Anesthesiologist instead of a CRNA

[Southpaw]

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Could you point me to some area where I can read this legislation, or it's name. I have not heard of it and would be interested in hearing more.

Just google 'Anesthesia rural pass through legislation' or some variation of that. I'm not going to post links because there's just too much information out there.

I don't know your background (AA, CRNA, med student, etc.?) but you appear to read the nursing sites. I grow tired of their dishonest comments regarding 'we provide all the rural care because Anesthesiologists won't go there'. It's a completely dishonest half-truth. I'll be the first to admit that some anesthesiologists, probably most, aren't willing to work in those locations (but neither are most nurses....) , but the fact remains that as the legislation currently reads we can't even go in the doors because those hospitals will lose their Medicare Part A funding. There's not a hospital administrator in this country who is going to give back 'free money' to the government, especially if that money helps them keep the doors open.

Those patients deserve the quality of care given to any other patient in this country. Whether its MD-only, or ACT (with AAs and CRNAs), those patients deserve an anesthesiologist involved in the decision making.

 

[jl lin]

Just google 'Anesthesia rural pass through legislation' or some variation of that. I'm not going to post links because there's just too much information out there.

I don't know your background (AA, CRNA, med student, etc.?) but you appear to read the nursing sites. I grow tired of their dishonest comments regarding 'we provide all the rural care because Anesthesiologists won't go there'. It's a completely dishonest half-truth. I'll be the first to admit that some anesthesiologists, probably most, aren't willing to work in those locations (but neither are most nurses....) , but the fact remains that as the legislation currently reads we can't even go in the doors because those hospitals will lose their Medicare Part A funding. There's not a hospital administrator in this country who is going to give back 'free money' to the government, especially if that money helps them keep the doors open.

Those patients deserve the quality of care given to any other patient in this country. Whether its MD-only, or ACT (with AAs and CRNAs), those patients deserve an anesthesiologist involved in the decision making.

You are right. Once law is made or manipulated, it is hard to change.

Those pts do deserve that same quality of care. CRNAs will argue that they do get it. They go in circles and twist the facts w/ their position. You take the time to carefully untangle the faulty reasoning, and they find a way to re-weave the same knots or at least similar ones. I 'love' arguing w/ people that play this game. They just want to wear you out with the weaving and tangling and unweaving and untangling.

I wonder that Denature is a CRNA, but I'm not the Internet police, so. . .

I don't think the pass-through deal will change until people that use those hospitals or live in those areas begin to demand it from their congressional legislatures. The catalyst for such a move would be trends that indicate real safety issues and cases that demonstrate how this is demonstrated in light of this legislation. And you know how things go that could lead to awareness of the inherent problems and actual problems. I mean I have personally seen things covered up in places--or buried--or pussed aside somehow. Some high profile stuff would have to happen and get broad exposure--exposure that one of more of these hospitals couldn't explain away or cover up.

 

[usncrna]

Let the sevo run dry? I once caught a physician anesthesiologist who was overdosing my patient with heparin for hours.... Does that make you feel safer?

The fact that you had a bad dog does not mean you cant find a good one 🙂

In our MDA left the lumbar drain opened during the spinal case and the patient died. Second one overdosed kid with versed. Regardless of the title behind oone's name (MD or CRNA) we all are human beings prone to error. There are other examples as well. I do not argue that CRNAs are as qualified as MDA's to administer anesthesia. I respect MDA's 4 year of med school and 3 years of residency. But maybe if you want to have anesthetic delivered 100% by MDA you need to first ask him or her to stop surfing the internet in their office, get off their butt and show up in the operating room. This is what some MDA do best while "incompetent" CRNAs they are paid to directly supervise do their cases from the begining to an end. If you get paid for surfing the internet and trade the stocks on your employer's time and dime, wouldn't you want to do it day in and day out. As simple as it gets.

 

[ssmallz]

In our MDA left the lumbar drain opened during the spinal case and the patient died. Second one overdosed kid with versed. Regardless of the title behind oone's name (MD or CRNA) we all are human beings prone to error. There are other examples as well. I do not argue that CRNAs are as qualified as MDA's to administer anesthesia. I respect MDA's 4 year of med school and 3 years of residency. But maybe if you want to have anesthetic delivered 100% by MDA you need to first ask him or her to stop surfing the internet in their office, get off their butt and show up in the operating room. This is what some MDA do best while "incompetent" CRNAs they are paid to directly supervise do their cases from the begining to an end. If you get paid for surfing the internet and trade the stocks on your employer's time and dime, wouldn't you want to do it day in and day out. As simple as it gets.

