Obviously, you can't answer just a simple question. You're all hyped. Calm down my friend. No punch intended. Yes, it's indeed very relevant.
Why would Sarjasy be able to answer a question you asked me?
Really, it's not relevant because how much we believe someone should be paid is opinion and because you are going to be distrustful of my opinion regardless of what I am. In fairness, I'm a PA and former Nurse. Like I said, I don't care about the bill specifically because I'm not affected by the issue and I'm not for NP independence with their current training. I do believe in same fee for same service.
Your arguement doesn't really make a lot of sense. My 4th year med student or intern can do the same work as my NP in taking an H+P and diagnosing/managing a UTI but they certainly don't get compensated similarly and I'm sure you wouldn't like it if you were taxed more to allow Medicare to pay a resident approrpriately based on your own logic. The reality is the compensation should be based on the knowledge of the provider not just the simple act/code; sure a simple UTI might be managed by an NP (I certaintly wouldn't advocate for this) but I would argue the training of the MD is far better in picking the one case that isn't a simple UTI and requires further workup, etc.
Actually, residency programs receive federal monies. So I am paying plenty for that service.
Because it helps defines who the opinon is coming from...an NP advocating for equal billing doesn't hold a lot of weight in my book
I'm guessing since I am a PA my opinion doesn't count either.
Probably. They're both physicians and you're paying for twenty minutes of their time, not the diagnosis. I don't know what's customary for these office fees. (yet😉) I would bet that insurance pays the specialist significantly more though. That's fair. You went to the nephrologist, you pay the nephrologist what he bills, not what the NP gets at CVS for a visit. Though they may actually get MORE at CVS. (being out of network, etc.)
You can add barriers to my seeing the nephrologist, but I pay more for premium insurance allowing me to bypass that trip to my pcp and just book an appointment with the appropriate specialist. I'm paying my insurance company more for better access to care. If it costs them more to have the dermatologist treat my kids acne that my pcp can treat just as well, oh well.
Do you think all physicians should be paid the same rate? Maybe by the hour? The busy FP working 70 hours a week making as much or more than the neuro and ortho spine surgeon and even less for the lowly anesthesiologist doing their cases, accepting significant liability, but only working 50 hours a week? If you want to pay me what a primary care physician makes, it's probably time for me to stop doing high risk patients, covering multiple rooms, etc. The risk is not worth the reward. But I guess the CRNAs will just fill in on those peds liver transplants and super sick neonates, etc. Right? Their leadership would have them practice independently with me as partners, with me doing the sick ASA 3-5 patients while they do the healthy ASA 1 and 2 patients for the same money, and we should also be available to jump in during an emergency and play fireman (accepting more unreinbursed liability). Sure man, sure. But we're all equal doing the same job with equivalent" training...
If a FP did anesthesia for surgery, I would expect him to be paid the same. This won't happen (well it actually does rarely with older GPs who did anesthesia before credentialing and Board certification became so big) because no hospital would dare hire him to do such a thing and no insurance company would pay for it. So really it's not relevant.
What is relevant is that would should be paying for outcomes. If we could pay people based on how well they performed (and I'm talking in ratios, not paying based on one individual patient) then I'm sure it would balance out and those with more training and fewer poor outcomes would be paid more. I'm sure their are problems with this idea, such as it providing and incentive for providers to cherry pick patients, but with some tweaks I think it would be optimal.
Anesthesiologist receives stipends from hospitals to be able to acquire their current level of income, therefore they cost more healthcare dollars.
And I'm sure if peds liver transplants were done at places that weren't huge academic centers with anesthesiology residencies and residents given first dibs, I'm sure there would be CRNAs doing them. I've seen claims that CRNAs don't independently do CABGs and TEE, but I've seen that too.
Anyway, this is not about independence. So that's the last I have to say on that matter. This is about pay. It's not about private insurance either, as you allude to. While CRNAs can bill 100% of medicaid/medicare, they often cannot with private insurance companies.
