So, bottom line... what is the future of anesthesiology for MDs?

[Carbocation1]

I've been doing 'gas' for 30 years. If you choose to be a hospitalist you do not have the option of independent practice. You're an employee from day one. As an anesthesiologist you might still have the option to work independently or as a partner in a practice. I can't imagine ever working for someone else.

I would agree, but it seems the general consensus is that pp will soon be dead, especially with the transition away from fee for service. So my understanding is that if you can't beat the big corporations, you might as well join them.

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[Wiscoblue]

I think Anesthesiologists still would bring more 'value' to the hospital and be paid more.

 

[Psai]

The hospitalists in my city are now slowly being replaced by nurse practitioners.

That's sad. Mid-level care is so inferior to physicians that it's not funny. Usually it doesn't make a huge impact on outcomes but it matters. I would hate to be the doc that has to "collaborate" with an independent np

 

[jwk]

Guess I will keep sniffing the forane then. Ahh, I like the high. Clearly, you are only piking and choosing to read what parts you don't like in my posts. As I said, I am somewhat neutral on the subject in regards to my state legislature as MD/DO's rule where I am. As it starts changing, I will support the AAs. But as of now, we are doing fine. I am not against AA's, just against supervision in general. Don't want to do it.
Thanks.

To be honest, I do feel it is completely hypocritical to let CRNAs practice independently but block AAs who don't want to practice independently. At least not yet. However, I don't also want to introduce my competition in the mix. The supervision of 3:1 or 4:1 that bothers me. Are the surgeons supervising more than one PA in the OR? Its ok for us to supervise that many nurses why? I can see 2:1 but anything above that doesn't sit well with me. I have walked in on disasters before because I was busy tied up in another room and the CRNA didn't bother calling me.

Not to yank your chain, but it's kind of a classic "if you're not for us, you're against us". I understand the rationale of wanting to continue doing your own cases. Supporting AA legislation doesn't change anything about your ability to do that, but keeping AA's out means that CRNA practice will continue to grow and flourish in your state unabated.

 

[RustBeltOnc]

Well, would you recommend it over gas?

The problem is, it's not possible to be a hospitalist for 30 years.

The real question should be --- of the things I could do after medicine residency (including hospitalist for 3, 4 years), are those possible career trajectories more attractive then anesthesiology?

 

[Wiscoblue]

I agree it is sad. But it makes money for the corporation that has the contract for the hospitalists. If they pay half the staff $200k and the other half $100k that's a lot of savings and profit for their company to provide big bonuses for the executives.

 

[deleted50478]

I agree it is sad. But it makes money for the corporation that has the contract for the hospitalists. If they pay half the staff $200k and the other half $100k that's a lot of savings and profit for their company to provide big bonuses for the executives.

Do hospital executives have a revolving door with corporate medical groups that they give contracts too, like congressmen and firms that benefit from acts of congress? Are hospital CEOs and other execs who give a hospitalist corporation using NPs access to his hospital going to be a well paid board member in the hospitalist group some day?

 

[chocomorsel]

Not to yank your chain, but it's kind of a classic "if you're not for us, you're against us". I understand the rationale of wanting to continue doing your own cases. Supporting AA legislation doesn't change anything about your ability to do that, but keeping AA's out means that CRNA practice will continue to grow and flourish in your state unabated.

I don't want to be against AA's. And I am not. I just am not ready for an ACT model currently. I am against CRNA's who keep touting independent practiced and better training than AA's which we all know is false. . Where I am right now, locationwise, I admit, I am on the fence.

 

[deleted171991]

I don't want to be against AA's. And I am not. I just am not ready for an ACT model currently. I am against CRNA's who keep touting independent practiced and better training than AA's which we all know is false. . Where I am right now, locationwise, I admit, I am on the fence.

