Bcbs cuts crna reimbursement

Started by amyl
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amyl said:
www.beckersasc.com

Anthem BCBS to cut CRNA reimbursements - Becker’s ASC

"Anthem Blue Cross Blue Shield reduces reimbursement for CRNA anesthesia services in multiple states, sparking criticism from AANA and concerns for access to ca
www.beckersasc.com www.beckersasc.com

It doesn’t look like all states will be affected… qz paying 85% now… like Cigna
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How does this apply to opt out states with “independent “ practice.
 
amyl said:
www.beckersasc.com

Anthem BCBS to cut CRNA reimbursements - Becker’s ASC

"Anthem Blue Cross Blue Shield reduces reimbursement for CRNA anesthesia services in multiple states, sparking criticism from AANA and concerns for access to ca
www.beckersasc.com www.beckersasc.com

It doesn’t look like all states will be affected… qz paying 85% now… like Cigna
Click to expand...

Now I'm waiting for the AANA to verbally diarrhea some nonsense response about being woefully discriminated against. Get the popcorn
 
Guillemot said:
I guess this is good for anesthesiologists, but the real reason for this probably isn’t noble. Insurance companies are just looking for any opportunity to cut costs.
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GassYous said:
I'm thinking further physician cuts are coming next
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Wont matter. You know how admins lie to you and tell you anesthesia costs money and is a loss leader? Well now they will be telliing the truth if insurance does cut your reimbursements. Salary will still be the same if not higher as more people leave the field.
 
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medicine2wallstreet said:
Absolutely not sitting my own cases. That is for bozos. I don't need to sit lap choles and cystos as an anesthesiologist. I take plenty of responsibility when I sign the anesthesia H and P and ensure they're safe for anesthesia.

Not carrying the water for crnas but they are valuable so I don't have to waste my time in sit and stare cases.

Moreover there's not enough anesthesiologists in my state to staff all the necessary anesthesia rooms.

Easy to say sit your own stool when you're out west. But there's not enough anesthesiologists nationally to staff all the necessary rooms right now. Not even close. Previous group has 20 anesthesiologists, 70 crnas. 35 main ORs, 6 GI suites, 6 endo/cath rooms, 2 IR rooms, 5 day surgery ORs, 5 ortho center ORs.

Find me the anesthesiologists to staff that overnight?

Your comment got alot of likes, but it is equivalent to politicians saying I'll cut taxes and reduce the federal deficit. Makes no real sense.
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Did you already graduate residency?
 
medicine2wallstreet said:
Absolutely not sitting my own cases. That is for bozos. I don't need to sit lap choles and cystos as an anesthesiologist. I take plenty of responsibility when I sign the anesthesia H and P and ensure they're safe for anesthesia.

Not carrying the water for crnas but they are valuable so I don't have to waste my time in sit and stare cases.

Moreover there's not enough anesthesiologists in my state to staff all the necessary anesthesia rooms.

Easy to say sit your own stool when you're out west. But there's not enough anesthesiologists nationally to staff all the necessary rooms right now. Not even close. Previous group has 20 anesthesiologists, 70 crnas. 35 main ORs, 6 GI suites, 6 endo/cath rooms, 2 IR rooms, 5 day surgery ORs, 5 ortho center ORs.

Find me the anesthesiologists to staff that overnight?

Your comment got alot of likes, but it is equivalent to politicians saying I'll cut taxes and reduce the federal deficit. Makes no real sense.
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Lol bozo? Who doesn't want the easy urology and lap chole rooms? Easy day, cases and units, go home happy. You want the ASA 6 GI day?? The AANA would be happy to have you as their spokesperson
 
l
medicine2wallstreet said:
At my first group. Previous group was my residency program.
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medicine2wallstreet said:
Absolutely not sitting my own cases. That is for bozos. I don't need to sit lap choles and cystos as an anesthesiologist. I take plenty of responsibility when I sign the anesthesia H and P and ensure they're safe for anesthesia.

Not carrying the water for crnas but they are valuable so I don't have to waste my time in sit and stare cases.

Moreover there's not enough anesthesiologists in my state to staff all the necessary anesthesia rooms.

