Supervision Questions

[regularjoegassman]

Hi all,

Long time reader, first time poster. Curious what you all think of this situation. Trying to keep details vague. Recently joined a group with CRNAs. Some days, we are 1:4 billing medical direction (the CRNAs are allowed to procede with starting and ending cases without notifying anyone so I am often running around to be present for induction, which is a whole other discussion). Often, however, we will be at an ASC or late at the main hospital doing our own cases while signing the chart for a CRNA next door who is essentially doing their own case. Sometimes, I will be stuck in an OR and be presented with a case to sign medical supervision for that has already been completed with the patient in the PACU. This feels off - is any of this kosher?

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[kidthor]

Hi all,

Long time reader, first time poster. Curious what you all think of this situation. Trying to keep details vague. Recently joined a group with CRNAs. Some days, we are 1:4 billing medical direction (the CRNAs are allowed to procede with starting and ending cases without notifying anyone so I am often running around to be present for induction, which is a whole other discussion). Often, however, we will be at an ASC or late at the main hospital doing our own cases while signing the chart for a CRNA next door who is essentially doing their own case. Sometimes, I will be stuck in an OR and be presented with a case to sign medical supervision for that has already been completed with the patient in the PACU. This feels off - is any of this kosher?

For medical direction you need to be present for induction and emergence, which it seems you aren't in the 1:4 model stated.

For the ASC question you're billing as direction but also doing your own room solo? Then who do you put down as having been in your room? In any event no that would be allowed under medical direction either.

 

[DocVapor]

Hi all,

Long time reader, first time poster. Curious what you all think of this situation. Trying to keep details vague. Recently joined a group with CRNAs. Some days, we are 1:4 billing medical direction (the CRNAs are allowed to procede with starting and ending cases without notifying anyone so I am often running around to be present for induction, which is a whole other discussion). Often, however, we will be at an ASC or late at the main hospital doing our own cases while signing the chart for a CRNA next door who is essentially doing their own case. Sometimes, I will be stuck in an OR and be presented with a case to sign medical supervision for that has already been completed with the patient in the PACU. This feels off - is any of this kosher?

Lots of "No No No No".

I would have this moved to private forum.

 

[regularjoegassman]

For medical direction you need to be present for induction and emergence, which it seems you aren't in the 1:4 model stated.

For the ASC question you're billing as direction but also doing your own room solo? Then who do you put down as having been in your room? In any event no that would be allowed under medical direction either.

Billing as supervision while doing your own room solo, sorry if that was unclear in my first post. I make it a point to be at each induction and emergence but that is not the norm.

 

[Gasmd98]

Oh boy! Run, don’t walk, out of there.

 

[gcc322]

Billing as supervision while doing your own room solo, sorry if that was unclear in my first post. I make it a point to be at each induction and emergence but that is not the norm.

In what world?

 

[linkin06]

You got lazy partners who established a horrible culture. I had similar situations and left my group. Didn't like it.

 

[sevo00]

That’s not medical direction. I would leave this practice

 

[marr65]

Not kosher signing charts for Crnas while doing your own case, probably billing fraud and a huge malpractice liability for you. I would refuse to sign those charts, make them fire you and start looking for another job tomorrow.

 

[anaesthetic]

Oh boy! Run, don’t walk, out of there.

But be sure to wait at least a year so that it doesn’t look so bad on your CV.

 

[cchoukal]

He’s distinguishing between DIRECTION (when he’s 1:4) and SUPERVISION (when he’s solo in a room). Different requirements. I still think he should find a different job, though.

 

[crash2500]

You can sit your own cases and bill supervision simultaneously? Sounds odd.