And boom goes the dynamite........

 

[Goldenyak2]

In our MDA left the lumbar drain opened during the spinal case and the patient died. Second one overdosed kid with versed. Regardless of the title behind oone's name (MD or CRNA) we all are human beings prone to error. There are other examples as well. I do not argue that CRNAs are as qualified as MDA's to administer anesthesia. I respect MDA's 4 year of med school and 3 years of residency. But maybe if you want to have anesthetic delivered 100% by MDA you need to first ask him or her to stop surfing the internet in their office, get off their butt and show up in the operating room. This is what some MDA do best while "incompetent" CRNAs they are paid to directly supervise do their cases from the begining to an end. If you get paid for surfing the internet and trade the stocks on your employer's time and dime, wouldn't you want to do it day in and day out. As simple as it gets.

What does the Maryland Department of Agriculture have to do with anesthesiology?

 

[Gern Blansten]

I'm sure they meant one of the following for MDA, but I can't decide which one.
Model Driven Architecture

Muscular Dystrophy Association

Media Development Authority

Mail Delivery Agent

Monochrome Display Adapter

MethyleneDiAniline

Minimum Descent Altitude

Minimum Detectable Activity

Milestone Decision Authority

Market Development Agreement

Missile Defense Act

McDonnell Douglas Aerospace

Mobile Digital Assistant

Media Arts Group, Inc.

Monochrome Display Adapter

Medical Defence Australia

Monochrome Display Adaptor

Microsoft Access Add-in

Mesocyclone Detection Algorithm

Minimum Decision Altitude

Machine Data Acquisition

Medical Digital Assistant

Music Direct Australia

Methylene Dioxy Amphetamine

 

[SitraAchra]

I respect MDA's 4 year of med school and 3 years of residency.

It's 4 years of residency. Obviously you don't respect it enough if you can just shave an entire year off our residency. You'd never forget that if you had anywhere near that amount of training.

 

[agonistmu2]

The OP was asking how to insure that his case was going to be done by an anesthesiologist not a CRNA; I had the same question for my own surgeries and procedures. First I was subjected to the gauntlet of CRNA's telling me how they were just as good as any anesthesiologist and that in our state they work under the ACT model. I was lead to believe that this ACT model meant that an anesthesiologist would be managing my case (and perhaps up to 4 CRNA simultaneously); but that wasn't even true. The outpatient surgical center where my case was scheduled often allows the surgeon to "manage" the CRNA..in short: on certian days they don't even have an anesthesiologist in the building. IMHO this invalidates any sort of "team care" model. My solution involved meeting with the chief of anesthesia and expressing my concerns; all we had to do was to move my case a little further into the future so that they could schedule an anesthesiologist to personally do my case 1:1. I asked the chief if it was unreasonable to request that an anesthesiologist personally perform my case 1:1 without supervising ther cases, he said that it was not. This was documented on the consent and nobody had a problem with this. My case was done without a problem. The anesthesiologist said that she understood my concerns about requesting that she personally perform my case; she even offered to do the sedation herself for my upcoming EGD and colonoscopy. Perhaps more patients should specify which type of provider they expect to perform their anesthesia?

 

[badasshairday]

Wow, the ASA should make it their number 1 priority to change the rural pass through law. That is absolutely ridiculous that it excludes Anesthesiologists. 😕

 

[imfrankie]

Wow, the ASA should make it their number 1 priority to change the rural pass through law. That is absolutely ridiculous that it excludes Anesthesiologists. 😕

I absolutely need to learn more about this law. I have been woefully uninformed on this. If it is true that certain hospitals get paid not to allow anesthesiologists privileges, I am going to round up the wagons and speak to some attorneys about a class action suit. No kidding.

 

[BLADEMDA]

I absolutely need to learn more about this law. I have been woefully uninformed on this. If it is true that certain hospitals get paid not to allow anesthesiologists privileges, I am going to round up the wagons and speak to some attorneys about a class action suit. No kidding.

Good luck. Remember, the govt. can decide which type of provider to give money to and how much. This is the reason you get $15 a unit in 2012 while surgeons will get 60% of commercial rates.

The govt, isn't stopping rural hospitals from hiring or recruiting an Anesthesiologist but rather providing funds for CRNA coverage at hospitals with minimal case loads.