I used to be on that fence, but I am more and more for solo providers, in whatever form, shape or color. I don't want to supervise people who think about themselves as my equal. And almost all of them get to that level of arrogance after a decade or less, whether they are NPs, PAs, CRNAs or AAs. It's just human nature, when one is told all day long that one should practice "at the top of one's license", that they are "professionals" blah-blah. That's what the bean counters want, that's what they push for, cheap labor with maximum profits and minimal risks for them.

I don't want to spend my career training my or my young colleagues' future replacements. I don't want to be liable for their mistakes. I don't want to be responsible for 4 times more patients than I should, just because I have to use physician "extenders". I want to provide safe and excellent care, at my standards, and that will never happen when I am not the one calling the shots.

So, from where I stand, I'd rather have completely independent CRNAs than AAs. Because I will probably always be just an employee, I don't want ACT in any form or shape. I have been their preop monkey a few times and that's not medicine, whatever the money-racking partners on this forum like to tell us. And shame on the ASA (and any medical organization) for supporting the team-care model wherever they do it. That's how we got the general public believing that doctors are only interested in money, because the good nurse (practitioner) gets to spend much more time with them than the bad doctor.

I had a needlestick injury this year, so I went to the ED after hours. My insurer got a $2000 bill for me spending literally 2 minutes with a rushed EM doctor, 2 minutes with his resident, 10 minutes with various nurses, and more than an hour waiting in-between (especially for the nurse/tech who drew my blood). The doctors were overworked, and the nurses/techs took their sweet time. Not only at no times was I given/offered proper counseling, but they managed to send my HIV test under my real name (while telling me it was anonymous, as it should have been). Absolutely shameful. That's what happens when there are too many cooks. And they knew I was an attending physician at their big box academic hospital. Imagine the level of care a poor soul gets. And they want me to let the midlevels run amok on my license and under my good name?

Mark my words: AAs are just CRNAs in a sheep's clothing. Just give them 15-20 years. Of course, if one doesn't have 20 years till retirement and/or one is racking in the dough as a partner, they are a godsend in a state where CRNAs are now independent.

 

[Consigliere]

when CRNAs consistently start killing people.

Who's to say they will? Better yet, who's to say the dopey public will be aware it's happening? All across rural America, ASA III - V's are dying at the hands of independent CRNAs and the party line is "well, there were complications during surgery...it was their time" and that is blindly accepted by the same "jury of your peers" that will render a multimillion dollar verdict against you when you off 94 y/o grandma Jones.

 

[deleted682700]

Do hospital executives have a revolving door with corporate medical groups that they give contracts too, like congressmen and firms that benefit from acts of congress? Are hospital CEOs and other execs who give a hospitalist corporation using NPs access to his hospital going to be a well paid board member in the hospitalist group some day?

Or may be kickbacks, it doesn't make dollar sense when they reward to the most expensive bid behind closed doors?

 

[anbuitachi]

Will you be happy making 3-400? The guys that were making 5-600 won't.
It's more gloom than doom.

Less than 500k is too little for super specialists..

 

[deleted682700]

The nps are independent but have to collaborate with a doc on tough cases. The docs hate it. Too many screw ups and near misses.

Oh yeah, but they do love walking around in that white coat and the stethoscope around their neck!!

And they must be taking courses, how to feign and act like the real ones

 

[deleted682700]

Assuming equal interest in both fields, would any attendings recommend Hospitalist medicine over General Anesthesiology as a career? Anesthesia seems more lucrative right now but Hospitalists seem to enjoy a decent combination of lifestyle, salary, and future job security.

If you can see working in inpatient facility, be skilled to do a lot of procedures and for that anesthesia is better. If you are happy taking care of outpatients then internal medicine is better. With the changes in health care and economy, the outpatient gig is where the flow going to end. If you could combine the two such as anesthesia with out patient pain medicine , then u are hedging all bets and positioning yourself to whatever the future unfolds.

 

[jwk]

Mark my words: AAs are just CRNAs in a sheep's clothing. Just give them 15-20 years.