Easy to say sit your own stool when you're out west. But there's not enough anesthesiologists nationally to staff all the necessary rooms right now. Not even close. Previous group has 20 anesthesiologists, 70 crnas. 35 main ORs, 6 GI suites, 6 endo/cath rooms, 2 IR rooms, 5 day surgery ORs, 5 ortho center ORs.

Find me the anesthesiologists to staff that overnight?

Your comment got alot of likes, but it is equivalent to politicians saying I'll cut taxes and reduce the federal deficit. Makes no real sense.
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You sound like the new grad at my place. Doesn’t want to sit their own cases. It’s not a punishment.

It’s the wrong way for approach anesthesia when you are new. You need a couple of years seasoning. There are many places you will encounter where it’s just you after 3pm. No help in site. No crna. No one to give you breaks.

Your first or second jobs won’t be your last job in this current environment. Remember that.

I can practice in any practice. Surgery center solo, surgery center act Act, solo md. Why? Because I’ve been in all those practices

I am not saying you can’t do that. But get some well rounded exposure on different anesthesia models before making blanket statements about wasting your time sitting cystos or lap choly. It’s the type of patient that matters. Not the case. Remember that also. You need that exposure. The most dangerous patient is asa 1 patient in a routine case. Don’t ever forget that.
 
aneftp said:
You sound like the new grad at my place. Doesn’t want to sit their own cases. It’s not a punishment.

It’s the wrong way for approach anesthesia when you are new. You need a couple of years seasoning. There are many places you will encounter where it’s just you after 3pm. No help in site. No crna. No one to give you breaks.

Your first or second jobs won’t be your last job in this current environment. Remember that.

I can practice in any practice. Surgery center solo, surgery center act Act, solo md. Why? Because I’ve been in all those practices

I am not saying you can’t do that. But get some well rounded exposure on different anesthesia models before making blanket statements about wasting your time sitting cystos or lap choly. It’s the type of patient that matters. Not the case. Remember that also. You need that exposure. The most dangerous patient is asa 1 patient in a routine case. Don’t ever forget that.
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If a moribund 90 year old dies in an ex lap, no one really questions you that much.

If a "healthy" 30 year old dies during a c section you're ****ed

I don't need to cover every single case. If I can pick and choose the patients that's better for me. Resources are finite, we cannot do everything for everyone immediately.
 
Type A dissection w DHCA, C3-6 lami fusion for acute traumatic quad, ex-lap for ischemic bowel with a lactate of 7+ and ph of 7.1, septic ex-lap in an ef 15% patient in respiratory failure, trauma with a penetrating carotid injury… just a few of the cases in the last few days solo.

Sprinkled in there is a finger i&d, a chole, 29 week septic ob patient for a cysto and a few other little cases.

Yeah… i like solo anesthesia. Lap chole after a Type A diss is a nice breather to my day. It’s not above me or below me.

Glad there are people like this @medicine2wallstreet guy.

I hope he graduates to 1:6 or 1:8.

Absolutely not doing that. That’s the real bozo gig.
 
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medicine2wallstreet said:
I am happy to sit my own cases. Actually like that i get the chance to do it now and again at my group. I do Not want to sit every case.

Your post shows you are a reasonable and good physician. The earlier guy who don't understand anesthesia manpower in today's environment is neither of those.
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You seem to have a lack of comprehension of the argument.
I choose to do my own cases and do not supervise or medically direct CRNAs.

My decision has no bearing on the shortage of anesthesiologists in the market. If the CRNAs want to do their own cases, that is perfectly fine. They can assume the risk of their prescribed anesthetic, carry their own malpractice, and be held accountable and legally liable for their own decision-making.

I did not become an anesthesiologist to be an anesthesia nurse manager or a pre/post op note clerk or a liability sponge for other less educated clinicians.

If the medical complex is truly worried about manpower, then the administrators and surgeons will triage the urgent/emergent cases accordingly.
Distribution of resources or 'anesthesia manpower' as you put it is upto the hospital system. They can pay more money and hire more locums or increase the compensation and attract more permanent staff. Their failure to do so is no reason for me to change my practice, nor is it my problem.
 
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medicine2wallstreet said:
Not saying you don't do difficult cases solo. I'm saying the model isn't applicable across the country due to provider shortages. The out west or up north solo docs talk their model up but it's like European governments acting like America doesn't know how to govern. It's just a different scale that doesn't apply.

