Major flaw in 2010 study showing independent CRNA practice is safe

[Chloroform4Life]

So, in 2010, the AANA funded a study and reported that independent CRNA practice resulted in no harm to patients.

This study:
http://www.ncbi.nlm.nih.gov/pubmed/20679649

They basically gathered data from medicare claims, and assumed that QZ billing was independent practice, and compared that to MD only as well as care team model. They analyzed mortality and complications rate and reported no difference in solo CRNA vs care team vs solo MD.

This is one of the principal paper that they cite when lobbying for independent practice.

We knew this paper was flawed in many different ways....and now we found one more.

A significant number of these "independent" crna practices were likely using medical supervision models. About 50% of them. The problem is that in a supervision model, CRNAs bill QZ and the supervising anesthesiologist does not bill...so medicare doesn't distinguish between medical supervision vs independent CRNA practice.

source:
http://www.anesthesiologynews.com/P...nd-Not-Representative-of-CRNA-Only-Care/35842

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[ranvier]

But let's not forget, nurses take care of the whole patient.

 

[Lurch]

So, in 2010, the AANA funded a study and reported that independent CRNA practice resulted in no harm to patients.

This study:
http://www.ncbi.nlm.nih.gov/pubmed/20679649

They basically gathered data from medicare claims, and assumed that QZ billing was independent practice, and compared that to MD only as well as care team model. They analyzed mortality and complications rate and reported no difference in solo CRNA vs care team vs solo MD.

This is one of the principal paper that they cite when lobbying for independent practice.

We knew this paper was flawed in many different ways....and now we found one more.

A significant number of these "independent" crna practices were likely using medical supervision models. About 50% of them. The problem is that in a supervision model, CRNAs bill QZ and the supervising anesthesiologist does not bill...so medicare doesn't distinguish between medical supervision vs independent CRNA practice.

source:
http://www.anesthesiologynews.com/P...nd-Not-Representative-of-CRNA-Only-Care/35842

Fake it till you make it

 

[Noyac]

This has been played out for some time now. The ASA has called this to the attention of various outlets but it still comes up. It comes up because we live in a day and time were it doesn't matter if your "study" has any merit. Just do the shabby study and someone will publish it. We as a medical community have lost the control of the research community and more importantly the research publishers. Studies like this should never see print. These flaws should be uncovered before any publisher ever agrees to print it. But instead we live in an era of the Internet and anyone can publish anything to push-ups forward an agenda. It is pathetic.

 

[deleted171991]

This has been played out for some time now. The ASA has called this to the attention of various outlets but it still comes up. It comes up because we live in a day and time were it doesn't matter if your "study" has any merit. Just do the shabby study and someone will publish it. We as a medical community have lost the control of the research community and more importantly the research publishers. Studies like this should never see print. These flaws should be uncovered before any publisher ever agrees to print it. But instead we live in an era of the Internet and anyone can publish anything to push-ups forward an agenda. It is pathetic.

Not only that, but all these losers get academic promotions based on their shabby research. It's quantity, not quality, that matters nowadays. Follow the money (grants)!

 

[IlDestriero]

Not only that, but all these losers get academic promotions based on their shabby research. It's quantity, not quality, that matters nowadays. Follow the money (grants)!

That's not really true, but there's certainly a lot of garbage published.


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Il Destriero

 

[criticalelement]

That's not really true, but there's certainly a lot of garbage published.


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Il Destriero

That is really true!

 

[Noyac]

Not only that, but all these losers get academic promotions based on their shabby research. It's quantity, not quality, that matters nowadays. Follow the money (grants)!

Actually, more and more "real" researchers and chairpersons are onto this scam.

 

[Psai]

To call that piece of garbage a trial is a slap in the face to all the physicians doing real research, not bull**** outcome studies that don't actually measure anything

 

[Chloroform4Life]

With more and more clinical qualities being measured by medicare, I hope someone is going to do a true comparison between independent crna practice and other models.

The researcher will have to figure out which QZ billers are trully independent vs being supervised. The researcher will also have to match patients characteristics, asa class, etc. for it to be a true comparison, but its doable.

Sure, the result may backfire, but sh** can't get any worse. They brought this war to us. They forged a sh*ty weapon and have used it relentlessly to beat us down while we defend with bare hands. Now we have to forge a mightier weapon to beat them back.

 

[IlDestriero]

That is really true!

I don't know about other universities, but the two where I have been on the faculty use impact factor to evaluate your publications. If you're pumping out crap in the Yemeni Journal of Modern Medical Practice, The Throwaway Newsletter of Advances in Pain Management and the Online Open Access Journal of Anesthesia, you're better off sleeping in.


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Il Destriero

 

[Man o War]

I pointed this out once to a militant CRNA I was having a conversation with, and he proceeded to totally ignore what I had just said and started blabbering on about the Cochrane review and how it's the "gold standard" for medical professionals and that body of evidence shows they are safe. I just had to walk away at that point and shake my head. No sense in arguing with stupid/intellectually lazy.