No offense, but your statement is simply incorrect as well as unfounded. We are now 45 years into AA's - I've been one nearly 35. None of us are beating the independent practice drum. I much prefer the ACT route for any number of reasons, but over the last 10 years or so, being an ACT-friendly AA is a huge plus compared to the independent leaning CRNA's being manufactured at their mills.

 

[deleted171991]

Until about 15 years ago, we didn't have independent CRNAs either. We also used to have (regular) nurses who did not debate our orders etc.

As respect for physicians is systematically eroded (intentionally), society will accept more and more "healthcare professionals" who practice independently. There will be fewer and fewer midlevels happy to practice under supervision, for less money than independent "providers". The cat is out of the bag.

 

[deleted126335]

Until about 15 years ago, we didn't have independent CRNAs either. We also used to have (regular) nurses who did not debate our orders etc.

As respect for physicians is systematically eroded (intentionally), society will accept more and more "healthcare professionals" who practice independently. Pandora's box is already open.

Not true. There has been plenty of independent CRNA practice for a long time in BFE. The AANA types have been just as venomous since I started practice 25 years ago. There were just fewer of them or most of them kept it under wraps more. The have been singing the same song for decades. They are only gaining traction now because money is tight and administrators are desperate for a perceived cost savings.

 

[QualityProcess]

great thread for medical students interested in anes but unsure about its future. I really like physiology, working with patients in acutely precarious situations, and working with my hands, but I wouldn't be happy supervising 5 people doing it for me. I really like surgery but I don't want to work 7 days a week until I'm 65. Sounds like I was born into the wrong era of anesthesiology.

What does everyone think about anes--> critical care?

and-

T/F: The clash between the roles of CNRAs and the traditional role of anesthesiologists will continue, and worsen, until the extra costs associated with their practice (presumably, according to this thread, inferior outcomes) outweigh the extra cost associated with having a physician present (higher pay/salary)

 

[bashwell]

great thread for medical students interested in anes but unsure about its future. I really like physiology, working with patients in acutely precarious situations, and working with my hands, but I wouldn't be happy supervising 5 people doing it for me. I really like surgery but I don't want to work 7 days a week until I'm 65. Sounds like I was born into the wrong era of anesthesiology.

What does everyone think about anes--> critical care?

and-

T/F: The clash between the roles of CNRAs and the traditional role of anesthesiologists will continue, and worsen, until the extra costs associated with their practice (presumably, according to this thread, inferior outcomes) outweigh the extra cost associated with having a physician present (higher pay/salary)

To each their own but while cc will help make you into a badass, cc is really hard work and in my opinion it seems harder to sustain when older too. If you like cc, it might be worth doing IM pulm/cc instead of anes/cc, so you can fall back on pulm? Although then IM might be a real slog to have to go thru. I haven't seen it myself, but I've been told sleep is lifestyle friendly too, though that's an extra year after pulm/cc. Anes/cc is admittedly very cool though.

 

[mja75]

So to all the attendings on here, if you were a CA-2, what fellowship would you apply to NOW, mid 2015? In my mind a cardiothoracic fellowship is my insurance to stay in the or.

 

[criticalelement]

So to all the attendings on here, if you were a CA-2, what fellowship would you apply to NOW, mid 2015? In my mind a cardiothoracic fellowship is my insurance to stay in the or.

I would NOT do CT. The number of cases in the last ten years that ct has done has drastically been reduced by maybe 40%.
I would do ICU. and thats it.(if you can stomach it)Maybe pain if you like it.

I went into the critical care forum, and they were discussing salaries. It seems they make 250K for one week on and one week off..That aint bad for 26 weeks off.

 

[Man o War]

So to all the attendings on here, if you were a CA-2, what fellowship would you apply to NOW, mid 2015? In my mind a cardiothoracic fellowship is my insurance to stay in the or.