Again not carrying the water or saying 1:6 is the way. But ain't enough docs in this country to provide anesthesia for all the people that need it without crnas and AAs. Not unless we ration care like sciatica is shockingly alluding to. Triaging urgent cases ain't doin nothing to staff the 45+ sites during the day in my old residency program.

I agree with the qz billing dock by the way.

Solo docs talking up their I ain't doin supervision holier than thou way is just annoying.
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No. You are the annoying one.
You said sitting cases is for bozos.
That rubs me the wrong way.
Holier than thou? WTF?
Nobody thinks that and we all know of the anesthesia shortage.
Go kick rocks kid and think of what you are saying.
We are all on the same team.
 
Insurance companies will continue to put on the squeeze but it won’t matter. Hospitals still raking in those facilities fees so they will pay what they need to run rooms.

I love that my job is a mix of direction and solo cases. I firmly believe it’s critical for new grads to continue to do their own cases in some capacity so they remain relevant. We all know of some MDs that can’t function even in the most basic cases and it’s frankly a bad look for anesthesiologists. I’m sure CRNAs are quick to sink their teeth in (and rightfully so) when MDs refuse to do OB/blocks/healthy peds due to being “uncomfortable”.
 
medicine2wallstreet said:
Not saying you don't do difficult cases solo. I'm saying the model isn't applicable across the country due to provider shortages. The out west or up north solo docs talk their model up but it's like European governments acting like America doesn't know how to govern. It's just a different scale that doesn't apply.

Again not carrying the water or saying 1:6 is the way. But ain't enough docs in this country to provide anesthesia for all the people that need it without crnas and AAs. Not unless we ration care like sciatica is shockingly alluding to. Triaging urgent cases ain't doin nothing to staff the 45+ sites during the day in my old residency program.

I agree with the qz billing dock by the way.

Solo docs talking up their I ain't doin supervision holier than thou way is just annoying.
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Why are you worrying about the anesthesia shortage? That's a facility/hospital staffing problem, not yours. You should advocate for sitting the case, because that's the best way.
 
Excluding anesthesia residents, does anybody have any data on what percentage of anesthesia in the US is personally provided by physicians?
 
2Fast2Des said:
Lol bozo? Who doesn't want the easy urology and lap chole rooms? Easy day, cases and units, go home happy. You want the ASA 6 GI day?? The AANA would be happy to have you as their spokesperson
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We all know people like this kid/troll. Sign charts. Never show up for inductions. Best found in the break room gossiping. Doing your own cases is beneath them. Same people that sold out our profession decades ago by embracing the garbage care team model so they could avoid doing any work themselves.
 
All of this is irrelevant just a matter of time. Market economics will drive all. I think the opportunities to provide md only anesthesia will never go away but it will slowly erode until only a small percentage. While CRNAs salaries have gone up, MD salaries have as well…albeit to a lesser degree. My guess is the average MD makes 600 now and crna 300-350. Yes one can argue hourly rates but when you factor in vacation weeks, easy call shifts with post call days off it gets murky. Point is that MDs still make significantly more. Throw in 1:6 or even 1:8 has been shown safe in many lower acuity models and 1:3 or 1:4 in higher acuity….economics will dictate the movement to supervision everywhere eventually. The limiting factor is the amount of CRNAs and AAs. as they have a huge shortage and many of their grads only work part time.

The only thing that will stop the erosion of md only practices will be salary equality which I don’t see happening although possible as it has happened in markets where MDs refuse to leave employment due to low salaries.

Anesthesia is also only getting safer…or should I say surgeries are becoming safer with technology and more minimally invasive procedures. This also supports higher supervision ratios
 
Howard888 said:
All of this is irrelevant just a matter of time. Market economics will drive all. I think the opportunities to provide md only anesthesia will never go away but it will slowly erode until only a small percentage. While CRNAs salaries have gone up, MD salaries have as well…albeit to a lesser degree. My guess is the average MD makes 600 now and crna 300-350. Yes one can argue hourly rates but when you factor in vacation weeks, easy call shifts with post call days off it gets murky. Point is that MDs still make significantly more. Throw in 1:6 or even 1:8 has been shown safe in many lower acuity models and 1:3 or 1:4 in higher acuity….economics will dictate the movement to supervision everywhere eventually. The limiting factor is the amount of CRNAs and AAs. as they have a huge shortage and many of their grads only work part time.

