You’re attesting that you were involved in the case. That’s it. Full stop. You’re absolutely liable no matter what your dunce hospital’s crack legal team thinks. Call your malpractice provider and ask them what attesting to a case means and if you’re liable. You know the answer.
100% this. Anyone want to bet that if an administrator or their loved one needed emergency surgery one of the anesthesiologists would be their first choice.
I bet the hospital gave you that competitive package without fully explaining what they had coming down the pipeline. If the hospital is forcing you to practice unethically at best and fraudulently/illegal at worst (at it sounds like you're much much closer to the latter), then you absolutely do need to tell admin to shove it.
There’s nothing wrong with supervising CRNAs, that’s a great way for them to be in the picture. But you have to actually supervise them and be in charge of the patient care not just sign charts. I’m curious to know why the hospital doesn’t want your “monitor” anesthesiologist listed as staff on the cases… what does the free person do all day?
Not sure how you arrived at fraudulent. We decided against medical direction to avoid fraud because we all agreed it'd be difficult to fulfill the 7 criteria for medical direction and for multiple rooms. We didn't want to be chart monkeys so we decided against medical supervision. We don't do any notes, we don't even meet the patient unless the CRNAs have a specific concern. Some of us are present for induction for a sicker patient / potential difficult airway. We'll perform blocks and line if the case warrants it. As it stands now, we'll do a chart review of the patient and have the CRNA tell us what their plan is and then give them feedback, whether they take that feedback or not is up to them but we've been filtering out and only hiring CRNAs who are very receptive to physician feedback...which is probably why we only have three. Again, we tried to design the program so that physicians are available as a consultant if there is a concern but otherwise leaving all care and billing to the "independent" CRNA. How is that fraudulent?
OB and billing gets complicated. It can be medical direction if you are directing no more than 4 locations and you are present for catheter placement/test/bolus or whatever your institution considers the critical portion of the procedure. Otherwise it should be billed as medical supervision or QZ if you are not involved at all.
My apologies. I went back a re-read the thread and realized I was getting you confused with the OP.
If you are in an opt-out state, tell the hospital that CRNAS DO NOT need your attestation. DONE. If you are comfortable with that arrangement, fine:stay. If you aren;t I would bounce. If you want to attest, tell them you want an exorbitant fee. When they say no, resign.
We have enough locums coverage for now to have a physician free to "monitor" the new CRNAs. Eventually the locums will be phased out and the AIC of the day will likely become the physician who is available to help the CRNAs. Does medical supervision require any physician involvement (pre-op, induction, emergence, attestation, etc) or is it just the billing modifier that matters? From what I've read there is no requirement for physicians to be involved in the case at all for medical supervision. If attestation/involvement isn't a requirement why would anyone even want to do medical supervision? From a collections standpoint, wouldn't it make sense to let the CRNA's be independent (which it seems like they already are in the supervision model) and take home full collections? I apologize in advance if these questions are elementary- essentially everyone in our department has only worked in a physician only practice and integrating CRNAs into our workflow is proving to be an uneasy transition.
Many practices bill using the "QZ" modifier eliminating any legal issues with billing. No Supervision or Direction is required to bill and collect under the QZ modifier if you are utilizing CRNAs.
What do you tell the patients? DO the patients ask questions? Are they that in the dark? DO you tell them, you will be getting a nurse today, but dont worry if that nurse gets in trouble with her or his decisions they can call the anesthesia in charge for back up? You really should be medically directing them to avoid those conversations. Also, how much are these crnas making?
You have to understand how little people (even us) know about supervising and the requirements. So once the circulator puts your name as Anesthesiologist, that can mean anything but most people will construe it as.... you are responsible for everything. IN their mind, how can it mean anything different? They dont know what American politics is all about yet. So good luck explaining to a jury or at deposition that even though it says you were supervising you were really only supervising if called in and you really arent responsible for the knocked out tooth, post op stroke, MI, aspiration or whatever. The good news is that you have plenty of time at deposition to explain yourself most places block out an entire day.
I have been around the block many times; I know what it's like to be in the hot seat. Rather than disagree with you, I fully agree that "supervision" is the same as "Medical Direction" in terms of malpractice/liability for your CRNAs. In fact, you are more likely to be sued with supervision, IMHO, because you are less involved with each anesthetic. The BUCK stops with the attending anesthesiologist of record, period.
Here is what i would do on days that you are "supervising". Do not examine ANY patients pre operatively!! Just be available by phone for any consultations by CRNAs. If you are consulted, only then, do you place a short sweet note in the chart saying something along the lines of
If you state laws and hospital by laws allow independent crna practice then keep your name off the record/chart. If your name appears on the chart in any manner you will be named as co-defendant. It’s possible you will be dropped from the suit later on in the case but that depends on your proving the crna was actually practicing independently.
There are no "good samaritans" in hospitals.
www.gfrlaw.com
I do understand the ultimate plan is to act more like code team responders. The ethical dilemma is that rescuing patients enables the hospital’s bad behavior and ensures more patients will need rescuing. Can’t imagine a hospitalist team would be too pleased if they were asked to respond to codes for an RN run inpatient service.
This is pretty much the textbook definition of "medical supervision". Of course you're on the hook.
Bingo. All the control has shifted to the hospital. As a hospital employee, they are in control of what will be done in their hospital. Don't like it? There's only one other choice.
If it is an opt out state, the hospitals are not liable, the crna is. That is the definition of opt out, the crnas are independent
Yes, I know that but this gives the hospital a buffer if there is a bad outcome, put blame on the anesthesiologist.
Why? if its legal? Im sure in the court of public opinion they will get toasted tho
Opt-Out is a billing distinction - not sure it absolves an anesthesiologist of all liability, especially if they're "attesting" etc.
But doesn't absolve the hospital.
The hospital is absolved already... this is the point of opt out. The CRNA is indy
What? I haven't heard this. I always thought it was that CRNA's are independent from anesthesiologist oversight... not that they're entirely independent from the hospital, their employer, etc.
Cmon,when you are an indy crna the hospital is not responsible for your actions. You can make an argument if the patient is not told they have an indy CRNA on their hands they would not have consented. We are all waiting for that lawsuit.
www.sommerspc.com