I went back for a cardiothoracic fellowship after almost 10 years out of residency. Best move I ever made. No problem finding jobs, and partnership tracks. High compensation. TEE is in demand, and groups/hospitals will pay for it. Keep in mind, there are all kinds of EP procedures that CT anesthesia does in addition to open hearts, as well as liver transplants if you are in a group that covers those. The TEE is really what is in demand (advanced certification), not necessarily the management of these cases, although obviously that's part of it. Well worth the 250K after taxes I gave up to go back. As far as insurance for being in the OR, I'd say maybe 20-30% of the jobs I looked at were supervising CRNAs 2:1 for cardiac cases, the rest were solo doc in room. Obviously this information is all regionally dependent, I was only looking in the Midwest/south central region.

 

[Man o War]

I will also add, a big reason I went back to fellowship was working for a short period for an AMC for some extra cash. It scared the s@@t out of me.

 

[mja75]

I will also add, a big reason I went back to fellowship was working for a short period for an AMC for some extra cash. It scared the s@@t out of me.

What specifically did you find most difficult?

 

[kbomb123]

http://www.gaswork.com/post/178379

What's the general opinion on these propofol pusher gigs at endoscopy suites?

"Anesthesiologist needed for Monday-Friday. 7a-3p. No call, No weekends. 100%Endoscopy. TIVA, prior GI endo experience of at least 1 yr. W-2 With Malpractice covered by the employer."

 

[nimbus]

http://www.gaswork.com/post/178379

What's the general opinion on these propofol pusher gigs at endoscopy suites?

"Anesthesiologist needed for Monday-Friday. 7a-3p. No call, No weekends. 100%Endoscopy. TIVA, prior GI endo experience of at least 1 yr. W-2 With Malpractice covered by the employer."

Just shoot me.

 

[Man o War]

What specifically did you find most difficult?

Not sure difficult is the right word. Scary is definitely the right word. I was basically a chart monkey/firefighter. The CRNAs were a mixed bag. Some were very good, many were not ready to practice independently, which is basically how this operation ran (independent minus the part where their license would be at stake, not mine). There was no discussion of anesthetic plan, there was no time to adequately interview MY patients, the CRNAs just did what they wanted to, and my impression was I was just there to clean up the ensuing mess. I was there to fix screw ups- respiratory distress from too many narcotics, freeze ups during major vascular cases, etc. I only worked a handful of shifts because I was genuinely concerned I was going to catch a malpractice case. There was a final straw that I won't go into in detail, but someone almost died who came in for a very simple procedure. Maybe every AMC doesn't work this way, but I've heard enough from other colleagues that I suspect it's similar in many of them. This pushed the envelope of safety in my opinion, and I don't consider myself a super conservative anesthesiologist. I'm pretty average in that regard I think.

 

[Guillemot]

http://www.gaswork.com/post/178379

What's the general opinion on these propofol pusher gigs at endoscopy suites?

"Anesthesiologist needed for Monday-Friday. 7a-3p. No call, No weekends. 100%Endoscopy. TIVA, prior GI endo experience of at least 1 yr. W-2 With Malpractice covered by the employer."

Just shoot me.

You will lose your skills doing that for too long. Sounds like a good option for somebody in the twilight of their career right before retiring.

 

[B-Bone]

You will lose your skills doing that for too long. Sounds like a good option for somebody in the twilight of their career right before retiring.

Two of my partners just "retired" to basically this exact job, at ages 61 and 70 respectively. It actually doesn't pay too bad, at least in my neck of the woods, like $1800/day (1099, no benefits). But with no nights, no weekends, and ability to do it part time, it's a reasonable option for those on the retirement track. The day-to-day sounds like a nightmare to me, though: "supervising" (chart-signing) 3 rooms of colon/EGD with like 15-20 patients in each room, rarely (if ever) doing any patient care. To each his own, I guess.

 

[mja75]

...

 

[Wiscoblue]

We have hired through gaswork for the past 15 years. We are an all md independent group. I would say we are 2 standard deviations above the mean national income of $275k.

