACT setting, etc).

I worked one rural locums gig in a state where CRNAs require physician supervision. This particular hospital went further, and its bylaws required anesthesiologist supervision of the CRNAs. An anesthesia practice owned by three CRNAs had the exclusive contract. They employed a retired military anesthesiologist who lived 45 miles away to "supervise" them. This anesthesiologist would come in one day/week to sign charts, and would occasionally take weekend call. Otherwise he was never seen.

The CRNAs were billing privately. They paid the anesthesiologist $200,000/yr for his employee services.

I can't speak to the details of the malpractice insurance or the liability questions this might raise. All I can say is that the surgeons were very nonchalant with me doing cases from start to finish with nary an anesthesiolgist in house.

What a sweet gig! Now THAT makes me wish I had went to med school! hahaha

 

[EtherMD]

I have licenses in several states and have worked in almost all practice settings (full autonomy, VA, university, military, private sector ACT setting, etc).

I worked one rural locums gig in a state where CRNAs require physician supervision. This particular hospital went further, and its bylaws required anesthesiologist supervision of the CRNAs. An anesthesia practice owned by three CRNAs had the exclusive contract. They employed a retired military anesthesiologist who lived 45 miles away to "supervise" them. This anesthesiologist would come in one day/week to sign charts, and would occasionally take weekend call. Otherwise he was never seen.

The CRNAs were billing privately. They paid the anesthesiologist $200,000/yr for his employee services.

I can't speak to the details of the malpractice insurance or the liability questions this might raise. All I can say is that the surgeons were very nonchalant with me doing cases from start to finish with nary an anesthesiolgist in house.

The hospital bylaws were a joke because they didn't clarify "supervision." Being 45 miles from the hospital is not real supervision and the surgeons should be the ones demanding real supervision or lobby to change the bylaws.


As for REAL CRNA solo practices that compete for contracts in the USA they do exist. Trinity, you need to tell the "junior" members here the truth. They are under the delusion that CRNA solo practices are theoretical. In fact, they are real and an integral part of the AANA's philosophy. While uncommon in desireable locations, CRNA Groups are out there and are competing for contracts. Trinity, just tell it like it is and not like they want it to be.

 

[Monty Python]

..........

As for REAL CRNA solo practices that compete for contracts in the USA they do exist. Trinity, you need to tell the "junior" members here the truth. They are under the delusion that CRNA solo practices are theoretical. In fact, they are real and an integral part of the AANA's philosophy. While uncommon in desireable locations, CRNA Groups are out there and are competing for contracts. Trinity, just tell it like it is and not like they want it to be.

While more common in the boonies, and where in compliance with other requirements of state law, BON regulations, and hospital bylaws, there are CRNA practices with exclusive contracts.

 

[johankriek]

While more common in the boonies, and where in compliance with other requirements of state law, BON regulations, and hospital bylaws, there are CRNA practices with exclusive contracts.

tell me a hospital where it is all crna.. where it is a city of 20k or more and i will go there and petition the hospital to have me come in and i will supervise all of them... real supervision.. call me for induction and emergence.. use a 7.5 tube, use vec instead of nimbex.. that sort of thing.. spinal vs geta.

 

[johankriek]

I An anesthesia practice owned by three CRNAs had the exclusive contract. They employed a retired military anesthesiologist who lived 45 miles away to "supervise" them. This anesthesiologist would come in one day/week to sign charts, and would occasionally take weekend call. Otherwise he was never seen.

.

i hope that military anesthesiologist had some serious asset protection. not to mention a good criminal defense attorney

 

[fval28]

tell me a hospital where it is all crna.. where it is a city of 20k or more and i will go there and petition the hospital to have me come in and i will supervise all of them... real supervision.. call me for induction and emergence.. use a 7.5 tube, use vec instead of nimbex.. that sort of thing.. spinal vs geta.

why does it have to be a city of 20k or more?

 

[VolatileAgent]

Was he then by default supervising me? Or was the anesthesiologist of record still supervising me from afar? I don't know. To my knowledge, this private hospital was all private pay and that freed us from TEFRA requirements of the anesthesiologist, from the perspective of Medicare billing fraud.

I'm guessing TEFRA is what you're referring to, above. Yes, there are people in the slammer for intentionally defrauding Medicare with shady supervision/billing arrangements. Whistle-blowers stand to collect a pretty penny from Uncle Sam if their allegations are proven in court.

well, the point is no one was really supervising you. and, if something had gone dreadfully wrong, the proverbial "stuff" would've hit the fan. heads would've rolled.

and, i'm not sure Tefra "loopholes" would've applied to this situation, especially if you were providing general anesthesia in the operating room without a qualified supervisor-role physician (ie., the guy getting paid to be the supervisor) present in the facility. in fact, the way it is described is a direct violation of TEFRA. the spirit of Tefra is when the anesthesiologist is not going to be physically present for the duration of the "anesthetic" (eg., a functioning epidural until delivery of the baby). it has to do more with being able to bill for the full service, and not a reduced rate, because you are still providing a "full" service to the patient. so, i'm not sure that this would cover you in the situation you describe, but probably how your "supervisor" was able to manipulate the paperwork in order to get paid. i pretty certain that such a presumed supervisory role, in absentia, is not the spirit of this regulation, and if you'd had a sentinel event you both would've gotten fried in court. you knowing this in advance, likewise, does not release you from culpability, as you were a willing and abetting party to the deception.