The only thing that will stop the erosion of md only practices will be salary equality which I don’t see happening although possible as it has happened in markets where MDs refuse to leave employment due to low salaries.

Anesthesia is also only getting safer…or should I say surgeries are becoming safer with technology and more minimally invasive procedures. This also supports higher supervision ratios
Click to expand...

In what world is "1:6 or even 1:8 has been shown safe in many lower acuity models" even remotely true? Are there studies? Or just because it has been happening in places without too much news of bad outcomes, you assume it must be safe?
 
Howard888 said:
All of this is irrelevant just a matter of time. Market economics will drive all. I think the opportunities to provide md only anesthesia will never go away but it will slowly erode until only a small percentage. While CRNAs salaries have gone up, MD salaries have as well…albeit to a lesser degree. My guess is the average MD makes 600 now and crna 300-350. Yes one can argue hourly rates but when you factor in vacation weeks, easy call shifts with post call days off it gets murky. Point is that MDs still make significantly more. Throw in 1:6 or even 1:8 has been shown safe in many lower acuity models and 1:3 or 1:4 in higher acuity….economics will dictate the movement to supervision everywhere eventually. The limiting factor is the amount of CRNAs and AAs. as they have a huge shortage and many of their grads only work part time.

The only thing that will stop the erosion of md only practices will be salary equality which I don’t see happening although possible as it has happened in markets where MDs refuse to leave employment due to low salaries.

Anesthesia is also only getting safer…or should I say surgeries are becoming safer with technology and more minimally invasive procedures. This also supports higher supervision ratios
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Are you actually an anesthesiologist? No right minded doc would even remotely support anything more than 1:3/4 or claim safety with that ratio, hell even higher! Even with that, the doc is barely involved except for being the chart monkey/liability sponge. There is literally nothing safe about that, and just hoping to hell you have a good CRNA or a not dying patient in a room. Anesthesia is safe, in the right hands...
 
2Fast2Des said:
Are you actually an anesthesiologist? No right minded doc would even remotely support anything more than 1:3/4 or claim safety with that ratio, hell even higher! Even with that, the doc is barely involved except for being the chart monkey/liability sponge. There is literally nothing safe about that, and just hoping to hell you have a good CRNA or a not dying patient in a room. Anesthesia is safe, in the right hands...
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$15.4 million reasons to agree with you.
 
Howard888 said:
Anesthesia is also only getting safer…or should I say surgeries are becoming safer with technology and more minimally invasive procedures. This also supports higher supervision ratios
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You assert that, but is that actually true?

For every minimally invasive procedure that spares a patient a riskier open procedure, there's one that brings a patient to the OR despite being so sick/frail that an open procedure is off the table.

TAVRs are neat but every time I see a 93 yo oughtta-be-Hospice patient get one I'm fully aware that absent this new technology that patient wouldn't go to the OR at all.

Patients are certainly getting sicker. Anyone who's done this job knows full well the risk and difficulty of a case is mostly dependent upon the patients and their comorbidities.

The argument that higher ratios or CRNA-only care is a good idea because "anesthesia is safe" is driven by money. It's the truth that they're needed in some care team scheme to meet demand, and maybe that risk is acceptable to society in return for the access-to-care benefit it brings.

But GTFO'here with this nonsense that the risk is declining. It's not.
 
We can argue all you want about safety and what is good for the whole of the profession. However, let's be pragmatic. When dissecting out the whole supervision vs. doing your own cases, it will ultimately come down to $$$. Not safety...not ethics...we live in a capitalistic society and we live and die by that sword. In addition, the train has left the station in terms of anesthesiologists dictating how anesthesia practice is run in our country decades ago. We (and I dare say all physician specialties) have long ago given up real say in the direction of health care As an aside (the idea of as individuals changing the market dynamics is laudable but not really realistic)...I dare say this argument is only effective if anesthesiologists were to utilize collective bargaining...