 

[OptionOffense]

Hi all,

Long time reader, first time poster. Curious what you all think of this situation. Trying to keep details vague. Recently joined a group with CRNAs. Some days, we are 1:4 billing medical direction (the CRNAs are allowed to procede with starting and ending cases without notifying anyone so I am often running around to be present for induction, which is a whole other discussion). Often, however, we will be at an ASC or late at the main hospital doing our own cases while signing the chart for a CRNA next door who is essentially doing their own case. Sometimes, I will be stuck in an OR and be presented with a case to sign medical supervision for that has already been completed with the patient in the PACU. This feels off - is any of this kosher?

What i would do in this scenario is collect as much information as possible in each instance this happens; MR numbers, dates, times and description. Gather AS MUCH info as you can. And blow the whistle. Report that **** as fraud. I hear it is a large payout. And it will make the newspapers.
Before you report it, resign tout suite.

You also did not specify whether you are in an opt out state or not?

 

[Gasmd98]

If true you need to contact an attorney well versed in this area of the law. They will then contact the DOJ OIG. You will remain anonymous. The OIG will conduct an investigation. Stop signing charts for CRNAs when you have not been involved in cases. Start looking for a new job. Good luck.

Edit: I would first sit down with CEO or whoever is in charge. Discuss your concerns about being asked to sign charts attesting to supervision when you are doing cases solo as well as the fact that CRNAS seem to be doing cases almost solo while you are supposedly directing. Maybe the CRNAS are going off the reservation? Get a copy of the compliance manual and read through it. What is spelled out? Maybe this is a recent development that said individual is not aware is occurring. If the discussion starts to head south you need to smile and ease your way out of the room. Then follow advice above. If you are threatened prior to speaking with an attorney keep your mouth shut and try to remember everything that is said. Write it all down immediately and file away safely.

I can’t believe anyone could be this blatant in 2022.

 

[IlDestriero]

Why wouldn’t they just bill as independently practicing CRNAs? Answer that and you’ll get a better handle on how bad this is. Is it prohibited by hospital/department policy? = bad Are you in an opt out state? No? = very bad.
You can’t be supervising/directing/liability sponging when you’re sitting your own cases. We can’t chart a concurrency violation. Epic is the big brother watching us all.
My father in law joined a newly expanded specialty practice years ago and within a couple weeks it was clear that the owner was committing insurance fraud. He refused to participate and resigned effective immediately when he pointed out the problem and was told “it was fine, not fraudulent billing.” He was threatened with a lawsuit for violating his contract to which he replied that he won’t sue him because then his insurance fraud would be on the record, and he wasn’t returning his relocation money either. The guy paid him for the work he did and he never heard from him again, until he read about his arrest in the newspaper several years later.
Don’t be that guy.

 

[Volatile]

You couldn’t pay me enough money to be involved in this, yikes. Our crnas NEVER start an induction until we arrive. All it takes is one pissed off person to report you and you’ll be hit with billing fraud, I’ve seen it.

 

[Southpaw]

He’s distinguishing between DIRECTION (when he’s 1:4) and SUPERVISION (when he’s solo in a room). Different requirements. I still think he should find a different job, though.

I don’t think you can supervise anything when you’re doing your own case. Am I wrong?

 

[kidthor]

You couldn’t pay me enough money to be involved in this, yikes. Our crnas NEVER start an induction until we arrive. All it takes is one pissed off person to report you and you’ll be hit with billing fraud, I’ve seen it.

I’ve also seen fraudsters retaliate openly and get away with it…. Scummy institutions are quick to normalize and defend illegal behavior if there’s a money train and/or a good ol’ boys network involved.

But yes I’d stay quiet for now while not participating in anything illegal, contact an employment attorney (ideally one with whistleblower experience if it gets that far), and plan your exit.

 

[Guillemot]

I’ve also seen fraudsters retaliate openly and get away with it…. Scummy institutions are quick to normalize and defend illegal behavior if there’s a money train and/or a good ol’ boys network involved.

But yes I’d stay quiet for now while not participating in anything illegal, contact an employment attorney (ideally one with whistleblower experience if it gets that far), and plan your exit.

This is absolutely true. You and your career are in grave danger at the moment both from within the institution where you work and from outside the institution.