 

[FollowTheMoney]

I used to be on that fence, but I am more and more for solo providers, in whatever form, shape or color. I don't want to supervise people who think about themselves as my equal. And almost all of them get to that level of arrogance after a decade or less, whether they are NPs, PAs, CRNAs or AAs. It's just human nature, when one is told all day long that one should practice "at the top of one's license", that they are "professionals" blah-blah. That's what the bean counters want, that's what they push for, cheap labor with maximum profits and minimal risks for them.

I don't want to spend my career training my or my young colleagues' future replacements. I don't want to be liable for their mistakes. I don't want to be responsible for 4 times more patients than I should, just because I have to use physician "extenders". I want to provide safe and excellent care, at my standards, and that will never happen when I am not the one calling the shots.

So, from where I stand, I'd rather have completely independent CRNAs than AAs. Because I will probably always be just an employee, I don't want ACT in any form or shape. I have been their preop monkey a few times and that's not medicine, whatever the money-racking partners on this forum like to tell us. And shame on the ASA (and any medical organization) for supporting the team-care model wherever they do it. That's how we got the general public believing that doctors are only interested in money, because the good nurse (practitioner) gets to spend much more time with them than the bad doctor.

I had a needlestick injury this year, so I went to the ED after hours. My insurer got a $2000 bill for me spending literally 2 minutes with a rushed EM doctor, 2 minutes with his resident, 10 minutes with various nurses, and more than an hour waiting in-between (especially for the nurse/tech who drew my blood). The doctors were overworked, and the nurses/techs took their sweet time. Not only at no times was I given/offered proper counseling, but they managed to send my HIV test under my real name (while telling me it was anonymous, as it should have been). Absolutely shameful. That's what happens when there are too many cooks. And they knew I was an attending physician at their big box academic hospital. Imagine the level of care a poor soul gets. And they want me to let the midlevels run amok on my license and under my good name?

Mark my words: AAs are just CRNAs in a sheep's clothing. Just give them 15-20 years. Of course, if one doesn't have 20 years till retirement and/or one is racking in the dough as a partner, they are a godsend in a state where CRNAs are now independent.

Easily the greatest thing I've ever read on this forum.

 

[Carbocation1]

http://www.jpost.com/Business-and-I...erious-shortage-of-Israeli-specialists-413208

"Prof. Michael C. Lewis of the University of Florida College of Medicine and Prof. Gilbert J. Grant of the anesthesiology department at New York University’s School of Medicine, advocate for the new system in the recently published issue of the open-access Israel Journal of Health Policy Research."

Non-physician anesthesiologist “extenders” (assistants), who carry out half of all anesthesia procedures in the US, could be a successful way of increasing the number of professionals available to administer anesthesia, the two authors write. “This pattern of practice would allow physician anesthesiologists to supervise a number of extenders, allow more surgeries to be completed and improve the quality of life for anesthesiologists.”

 

[Carbocation1]

The leadership of the medical specialty sounds like the AANA!

 

[Psai]

http://www.jpost.com/Business-and-I...erious-shortage-of-Israeli-specialists-413208

"Prof. Michael C. Lewis of the University of Florida College of Medicine and Prof. Gilbert J. Grant of the anesthesiology department at New York University’s School of Medicine, advocate for the new system in the recently published issue of the open-access Israel Journal of Health Policy Research."

Non-physician anesthesiologist “extenders” (assistants), who carry out half of all anesthesia procedures in the US, could be a successful way of increasing the number of professionals available to administer anesthesia, the two authors write. “This pattern of practice would allow physician anesthesiologists to supervise a number of extenders, allow more surgeries to be completed and improve the quality of life for anesthesiologists.”

I don't know how my quality of life would be improved when I can't find a job because jokers like these gave the specialty away. Greed and sloth.

 

[Amazingmuzmo]

If anyone is able share the recent MGMA report, I'm sure the prime minister (PM) of Inbox would be interested in hearing about it.