I don't begrudge peeps taking opportunities that I personally wouldn't. They can supervise 6:1, hell 100:1. It's a capitalistic system. We all have different risk tolerances and skills. (we all know this on seeing difference in what we are willing to do and we cancel). My only admonishment is that if we don't "sit in the seat" and have someone else sit in that seat. We will ultimately be faced with the question "what value do you provide?" The answer to that is the future of our profession. As we all can see, this question is all ready asked. And insitutions are coming up with very different answers.

Also remember that value is in the eyes of the buyer. How much downside are you willing to take for the price? So yeah, anesthesiologists may be better but is it worth the price?
 
Status Sciaticus said:
Ask your patient that question. See what they say.
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They don't know.

Mostly they have no idea if the person in scrubs from anesthesia is a doctor or nurse.

They aren't informed and don't understand the differences.

They aren't given the choice.

They're brainwashed by the media to worship those kind, caring, overworked, dedicated nurses, and to resent those greedy, arrogant, inattentive doctors.

Patients are the last people on earth who should be asked about the quality of the healthcare offered to them. Good care to a layperson is a "provider" who smiles at them, magazines less than a year old in the waiting room[1], and zero wait times. They don't know if they're getting the right antibiotic, if their kid's asthma is being managed optimally, or if the person aneathetizing them is going to let their systolic BP slouch at 71 for 20 minutes while waiting for surgical stimulation.


[1] in the pre-smartphone era, anyway, now nobody reads magazines
 
Doesn’t matter what patients say. It’s about the dollars and govt and payers dictate the dollars.

While I’m not advocating these ratios (I’d be fine 1:5 at an ASC or something though but any hospital with acuity 1:4.) 1:6-1:8 is practiced at many low acuity places and there has not been an explosion in patient mortality or adverse outcomes despite what many on here want to believe. These are low risk surgeries in healthier populations. The incident of adverse events is extremely low and only getting lower.

This won’t happen overnight but so long as md salaries remain 50-100% higher it will go that direction as fast as crna or aa schools can graduate folks. MD only practices won’t survive as hospital margins are getting tighter and the ability to pay for an md only stipend just won’t happen
 
With regards to safety surgeries have one hundred % gotten safer. No one gets type and screens anymore on primary total joints and some areas are getting close to 50% in some markets that go home same day. It used to be standard for a type and screen and giving blood was pretty common. They would stay 3-4 days too.

Thoracic surgery…not only are there less cases but the good minimally invasive surgeons are very good. I know some places where a lines are only used sometimes now they’re that good. Large liver or pancreas wacks….still high risk but nothing like what it used to be. Open vascular procedures? I don’t know numbers but probably 20% of what it used to be…

Awake intubations…maybe 5% of what used to occur now with all the video blades. US IVs….probably reduced central lines 70-80%.

Don’t fool yourself. Talk to some folks who have been doing this 20+ years. Acuity, work load, type surgery, etc….night and day given technological advances in both surgery and anesthesia.
 
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pgg said:
They don't know.

Mostly they have no idea if the person in scrubs from anesthesia is a doctor or nurse.

They aren't informed and don't understand the differences.

They aren't given the choice.

They're brainwashed by the media to worship those kind, caring, overworked, dedicated nurses, and to resent those greedy, arrogant, inattentive doctors.

Patients are the last people on earth who should be asked about the quality of the healthcare offered to them. Good care to a layperson is a "provider" who smiles at them, magazines less than a year old in the waiting room[1], and zero wait times. They don't know if they're getting the right antibiotic, if their kid's asthma is being managed optimally, or if the person aneathetizing them is going to let their systolic BP slouch at 71 for 20 minutes while waiting for surgical stimulation.


[1] in the pre-smartphone era, anyway, now nobody reads magazines
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Howard888 said:
Doesn’t matter what patients say. It’s about the dollars and govt and payers dictate the dollars.

While I’m not advocating these ratios (I’d be fine 1:5 at an ASC or something though but any hospital with acuity 1:4.) 1:6-1:8 is practiced at many low acuity places and there has not been an explosion in patient mortality or adverse outcomes despite what many on here want to believe. These are low risk surgeries in healthier populations. The incident of adverse events is extremely low and only getting lower.