 

[deleted171991]

I don't know about other universities, but the two where I have been on the faculty use impact factor to evaluate your publications. If you're pumping out crap in the Yemeni Journal of Modern Medical Practice, The Throwaway Newsletter of Advances in Pain Management and the Online Open Access Journal of Anesthesia, you're better off sleeping in.


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Il Destriero

As long as they still add up those impact factors, it's still worthless. There is a lot of junk even in "Anesthesiology". The journals are becoming thicker and thicker, instead of publishing only 10 good papers or less per issue. I am not reading even the table of contents anymore, and that applies to most famous journals.

The way to make research relevant is to consider only the 3 highest IF articles a person has published in the last 10 years, or the average IF of his/her papers in the last 10 years. That way people will stop publishing junk for the sake of junk.

There are people and departments which consider research a matter of PR. The more stuff you put out, the more people will hear about you. It's almost like saying there is no bad publicity.

Criticizing research should be considered even better than research, for academic promotion purposes. The main reason we have all this garbage today is that people are not motivated to acquire strong statistical knowledge and start ripping 80% of the current authors/papers a new one. That's why most "scientists" have never heard of Ioannidis.

Of course, the latter does not bring grants, or friends. Hence the emperor still has no clothes, but everybody is in awe of him.

Also, if somebody's "research" is later disproved, it should be treated as research malpractice, for life.

tl; dr: The medical research community should start focusing on quality, and punish pure quantity. Research should not be done by ambitious average minds purely for the sake of promotion. We should have ten times fewer and ten times better quality publications.

 

[OB1🤙]

Rather than whining about this drivel masquerading as "research", people out there should stop using QZ for anesthetics in which an anesthesiologist is involved.

It's so much easier than meeting TEFRA requirements. I get it. The economic pressure to use it is great. But it results in crap like this.

 

[IlDestriero]

I think we bill that way, as nobody cares if we go to the CRNA extubations, though the majority of us go to every one. Maybe not a deep LMA removal. If you told the resident to extubate without you I think alarms would sound. I will find out.


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Il Destriero

 

[OB1🤙]

Widespread QZ billing allows these shoddy papers that are letting them win the PR battles.

Our public defense in the PR war cannot rest on the semantics of QZ billing, because nobody outside of anesthesia will understand or care.

Minimizing inappropriate QZ billing is a must.

 

[Planktonmd]

QZ is a way to get the most billing without having to do all the stupid things required for true direction and even allows exceeding the magic number of 4 rooms if needed. It never meant that CRNAs are truly practicing solo.
Don't expect QZ to go away anytime soon especially where AMCs are running the show.

 

[OB1🤙]

I understand that, Plank. Just saying that for as long as this is common, it hands them the rope they'll use to hang us.

"Facts are meaningless. They can be used to prove anything." - Homer Simpson

 

[soorg]

I don't understand how CRNAS are allowed to bill for themselves using the QZ modifier? Also, what exact things are needed to show medical direction? Can someone explain?

 

[Arch Guillotti]

I don't understand how CRNAS are allowed to bill for themselves using the QZ modifier? Also, what exact things are needed to show medical direction? Can someone explain?

TEFRA, the QZ modifier and the 7 requirements for medical direction have all been discussed previously. Try a search of the forum and you will find loads of information.

 

[OneFellSwoop]

I think we bill that way, as nobody cares if we go to the CRNA extubations, though the majority of us go to every one. Maybe not a deep LMA removal. If you told the resident to extubate without you I think alarms would sound. I will find out.


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Il Destriero

Maybe I'm misunderstanding the spirit of your post, but TEFRA doesn't require present for extubation so you wouldn't need to do that to avoid QZ billing. It requires emergence (which has already been legally ruled as a continuum and technically continues into PACU) and critical parts of the case. The legal (not necessarily clinical) precedent has yet to be set for extubation counting as critical portion of case. However whistle blower cases have alluded to this as a possibility. Lastly, I extubated all the time after CA1 (and late CA1) without an attending and that was within the last 5 years.

If someone has information to the contrary I'm all ears.


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[Arch Guillotti]

I think we bill that way, as nobody cares if we go to the CRNA extubations, though the majority of us go to every one.

That sounds awful.

 

[IlDestriero]

Maybe you're ok with your sick kids getting extubated with only a CRNA or resident present, I think that's a dangerous period and put the coffee down for 5 minutes. My partners seem to agree.


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Il Destriero

 

[Arch Guillotti]

Maybe you're ok with your sick kids getting extubated with only a CRNA or resident present, I think that's a dangerous period and put the coffee down for 5 minutes. My partners seem to agree.


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Il Destriero

I can understand that. I was referring to an average adult case.