 

[Guillemot]

If true you need to contact an attorney well versed in this area of the law. They will then contact the DOJ OIG. You will remain anonymous. The OIG will conduct an investigation. Stop signing charts for CRNAs when you have not been involved in cases. Start looking for a new job. Good luck.

Edit: I would first sit down with CEO or whoever is in charge. Discuss your concerns about being asked to sign charts attesting to supervision when you are doing cases solo as well as the fact that CRNAS seem to be doing cases almost solo while you are supposedly directing. Maybe the CRNAS are going off the reservation? Get a copy of the compliance manual and read through it. What is spelled out? Maybe this is a recent development that said individual is not aware is occurring. If the discussion starts to head south you need to smile and ease your way out of the room. Then follow advice above. If you are threatened prior to speaking with an attorney keep your mouth shut and try to remember everything that is said. Write it all down immediately and file away safely.

I can’t believe anyone could be this blatant in 2022.

Bad and dangerous advice.

 

[vector2]

I don’t think you can supervise anything when you’re doing your own case. Am I wrong?

Indeed, I think you still have to be immediately available with supervision.

 

[D P356]

Culture sounds terrible.

 

[OptionOffense]

I would first sit down with CEO

Not a good idea. You sit down with the CEO and point out whats wrong with the place you will be fired. Stay away from CEO. I do agree with DOJ OIG.

 

[Cookie]

A separate but a bit related question. How about OB/epidural coverage if the CRNAs are doing the epidurals , do you sign the chart if you are available but not physically present for placement ?

 

[Dr. Rude]

A separate but a bit related question. How about OB/epidural coverage if the CRNAs are doing the epidurals , do you sign the chart if you are available but not physically present for placement ?

That is ok if the CRNAs are billing QZ for epidurals. Doesn’t get you off the hook medicolegally, but it is not inappropriate billing.

 

[amyl]

Omg. Get out of there now. Do not sign anymore charts.

 

[Greenbayslacker]

 

[Gasmd98]

I appreciate the comments regarding my advice to speak with CEO. Point taken. The bottom line is that once you stop signing random charts, as you must, you will probably be meeting with CEO shortly thereafter. Speak with a good employment lawyer ASAP. Who knows what is really going on here but you need to protect yourself now, especially if this is a shady operation. As an aside, I take it that you are signing actual paper anesthesia records? This speaks to a hospital running on fumes. That would be reason enough for me to leave.

 

[Beeftenderloin]

OP reading these replies like:

 

[gcc322]

That is ok if the CRNAs are billing QZ for epidurals. Doesn’t get you off the hook medicolegally, but it is not inappropriate billing.

If not in an opt-out state, someone will still be required to serve as the “supervising physician” overseeing the epidural placement…whether this has been worked out within the hospital - it can be an anesthesiologist, OB, or whomever. As you said, it is not appropriate billing if you are sitting in your own case while it is being placed.

 

[Greenbayslacker]

As an aside, I take it that you are signing actual paper anesthesia records? This speaks to a hospital running on fumes. That would be reason enough for me to leave.

Not sure why you think this is the case. Implementing an OR EMR is quite costly with nearly no returns other than employee satisfaction. We use paper records and I am happy with our system, and we are definitely not running on fumes.

 

[pasgasser2]

I don't mean to hijack this thread but our physician group recently became hospital employed and the administration has started to bring CRNA's in. We only have three right now but there will be more. These will be independent CRNAs who bill on their own and ultimately will not need supervision/direction but the admins really favor our core group of anesthesiologists and they are very receptive to us setting the culture of how these CRNA's operate. As of now, these CRNA's are "monitored" everyday by an anesthesiologist who is specifically out of the OR for this. We don't put our names as "Staff" in EPIC but we do note an attestation along the lines of "Chart was reviewed, case was discussed with CRNA, I or my surrogate are available for key portions of the anesthetic". We've been told that as anesthesiologists we are just providing a consultation service to the CRNA's and therefore not liable for any bad outcomes to the patient. Is this true? I think we are also a bit confused with the terminology, we keep referring to our model as a care team model but with independent CRNA's who do the pre-op/intraop/post-op all on their own and bill independently, this is more of a collaborative model, is it not?