 

[Planktonmd]

http://www.jpost.com/Business-and-I...erious-shortage-of-Israeli-specialists-413208

"Prof. Michael C. Lewis of the University of Florida College of Medicine and Prof. Gilbert J. Grant of the anesthesiology department at New York University’s School of Medicine, advocate for the new system in the recently published issue of the open-access Israel Journal of Health Policy Research."

Non-physician anesthesiologist “extenders” (assistants), who carry out half of all anesthesia procedures in the US, could be a successful way of increasing the number of professionals available to administer anesthesia, the two authors write. “This pattern of practice would allow physician anesthesiologists to supervise a number of extenders, allow more surgeries to be completed and improve the quality of life for anesthesiologists.”

These characters at the ivory tower don't have the same view of the world the rest of us have, they don't represent anyone but themselves, and they are the worst problem this specialty has. I can even say with confidence that they are more dangerous to anesthesiology than the AANA.
It's funny to see some of them evolve though because when they were junior faculty they were outspoken defenders of the specialty and openly fighting the CRNAs!

 

[deleted126335]

These characters at the ivory tower don't have the same view of the world the rest of us have, they don't represent anyone but themselves, and they are the worst problem this specialty has. I can even say with confidence that they are more dangerous to anesthesiology than the AANA.
It's funny to see some of them evolve though because when they were junior faculty they were outspoken defenders of the specialty and openly fighting the CRNAs!

There are professorships to be built and tenures to be had by giving organized medicine the "evidence" to justify further expansion of mid levels scope and utilization.

 

[TrickMcJanky]

Hey. Someone in here mentioned anesthesiologists owning a private practice. How does that work? As in, what services are provided in these practices? I would imagine anesthesiologists work for private surgical centers but that doesn't make it an anesthesia practice no?
First year US MD student. Educate me please.

 

[Planktonmd]

Owning a private practice in anesthesiology means a group of anesthesiologists get together and form a corporation that negotiates contracts to provide anesthesia services at one or more hospital or surgicenter. The survival of this corporation is contingent on maintaining the contracts with these facilities. They could have employees (MDs, CRNAs, Billing staff...) and business offices but otherwise their main asset is the contract.
It's basically a small business model that is gradually disappearing because big management companies are taking over the market.

 

[TrickMcJanky]

Owning a private practice in anesthesiology means a group of anesthesiologists get together and form a corporation that negotiates contracts to provide anesthesia services at one or more hospital or surgicenter. The survival of this corporation is contingent on maintaining the contracts with these facilities. They could have employees (MDs, CRNAs, Billing staff...) and business offices but otherwise their main asset is the contract.
It's basically a small business model that is gradually disappearing because big management companies are taking over the market.

I think this is what I was asking about, thank you. Would you happen to know where in the country is model has remained prevalent?
I'm basically 95% positive anesthesia is the only specialty I really really want to go for, despite everything I've read here. Im certain that I don't know anything about anything at this stage, so I'm just trying to learn as much as possible.

 

[nimbus]

I think this is what I was asking about, thank you. Would you happen to know where in the country is model has remained prevalent?
I'm basically 95% positive anesthesia is the only specialty I really really want to go for, despite everything I've read here. Im certain that I don't know anything about anything at this stage, so I'm just trying to learn as much as possible.

By the time you are finished, it won't be prevalent anywhere. There may be small pockets of autonomous private practice but most people will be working for "the man".

 

[Planktonmd]

By the time you are finished, it won't be prevalent anywhere. There may be small pockets of autonomous private practice but most people will be working for "the man".

That's unfortunately true!

 

[aneftp]

It's going to get even harder to prove "independent CRNAs" are "unsafe". Why? Metrics and how to game the system. With the ACA, more and more hospitals even smaller ones are rigging their quality score (morbidity and mortality) to make them appear safe. What better way to appear safe than to "punt" the difficult cases to another hospital.

I've seen it time and time again especially in the last 4-5 years. When I was back in academics, we had so many smaller hospitals (even a community hospital literally right next door that did the 2x more open hearts than the academic hospital open heart). That hospital punted the difficult hearts (aka patients prone to poor outcome) over to the academic medical center. It's was ridiculous.

