Medical Supervision

[Low Flow]

Out in private practice, how common is medical direction vs supervision? And I’m talking like 1:8 CRNA supervision. That sounds awful.

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[coffeebythelake]

Out in private practice, how common is medical direction vs supervision? And I’m talking like 1:8 CRNA supervision. That sounds awful.

I do medical direction.. usually 1:2 or 1:3, occasionally 1:4. what you describe sounds absolutely bonkers. At those ratios you are there as a liability sponge.

 

[ryanjmy]

I supervise. At minimum you want to see every pt before the anesthetic and to prescribe the anesthetic plan if your name will be on the chart. From there you can decide how involved you need to be in the case.

8 to 1 is a joke. That’s an independent crna practice with an MD there for crisis management.

 

[NitroS]

I think 1:3 to 1:4 is most common. 1:8 is not common and for good reason

 

[Low Flow]

I supervise. At minimum you want to see every pt before the anesthetic and to prescribe the anesthetic plan if your name will be on the chart. From there you can decide how involved you need to be in the case.

8 to 1 is a joke. That’s an independent crna practice with an MD there for crisis management.

I was watching a lecture on CMS billing and trying to understand how most groups do it. When “supervising” are you talking about directing (ie, billing QK) or are you not meeting the directing requirements and billing AD? Is it common for groups to just let the CRNAs do their own thing and bill QZ?

If there is an anesthesiologist in house when a CRNA is doing their own case and billing QZ and an emergency happens, does a responding anesthesiologist soak up any liability for a bad outcome?

 

[gasdoc77]

Are they paying you 2.5 FTE? That is what they are trying to get out of you😡. Offer to solo in your own room and not be named anywhere on anyone else's chart. Then, if you happen to be available and things go bad, good Samaritan protection.

 

[deleted126335]

Are they paying you 2.5 FTE? That is what they are trying to get out of you😡. Offer to solo in your own room and not be named anywhere on anyone else's chart. Then, if you happen to be available and things go bad, good Samaritan protection.

No. There is no Good Samaritan protection in this circumstance.

 

[jwk]

Out in private practice, how common is medical direction vs supervision? And I’m talking like 1:8 CRNA supervision. That sounds awful.

Medical direction can't be more than 1:4. Anything more than that, or in any case where you can't satisfy the seven conditions of TEFRA is considered medical supervision.

Billing QZ is unfortunately becoming more common. One of the many problems with that is that it under-represents the participation of an anesthesiologist with a case. QZ is also used quite often with groups where anesthesiologists totally cede their responsibilities in labor and delivery to CRNAs because they either don't like OB, don't want to come in at night, or both.

1:8 is a joke - and is what the CRNAs are now calling "collaborative" practice. If you're collaborating, you're on the hook if something happens.

 

[deleted126335]

I was watching a lecture on CMS billing and trying to understand how most groups do it. When “supervising” are you talking about directing (ie, billing QK) or are you not meeting the directing requirements and billing AD? Is it common for groups to just let the CRNAs do their own thing and bill QZ?

If there is an anesthesiologist in house when a CRNA is doing their own case and billing QZ and an emergency happens, does a responding anesthesiologist soak up any liability for a bad outcome?

You are confusing billing rules (Medical Supervision) with Supervision to meet state law, or hospital bylaws, or employment contracts. Depending on the above you may be on the hook medico legally for QZ billing on a patient that you never saw.

 

[jwk]

No. There is no Good Samaritan protection in this circumstance.

Agree. That's a totally different standard, and this isn't it.

 

[gasdoc77]

No. There is no Good Samaritan protection in this circumstance.

That is unfortunate (or perhaps not, for the sake of our specialty and patient safety standards).

Caveat emptor

 

[itwasalladream]

Mid-size metro area -- I know of two groups around that use (or recently used) this model. I have heard up to 1:12 but I'm not familiar with the details.

 

[Mman]

Mid-size metro area -- I know of two groups around that use (or recently used) this model. I have heard up to 1:12 but I'm not familiar with the details.

I can medically direct 1:4 in good safe fashion as long as the case mix is right. I could probably supervise reasonably well maybe 6 rooms if it all lined up just right (but I'd be physically and mentally drained after that). 1:12 there are no details required. You can't even preop every patient at that point, let alone be of any use during a case.

 

[GassYous]

I can barely do one case at a time lol

 

[coffeebythelake]

Medical direction can't be more than 1:4. Anything more than that, or in any case where you can't satisfy the seven conditions of TEFRA is considered medical supervision.

Billing QZ is unfortunately becoming more common. One of the many problems with that is that it under-represents the participation of an anesthesiologist with a case. QZ is also used quite often with groups where anesthesiologists totally cede their responsibilities in labor and delivery to CRNAs because they either don't like OB, don't want to come in at night, or both.

1:8 is a joke - and is what the CRNAs are now calling "collaborative" practice. If you're collaborating, you're on the hook if something happens.

"Collaboration" = crna does whatever they want and you take the blame when something bad happens. Realistically you wouldn't have opportunity to review much beforehand and almost certainly not preop them.

 

[jwk]

"Collaboration" = crna does whatever they want and you take the blame when something bad happens. Realistically you wouldn't have opportunity to review much beforehand and almost certainly not preop them.

Oh absolutely. Unless your group/hospital/practice has a solid requirement that CRNAs have to discuss every case with an anesthesiologist preoperatively, they are pretty much free to do whatever the hell they want to do.