Our main concern is the liability issue since our name does appear in the chart under "attestation". Are there ways we can further mitigate our liability for being a consult service to the CRNAs?

 

[kidthor]

I don't mean to hijack this thread but our physician group recently became hospital employed and the administration has started to bring CRNA's in. We only have three right now but there will be more. These will be independent CRNAs who bill on their own and ultimately will not need supervision/direction but the admins really favor our core group of anesthesiologists and they are very receptive to us setting the culture of how these CRNA's operate. As of now, these CRNA's are "monitored" everyday by an anesthesiologist who is specifically out of the OR for this. We don't put our names as "Staff" in EPIC but we do note an attestation along the lines of "Chart was reviewed, case was discussed with CRNA, I or my surrogate are available for key portions of the anesthetic". We've been told that as anesthesiologists we are just providing a consultation service to the CRNA's and therefore not liable for any bad outcomes to the patient. Is this true? I think we are also a bit confused with the terminology, we keep referring to his as a care team model but with independent CRNA's who do the pre-op/intraop/post-op all on their own and bill independently, this is more of a collaborative model, is it not?

But our main concern is the liability issue since our name does appear in the chart under "attestation". Are there ways we can further mitigate our liability for being a consult service to the CRNAs?

DUDE.

You've been gaslight into oblivion and you're asking questions that make no sense. Which means the hospital pulled a fast one on you in plain view. Not your fault (it seems the writing's on the wall anyway), but you're getting played.

How can the admins favor your core group of physicians while simultaneously bringing in CRNAs to work "independently" while you sign and attest that you're monitoring and supervising them? How is the culture to be set by you while the hospital also dictates an absurd care model and brings in people you don't have control over?

You are absolutely liable as a supervisor if you're providing this stated supervisory service. I mean you're on the chart and attesting that you were available and that you reviewed the case and discussed it with them. You're liable.

Just as a theoretical example - say a patient aspirates on emergence because one of these CRNAs deep extubates an open bowel resection to be "smooth". The patient aspirates and dies. Your name is in the chart with your attestation of "Chart was reviewed, case was discussed with CRNA, I or my surrogate are available for key portions of the anesthetic" and also you've got this system of "monitoring". You seriously think there's any way to spin that such that you won't be liable? As in you're supervising them but not really supervising because Janet RN-CC AA BA MHA ACLS BLS WTF in hospital admin says you're not really supervising so it's fine, members of the jury?

There's no way this will end well. Sorry this is happening to you. If it were me I'd have quit already.

 

[pasgasser2]

DUDE.

You've been gaslight into oblivion and you're asking questions that make no sense. Which means the hospital pulled a fast one on you in plain view. Not your fault (it seems the writing's on the wall anyway), but you're getting played.

How can the admins favor your core group of physicians while simultaneously bringing in CRNAs to work "independently" while you sign and attest that you're monitoring and supervising them? How is the culture to be set by you while the hospital also dictates an absurd care model and brings in people you don't have control over?

You are absolutely liable as a supervisor if you're providing this stated supervisory service. I mean you're on the chart and attesting that you were available and that you reviewed the case and discussed it with them. You're liable.

Just as a theoretical example - say a patient aspirates on emergence because one of these CRNAs deep extubates an open bowel resection to be "smooth". The patient aspirates and dies. Your name is in the chart with your attestation of "Chart was reviewed, case was discussed with CRNA, I or my surrogate are available for key portions of the anesthetic" and also you've got this system of "monitoring". You seriously think there's any way to spin that such that you won't be liable? As in you're supervising them but not really supervising because Janet RN-CC AA BA MHA ACLS BLS WTF in hospital admin says you're not really supervising so it's fine, members of the jury?