 

[johankriek]

why does it have to be a city of 20k or more?

because trinity intimated that there were crna exclusive groups not only in the boonies but in a neighbborhood hospital near you. SO i called him out on it and he has not responded

 

[johankriek]

and if you'd had a sentinel event you both would've gotten fried in court. you knowing this in advance, likewise, does not release you from culpability, as you were a willing and abetting party to the deception.

He was perpetrating a fraud.. Hey trinity how does it feel to committ a crime and get away with it?

 

[militarymd]

While more common in the boonies, and where in compliance with other requirements of state law, BON regulations, and hospital bylaws, there are CRNA practices with exclusive contracts.

Prior to my arrival, the CRNA's who I work with now made a bid to take the contract away from the anesthesiologists who were working at the time.

Having worked with the anesthesiologists who were present at the time, I'm surprised my hospital didn't hand the contract over.

 

[VolatileAgent]

Prior to my arrival, the CRNA's who I work with now made a bid to take the contract away from the anesthesiologists who were working at the time.

Having worked with the anesthesiologists who were present at the time, I'm surprised my hospital didn't hand the contract over.

i think that's kind of the primary, germane point here. in most instances, hospitals will chose a md/do-run group over a crna one. it's less hassle for the hospital all the way around.

 

[johankriek]

Prior to my arrival, the CRNA's who I work with now made a bid to take the contract away from the anesthesiologists who were working at the time.

Having worked with the anesthesiologists who were present at the time, I'm surprised my hospital didn't hand the contract over.

the fact that your hospital was thinking about it speaks volumes..

 

[cowboy71]

..

 

[Monty Python]

well, the point is no one was really supervising you. and, if something had gone dreadfully wrong, the proverbial "stuff" would've hit the fan. heads would've rolled.

and, i'm not sure Tefra "loopholes" would've applied to this situation, especially if you were providing general anesthesia in the operating room without a qualified supervisor-role physician (ie., the guy getting paid to be the supervisor) present in the facility. in fact, the way it is described is a direct violation of TEFRA. ......... but probably how your "supervisor" was able to manipulate the paperwork in order to get paid. i pretty certain that such a presumed supervisory role, in absentia, is not the spirit of this regulation, and if you'd had a sentinel event you both would've gotten fried in court. you knowing this in advance, likewise, does not release you from culpability, as you were a willing and abetting party to the deception.

Since they were private pay, TEFRA requirements wouldn't be applicable, correct? I thought TEFRA requirements of anesthesiologist participation (the seven steps) only applied to billing for Medicare patients.

Also, given that these were non-TEFRA private-pay patients, would it be my responsibility to ensure the supervising anesthesiologist was present in house? I would think the burden of liability and responsibility would be his, not necessarily mine as he was the supervisor and I was the supervisee. How would it be different if the anesthesiologist had been in house, but was giving a lunch break to the other CRNA in the other room (or was upstairs putting in an OB epidural)?

I signed my billing rights over to the group when I contracted to go there through the locums agency. I was paid as a independent contractor by the agency and never saw nor signed any billing paperwork. And since I was in compliance with state law and BON regs I would think I'm on sound legal footing should something unfortunate happen.

Not trying to be argumentative, just asking theoretical questions for the sake of discussion.

 

[Monty Python]

He was perpetrating a fraud.. Hey trinity how does it feel to committ a crime and get away with it?

To my knowledge I haven't commited a crime so I cannot answer your question.

 

[EtherMD]

To my knowledge I haven't commited a crime so I cannot answer your question.

Trinity,

You didn't do anything wrong legally or morally. The AANA and its legal team would definitely agree with me on this issue. Thanks for the posts.

 

[Noyac]

Trinity,

You didn't do anything wrong legally or morally. The AANA and its legal team would definitely agree with me on this issue. Thanks for the posts.

 

[EtherMD]

Hey, keep laughing but at the rate the AANA is going who will have the last laugh?

 

[johankriek]

Hey, keep laughing but at the rate the AANA is going who will have the last laugh?

not friggin likely

 

[Taurus]

Here's a hypothetical. If AA's become more popular and number in the thousands or tens of thousands, what's to stop them from wanting independent rights? If indepedent practice CRNA laws are already on the books in several states, why can't AA's lobby for the same rights? 5 years out of school, I don't think there is much difference between a CRNA and an AA.

 

[johankriek]

Here's a hypothetical. If AA's become more popular and number in the thousands or tens of thousands, what's to stop them from wanting independent rights? If indepedent practice CRNA laws are already on the books in several states, why can't AA's lobby for the same rights? 5 years out of school, I don't think there is much difference between a CRNA and an AA.

i think its because they have the nursing boards behind them (the ignoramus's) and they have I guess a strong lobby.... and they fight together.. they all have the same interests...... the AAs I dont think have a strong lobby and they dont fall under nursing. they fall under us......

soon the crnas will say.. not only do we wanna be independent.. we want to supervise anesthesiologists and AAs too. throw enough money at a politican.. voila....