This won’t happen overnight but so long as md salaries remain 50-100% higher it will go that direction as fast as crna or aa schools can graduate folks. MD only practices won’t survive as hospital margins are getting tighter and the ability to pay for an md only stipend just won’t happen
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the point I made was in response to the questions quoted above being asked to the patient after being told that an anesthesiologist is better and asking their risk tolerance:

Ask your patient how much risk they are willing to take to save on the anesthesia bill. Tell them that an anesthesiologist may be better, but will cost more. Tell them that you have 20,000 hours of training vs. 7000 hours for CRNAs.
Then ask, do they want to save that extra 15% (which of course they dont save anyway, the hospital does).

Clearly, this is an exercise in retort. No one is going on a diatribe about it with every preop.

That said, all my family members know to ask for physician only anesthesia and we typically go to places that are staffed in that manner.
 
I only represent one corner of the USA, but the ACT model absolutely failed in my region.

USAP took over a competing hospital system, implemented the ACT model and it quickly went up in flames before USAP lost the contract and the MD only model once again became the predominant model in our region.

Bad outcomes, poor efficiency, Crnas not taking ANY call, poor margins, pissed off surgeons, unhappy anesthesiologists, poor receuitment, costly benefits, headaches, entitlement, etc.
Just was not worth it.

It actually led to an increase in physician reimbursement and an influx of anesthesiologists to our area.

The smart hospital administrators are wising up to the importance of a well functioning and stable anesthesia group.

There has been an enormous injection of support since the anesthesia shortage began to shut down OR’s.

Reimbursement continues to go down, but our salaries have finally started to tick up. There is only one place that bump in salary is coming from.
 
Hats off to those who run 4 rooms at a time.
Hats off to those firefighters that sign charts for 8-10 rooms and overnight OB cases.
I’m not dogging any of those models. It has it’s own pluses and minuses and I think most of us here understand that this is sometimes not a money factor but a necessity factor.
Fortunately for those who don’t want those models, there are still options. Harder to hit 90% MGMA average with the MD only model , but the delta in income is not that big.

QZ getting a 15% cut is long overdue.

You need to run a very tight and efficient 1:3-1:4 to beat out MD only compensation.

Subsidies going forward is a must if you want a stable anesthesia service. At least for now.
 
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There is definitely a doctor shortage and an anesthesia mid level shortage. While I’m sure the insurance companies motives are evil it is good to reduce crna reimbursement. I wish they would focus their attention on patient non compliance and make the patients do a little work toward a good surgical outcome. If we made obese joint patients loose weight for surgery many wouldn’t need it anymore… of course that’s not the capitalism way… but some patient ownership of lifestyle comorbidities is warranted.

Of note I hear gossip the limiting of Usap’s footprint in Colorado has opened up the market and raised salaries - anyone know for sure?
 
sevoflurane said:
Hats off to those who run 4 rooms at a time.
Hats off to those firefighters that sign charts for 8-10 rooms and overnight OB cases.
I’m not dogging any of those models. It has it’s own pluses and minuses and I think most of us here understand that this is sometimes not a money factor but a necessity factor.
Fortunately for those who don’t want those models, there are still options. Harder to hit 90% MGMA average with the MD only model , but the delta in income is not that big.

QZ getting a 15% cut is long overdue.

You need to run a very tight and efficient 1:3-1:4 to beat out MD only compensation.

Subsidies going forward is a must if you want a stable anesthesia service. At least for now.
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So I’ll just point out that the issue described with this situation has nothing to do with CRNAs sitting cases vs MDs. Or very little at least. It was about manpower and shortages and private equity being arrogant. Private equity teaches to promise anything…get the contract and renegotiate. The issue with your situation was that private equity promised something they couldn’t deliver. Had they secured CRNAs first (which is difficult as West coast) and MDs willing to direct CRNAs and paid all extremely well to start (all hard things to do), they would have pulled it off easily.

The issue here wasn’t that it couldn’t be done but that it was a west coast market and it was arrogant private equity that didn’t understand how to get it done. A savy southeast private group could have pulled it off although the juice wouldn’t have likely been worth the squeez given west coast issues. Good example though if how to protect your turf if md only. It will still fail eventually though. Oregon failed miserably for same reasons but they haven’t gone back to md only…they just are hiding the losses and are committed to direction.
 
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