There's no way this will end well. Sorry this is happening to you. If it were me I'd have quit already.

It wasn't Janet but our hospital's legal counsel who attended our department meeting and tried to reassure us. And I have little doubt that our hospital's malpractice coverage and legal team would make every effort to protect us in the case of a bad outcome. I'm more concerned about actually getting named in a lawsuit because that follows you forever.

There are hospitals out there where the physician and CRNA's work completely independently from one another but a physician will still bail a CRNA out in a bind. Would the MD in this scenario still be liable when they came in just to help?

 

[DrZzZz]

It wasn't Janet but our hospital's legal counsel who attended our department meeting and tried to reassure us. And I have little doubt that our hospital's malpractice coverage and legal team would make every effort to protect us in the case of a bad outcome. I'm more concerned about actually getting named in a lawsuit because that follows you forever.

There are hospitals out there where the physician and CRNA's work completely independently from one another but a physician will still bail a CRNA out in a bind. Would the MD in this scenario still be liable when they came in just to help?

You needed to be looking for a new job yesterday. This is horrible.

 

[ERRES2288]

It wasn't Janet but our hospital's legal counsel who attended our department meeting and tried to reassure us. And I have little doubt that our hospital's malpractice coverage and legal team would make every effort to protect us in the case of a bad outcome. I'm more concerned about actually getting named in a lawsuit because that follows you forever.

There are hospitals out there where the physician and CRNA's work completely independently from one another but a physician will still bail a CRNA out in a bind. Would the MD in this scenario still be liable when they came in just to help?

You can bet you’re getting named in any lawsuits that involve these patients. Now you might get dropped but you’re getting named.

Why would your group agree to this? I’d much rather just have them practice independently without your name on anything. Make clear to hospital administration you are not there to bail them out. If they want that then you supervise or direct. This is a dream for the hospital and I’m sure they love you guys. They can hire cheaper CRNAs and still shift liability to you.

 

[Beeftenderloin]

It wasn't Janet but our hospital's legal counsel who attended our department meeting and tried to reassure us. And I have little doubt that our hospital's malpractice coverage and legal team would make every effort to protect us in the case of a bad outcome. I'm more concerned about actually getting named in a lawsuit because that follows you forever.

There are hospitals out there where the physician and CRNA's work completely independently from one another but a physician will still bail a CRNA out in a bind. Would the MD in this scenario still be liable when they came in just to help?

I would have some doubts about this. Sure they’re going to protect you as long as your interests are aligned. But the primary responsibility of the hospital legal counsel is to protect the hospital, you are a very distant second to that primary goal. In the event of a bad outcome, if they can throw you under the bus in the name of protecting the hospital, you better believe they’ll do it.

 

[kidthor]

I would have some doubts about this. Sure they’re going to protect you as long as your interests are aligned. But the primary responsibility of the hospital legal counsel is to protect the hospital, you are a very distant second to that primary goal. In the event of a bad outcome, if they can throw you under the bus in the name of protecting the hospital, you better believe they’ll do it.

I agree - you're totally getting named. If you, the CRNAs, and the hospital all have the same insurer then the hospital/insurer will want to defend the suit in aggregate as a unit. But there's no way you aren't named.

There are hospitals out there where the physician and CRNA's work completely independently from one another but a physician will still bail a CRNA out in a bind. Would the MD in this scenario still be liable when they came in just to help?

Yes - they could still be liable. A friend was a defense expert witness in a lawsuit where an overhead was called for an in OR emergency, a helpful otherwise uninvolved anesthesiologist came in an helped place a central line that caused a pneumo (which was really just collateral damage on top of the patient otherwise not doing well). The helpful anesthesiologist settled as did the rest of the defendants.