 

[EtherMD]

Here's a hypothetical. If AA's become more popular and number in the thousands or tens of thousands, what's to stop them from wanting independent rights? If indepedent practice CRNA laws are already on the books in several states, why can't AA's lobby for the same rights? 5 years out of school, I don't think there is much difference between a CRNA and an AA.

Wrong. Dead Wrong. This what the AANA wants you to believe. I don't understand why people post this trash. The AANA believes its membership is the only Mid-Level Provider capable of providing Anesthesia at a level equal to an MD/DO. The AANA and most CRNA's view AA's as inferior "trash" that should not even be allowed to practice in any state. The AANA has spent big money blocking AA licensure in many States. Recently, the AANA waged a brutal smear campaign in North Carolina to block AA licensure. The AANA won the first battle by getting the bill for AA licensure killed in committee.

The AA profession is committed to the ACT model. The AA profession is the only friend the ASA has forthe Mid-Levels. Why would the ASA and the AANa allow AA's to gain independent practice? This would only take more jobs away from CRNA's in BFE. No sir. The AANA and ASA definitely agree on this issue and the AA's wouldn't stand a snow ball's chance in hell of ever getting Independent Practice rights. In fact, it will take decades just to get licensure in all states for AA's to practice in the ACT model.

 

[johankriek]

Wrong. Dead Wrong. This what the AANA wants you to believe. I don't understand why people post this trash. The AANA believes its membership is the only Mid-Level Provider capable of providing Anesthesia at a level equal to an MD/DO. The AANA and most CRNA's view AA's as inferior "trash" that should not even be allowed to practice in any state. The AANA has spent big money blocking AA licensure in many States. Recently, the AANA waged a brutal smear campaign in North Carolina to block AA licensure. The AANA won the first battle by getting the bill for AA licensure killed in committee.

The AA profession is committed to the ACT model. The AA profession is the only friend the ASA has forthe Mid-Levels. Why would the ASA and the AANa allow AA's to gain independent practice? This would only take more jobs away from CRNA's in BFE. No sir. The AANA and ASA definitely agree on this issue and the AA's wouldn't stand a snow ball's chance in hell of ever getting Independent Practice rights. In fact, it will take decades just to get licensure in all states for AA's to practice in the ACT model.

I agree with you man. I would support AA licensure and the opening up more AA schools. Moreover, I would also support Physician Assistants to be granted the privileges to provide anesthesia after 18 months or so in the Operating room.. so that would make 3 midlevel providers...

EtherMD email the "big boys" and tell me what they say.> im not an asa member because i was so pissed off at them.. But im gonna join soon because i have to start doing that ACe program for MOCA and they make non members pay 800 dollars and members pay 220. So it would behoove me to become a member. anyway, and please invite more and more attendings to this site.

 

[johankriek]

Valley View Medical Center in Cedar City, Utah

thats funny when i bring it up on the website they say find a doctor and i click on anesthesiologists a bunch of names come up . Maybe I should call the OR and maybe I should write a letter to the editor of the cedar city times to inform them that there is no doctor trained in anesthesia who works there and if their patients have surgery there, they will not have an anesthesiologist. news papers love that kind of ****
www.cedarcityreview.com/local_news.php?id=124

 

[harryh]

thats funny when i bring it up on the website they say find a doctor and i click on anesthesiologists a bunch of names come up . Maybe I should call the OR and maybe I should write a letter to the editor of the cedar city times to inform them that there is no doctor trained in anesthesia who works there and if their patients have surgery there, they will not have an anesthesiologist. news papers love that kind of ****
www.cedarcityreview.com/local_news.php?id=124

Small town newspapers know who pays the bills. Hospital are usually one of the biggest advertisers in town. So I doubt you will get them to run something critical of the hospital. I worked in a small town where the hospital administration was a bunch of crooked greedy thieves. There was a constant stream of lawsuit and scandals emanating from the corruption at the hospital. Yet noting ever showed up in the newspaper.

 

[johankriek]

Small town newspapers know who pays the bills. Hospital are usually one of the biggest advertisers in town. So I doubt you will get them to run something critical of the hospital. I worked in a small town where the hospital administration was a bunch of crooked greedy thieves. There was a constant stream of lawsuit and scandals emanating from the corruption at the hospital. Yet noting ever showed up in the newspaper.

if you youthink small time newspaper is a small time newspaper you are wrong.. it is usually owned by companies with revenues in the 100 million dollars range and more.... look at www.freedom.com

and small time newspapers love writing articles about hospitals..

 

[harryh]

if you youthink small time newspaper is a small time newspaper you are wrong.. it is usually owned by companies with revenues in the 100 million dollars range and more.... look at www.freedom.com

and small time newspapers love writing articles about hospitals..

The over concentration of media ownership in the hands of a privileged few does not encourage anti establishment investigative reporting but subjects the reader to the same worthless pro business drivel day after day.


Yes they love to write fluff articles, spoon feed to them by the hospitals public relations department, but Newspapers will almost never write an article critical of the hospital administration.