It's all about metrics these days boys and girls. "quality" care. Now I am on the other side (community hospital) and we have quite a few cases we punt to the major academic level one hospital. And we do everything in the hospital from kids to cranis and open heart.

So how are you going to prove poor outcome of independent crna when the difficulty cases get moved. On paper they may be doing the same AAA, VATs, crani's etc. Yet they are not the same patients. We all know that. It's difficult to compare ASA 4 (more like ASA 3.75) vs real ASA 4 patient (closer to ASA 4.75 ha) cases.

 

[deleted162650]

By the time you are finished, it won't be prevalent anywhere. There may be small pockets of autonomous private practice but most people will be working for "the man".

Very true. Even in my notoriously MD only neck of the woods, long standing very successful private groups are out actually shopping and actively looking for whichever AMC will make the best offer to buy them out.

 

[Pooh & Annie]

It's going to get even harder to prove "independent CRNAs" are "unsafe". Why? Metrics and how to game the system. With the ACA, more and more hospitals even smaller ones are rigging their quality score (morbidity and mortality) to make them appear safe. What better way to appear safe than to "punt" the difficult cases to another hospital.

I've seen it time and time again especially in the last 4-5 years. When I was back in academics, we had so many smaller hospitals (even a community hospital literally right next door that did the 2x more open hearts than the academic hospital open heart). That hospital punted the difficult hearts (aka patients prone to poor outcome) over to the academic medical center. It's was ridiculous.

It's all about metrics these days boys and girls. "quality" care. Now I am on the other side (community hospital) and we have quite a few cases we punt to the major academic level one hospital. And we do everything in the hospital from kids to cranis and open heart.

So how are you going to prove poor outcome of independent crna when the difficulty cases get moved. On paper they may be doing the same AAA, VATs, crani's etc. Yet they are not the same patients. We all know that. It's difficult to compare ASA 4 (more like ASA 3.75) vs real ASA 4 patient (closer to ASA 4.75 ha) cases.

I understand the idea here, but cherry picking is a bad long term business move when referral bases have options other than you.

 

[BLADEMDA]

I understand the idea here, but cherry picking is a bad long term business move when referral bases have options other than you.

Disagree. Cherry-picking is a great idea when CMS decides to start publishing the stats for outcome. Remember, the better insured patients are generally in better health than those on governmental plans or no insurance at all. So, "punting" those cases makes great fiscal sense and will improve your scores.

 

[aneftp]

I understand the idea here, but cherry picking is a bad long term business move when referral bases have options other than you.

No. U only punt the bad cases. Not many of them. Say 200 cases (non GI cause they can inflate the numbers) done at rural hospital they punt 1-2 each month.

But those 1-2 cases that they put have a greater than 50% mortality rate. So instead of having 1-2 patients dying at rural hospital perioperatively (1% rate). They drive that rate even lower.

It's not like they send 20% of the cases out. That's how the numbers game is played.

 

[Pooh & Annie]

No. U only punt the bad cases. Not many of them. Say 200 cases (non GI cause they can inflate the numbers) done at rural hospital they punt 1-2 each month.

But those 1-2 cases that they put have a greater than 50% mortality rate. So instead of having 1-2 patients dying at rural hospital perioperatively (1% rate). They drive that rate even lower.

It's not like they send 20% of the cases out. That's how the numbers game is played.

This may work since its subtle.

 

[Pooh & Annie]

Disagree. Cherry-picking is a great idea when CMS decides to start publishing the stats for outcome. Remember, the better insured patients are generally in better health than those on governmental plans or no insurance at all. So, "punting" those cases makes great fiscal sense and will improve your scores.

Why doesn't everyone that's not public do this? Because their referral base pays attention. If your hospital doesn't occasionally pick up someone's problem patients, you think they're going to send you all their easy money makers?
Like I said, it's a bad long term business move.