 

[kidthor]

I would have some doubts about this. Sure they’re going to protect you as long as your interests are aligned. But the primary responsibility of the hospital legal counsel is to protect the hospital, you are a very distant second to that primary goal. In the event of a bad outcome, if they can throw you under the bus in the name of protecting the hospital, you better believe they’ll do it.

Agreed 100%. The hospital attorney is your friend till they aren't, then they'll crush you if the enterprise wants them to. They're an agent of the hospital with a legal duty to the hospital not you.

 

[Maz777]

I don't mean to hijack this thread but our physician group recently became hospital employed and the administration has started to bring CRNA's in. We only have three right now but there will be more. These will be independent CRNAs who bill on their own and ultimately will not need supervision/direction but the admins really favor our core group of anesthesiologists and they are very receptive to us setting the culture of how these CRNA's operate. As of now, these CRNA's are "monitored" everyday by an anesthesiologist who is specifically out of the OR for this. We don't put our names as "Staff" in EPIC but we do note an attestation along the lines of "Chart was reviewed, case was discussed with CRNA, I or my surrogate are available for key portions of the anesthetic". We've been told that as anesthesiologists we are just providing a consultation service to the CRNA's and therefore not liable for any bad outcomes to the patient. Is this true? I think we are also a bit confused with the terminology, we keep referring to our model as a care team model but with independent CRNA's who do the pre-op/intraop/post-op all on their own and bill independently, this is more of a collaborative model, is it not?

Our main concern is the liability issue since our name does appear in the chart under "attestation". Are there ways we can further mitigate our liability for being a consult service to the CRNAs?

You will 100% be held liable. Lawyers will name everyone associated with the medical record. The hospital's legal counsel does not care about you whatsoever. As others have said, they are solely there to protect the hospital. You are a nobody. Let them practice 100% independently and do not agree to bail them out.

 

[OptionOffense]

We don't put our names as "Staff" in EPIC but we do note an attestation along the lines of "Chart was reviewed, case was discussed with CRNA, I or my surrogate are available for key portions of the anesthetic". We've been told that as anesthesiologists we are just providing a consultation service to the CRNA's and therefore not liable for any bad outcomes to the patient. Is this true?

Our main concern is the liability issue since our name does appear in the chart under "attestation". Are there ways we can further mitigate our liability for being a consult service to the CRNAs?

You are attesting to being available for key portions of the anesthetic. In my mind, this means it is your anesthetic and you are liable for anything that happens I would not sign or attest anything. In fact I would not even log into the patients chart. Do you see the patients pre op? This is a complete disaster. Is this an opt out state? I would NOT get involved with this whatseover.

 

[OptionOffense]

Would the MD in this scenario still be liable when they came in just to help?

yes and please let us know if you are in an opt out state. This kinda s hit cannot be going on in any other place but an opt out state.

 

[anaesthetic]

Our main concern is the liability issue since our name does appear in the chart under "attestation". Are there ways we can further mitigate our liability for being a consult service to the CRNAs?

“We would like you to attest to being present for key portions of the case despite not being present for key portions of the case. Don’t worry! You won’t be liable if anything bad happens even though you attested in the chart that you were present during key portions of the case despite not being present for key portions of the case. Trust us. We’ll protect you.”

Run, don’t walk.

After a year.

 

[Cookie]

Sorry to bring OB one more time. Can you attest you're medically directing/sign the chart for epidural placement if you're available (covering other OR cases)but not physically present when it is placed by the CRNA. I believe some/many practices have CRNAs do epidurals, are you present for every placement like you do for OR inductions ?

 

[NitroS]

I don't mean to hijack this thread but our physician group recently became hospital employed and the administration has started to bring CRNA's in. We only have three right now but there will be more. These will be independent CRNAs who bill on their own and ultimately will not need supervision/direction but the admins really favor our core group of anesthesiologists and they are very receptive to us setting the culture of how these CRNA's operate. As of now, these CRNA's are "monitored" everyday by an anesthesiologist who is specifically out of the OR for this. We don't put our names as "Staff" in EPIC but we do note an attestation along the lines of "Chart was reviewed, case was discussed with CRNA, I or my surrogate are available for key portions of the anesthetic". We've been told that as anesthesiologists we are just providing a consultation service to the CRNA's and therefore not liable for any bad outcomes to the patient. Is this true? I think we are also a bit confused with the terminology, we keep referring to our model as a care team model but with independent CRNA's who do the pre-op/intraop/post-op all on their own and bill independently, this is more of a collaborative model, is it not?

Our main concern is the liability issue since our name does appear in the chart under "attestation". Are there ways we can further mitigate our liability for being a consult service to the CRNAs?

Like everyone has said, I think you can still be liable since your name is on the chart and you’re attesting you discuss with CRNA and be available for key portions of the case.

it’s fine to help set the culture how the CRNAs operate and help them with difficult cases (we help each other out all the time). Just make sure your name is NOT on the chart.

 

[Arch Guillotti]

Sorry to bring OB one more time. Can you attest you're medically directing/sign the chart for epidural placement if you're available (covering other OR cases)but not physically present when it is placed by the CRNA.

yes

 

[pasgasser2]

Thank you all for the helpful feedback. What I gather is that 2-liner attestation we are noting in the chart is hurting us more than helping us in terms of liability. Would the terms of this set up be more acceptable if an attestation wasn't required? If not, really what model would be acceptable to you guys when CRNAs are in the picture? Medical direction, supervision? Regardless, your name would be in the chart and you would at least be named in a lawsuit, correct?

And yes I am in an opt-out state.

 

[NitroS]

Thank you all for the helpful feedback! What I gather is that 2-liner attestation we are noting in the chart is hurting us more than helping us in terms of liability. Would the terms of this set up be more acceptable if an attestation wasn't required? If not, really what model would be acceptable to you guys when CRNAs are in the picture? Medical direction, supervision? Regardless, your name would be in the chart and you would at least be named in a lawsuit, correct?

And yes I am in an opt-out state.

You mentioned

These will be independent CRNAs who bill on their own and ultimately will not need supervision/direction

So I think you treat these CRNAs as if they were solo MDs in the room. They can curbside consult you and you’re welcome to show them how you guys do things around there and what the surgeons like etc…but ultimately they’re on their own. No attestation and no names on their chart.

 

[DocVapor]

Thank you all for the helpful feedback! What I gather is that 2-liner attestation we are noting in the chart is hurting us more than helping us in terms of liability. Would the terms of this set up be more acceptable if an attestation wasn't required? If not, really what model would be acceptable to you guys when CRNAs are in the picture? Medical direction, supervision? Regardless, your name would be in the chart and you would at least be named in a lawsuit, correct?

And yes I am in an opt-out state.

True medical direction 1:3 max is really the only acceptable way to deal with CRNA's. Even if they're truly independent you can bet your ass that your helpful suggestion when they curbside you us going to end up in the chart somewhere.

"Discussed case with Dr. Pasgasser2 who suggested ..."

And the best part is, because they're independent and you don't look at their charts, you'll never know until you get served the papers.

 

[Dr. Rude]

True medical direction 1:3 max is really the only acceptable way to deal with CRNA's. Even if they're truly independent you can bet your ass that your helpful suggestion when they curbside you us going to end up in the chart somewhere.

"Discussed case with Dr. Pasgasser2 who suggested ..."

And the best part is, because they're independent and you don't look at their charts, you'll never know until you get served the papers.

“Opt out state” only has to do with billing issues.

CRNAs may or may not be required to be supervised by a physician to meet state law requirements.

They may or may not be required to be supervised by an anesthesiologist per your hospital bylaws.

The hospital attorney is absolutely not your friend.

You need to get an UNCONFLICTED attorney who works for you, paid for by you to represent you and your group’s interest in clarifying these questions. Specifically insulating you from liability which may not even be possible. Hospital bylaws and your written agreement with the hospital do not supersede state law.