California Opt Out of CRNA supervision

[GasDaddy]

"The California Society of Anesthesiologists has confirmed that Governor Arnold Schwarzenegger sent a letter to CMS stating that California is opting out of the Medicare requirement that CRNAs be supervised by physicians.
We have verified that CMS received this notification and deemed it to be effective July 17, 2009."



from https://www.csahq.org/files/Member Alert 072309_final.pdf



Unbelievable since everyone thought California would be the LAST state to opt out. Not to mention, there is clearly no shortage of anesthesiologists (except maybe in the rural areas) for California to opt out.

Surprised no one has posted on this.



here are more links proving it in case no one believes it....

Here is the official letter: http://ourpvh.com/docs/News/opt-out_letter.pdf

Honestly, there is no one to blame other than ourselves. We have to step up and fight back, because this is ridiculous. We can't just sit around and expect things to work out in our favor. Amazing how so many things are set to a higher standard, but when it comes to giving anesthesia less qualified people will suffice.

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[maceo]

old news next.....

 

[crnapain2]

wOW THAT IS CURRENT....not

 

[drpainfree]

didn't know this is legal in california...if it happens in california (with plenty of anesthesiologist supply), the days it will come to the other states are near, especially when obama is trying to replace specialist with PCP, physicians with NP, PA and CRNA.

 

[jwk]

http://forums.studentdoctor.net/showthread.php?t=649582

It was in the mid-level subforum a month ago - can't remember if it started there or got moved there.

 

[foxtrot]

didn't know this is legal in california...if it happens in california (with plenty of anesthesiologist supply), the days it will come to the other states are near, especially when obama is trying to replace specialist with PCP, physicians with NP, PA and CRNA.

I still don't understand the theory of replacing anesthesiologists with CRNA's. Most CRNA's make well over $100k per year and they work 3-4 days per week. I know that where I did my training, the CRNA's made $130k (in an academic center). Took no call and were out by 3 every day. They had CRNA's who worked nights but didn't work days so none of them ever took 24 hour call. Very few of them work everyday with 5 weeks of vacation and only the post call day off (which seems to be the going rate in private practice these days for anesthesiologists). I have heard several hospital employed anesthesiologists tell me that for every doc they employ, they would need to hire 2 CRNA's to do the same amount of work. Financially it doesn't make that much sense to me. I guess the CRNA's are very politically savvy which accounts for alot of this power.

 

[ProRealDoc]

I still don't understand the theory of replacing anesthesiologists with CRNA's. Most CRNA's make well over $100k per year and they work 3-4 days per week. I know that where I did my training, the CRNA's made $130k (in an academic center). Took no call and were out by 3 every day. They had CRNA's who worked nights but didn't work days so none of them ever took 24 hour call. Very few of them work everyday with 5 weeks of vacation and only the post call day off (which seems to be the going rate in private practice these days for anesthesiologists). I have heard several hospital employed anesthesiologists tell me that for every doc they employ, they would need to hire 2 CRNA's to do the same amount of work. Financially it doesn't make that much sense to me. I guess the CRNA's are very politically savvy which accounts for alot of this power.

Add to that the laziness, greediness and stupidity of some anesthesiologists (academic and PP) to teach them everything there's to know because they are too lazy to do it themselves and we ain't going nowhere.

 

[foxtrot]

Add to that the laziness, greediness and stupidity of some anesthesiologists (academic and PP) to teach them everything there's to know because they are too lazy to do it themselves and we ain't going nowhere.

I hate to say it but you are right, laziness does have alot to do with it (at least from what I saw when I was a resident in the academic world).

 

[foxtrot]

Going along with this thread, how many states now have opted out of CRNA supervision?

 

[BLADEMDA]

States That Have Opted Out From the Federal Supervision Requirement Since Publication of the November 13, 2001 CMS Rule Permitting Such Opt-Outs

(15 states as of July 2009)​

• Iowa opted out of the federal supervision requirement in December 2001.​
• Nebraska opted out in February 2002.​
• Idaho opted out in March 2002.​
• Minnesota opted out in April 2002.​
• New Hampshire opted out in June 2002.​
• New Mexico opted out in November 2002.​
• Kansas opted out in March 2003.​
• North Dakota opted out in October 2003.​
• Washington opted out in October 2003.​
• Alaska opted out in October 2003.​
• Oregon opted out in December 2003.​
• Montana opted out in January 2004.
  (Gov. Judy Martz opted-out; Gov. Brian Schweitzer reversed the opt-out in May 2005, without citing any evidence to justify the decision. Subsequently, after the governor and his staff became more familiar with the reasons justifying the January 2004 opt-out, Gov. Schweitzer restored the opt-out in June 2005. Montana’s opt-out, therefore, is currently in effect.)​
• South Dakota opted out in March 2005.​
• Wisconsin opted out in June 2005.​
• California opted out in July 2009.​

 

[DO4lifer]

• PhDs call themselves doctor
• Practically everyone and their moms wear long white coats in the hospital except for med students
• Psychiatrists have be pointing out the encroachment of psychologists for many many years that continues to grow, the average american probably dont even know the difference
• NPs dont need supervision in primary care, and some want to be called doctor because of their advanced degree
• Physicians hire PAs instead of other physicians
• CRNAs dont need supervision in a growing number of states.

its been a trend for a long time. people blame obama or somebody else, but the people to blame are physicians. we did this by ignoring the trend and thinking that it wont affect us. but it already has and will continue to grow. the best thing to do now is get active in the political organizations and stop thinking that it wont affect you personally.

 

[Taurus]

A few years ago I was arguing with a resident on this forum about opt-outs. He argued that because the existing states that opt-outed constituted sparsely populated states that anesthesiologists shouldn't worry about this issue. I took the opposite view that even 1 opt-out state was too many. I wonder what that resident would say today about the most populous state in the union opting out.

I agree with Blade that we should assume that all states will opt-out. However, even if this happens, it is not the end of medical anesthesiology because most operating centers will want an anesthesiologist available. It is too risky liability-wise otherwise. Furthermore, there are only so many opportunities for CRNA's to practice without anesthesiologist supervision. If CRNA's don't want to work with anesthesiologists in an ACT model, then kick them out and replace them with AA's. Let the CRNA's compete among themselves for the few solo gigs out there. That will only drive down their own earning opportunities. At this moment, it is critical to expand the AA's. Open more AA programs. Get more states to pass AA licensure laws. Every anesthesiology residency program is equipped to train AA's and should consider opening AA training programs.

 

[coprolalia]

...but the people to blame are physicians.

The "people" to blame are the COGME. They've been behind the wave for years. Years.

-copro

 

[coprolalia]

I wonder what that resident would say today about the most populous state in the union opting out.

Schwarzenegger didn't follow proper procedure. Technically, this could go to court and be reversed. But, it would just subsequently be enacted after he went back and followed procedure. All this would likely do is just delay the enactment of this "opt-out", and probably isn't worth the ASA's time and effort (and $$$) to fight.

I've said it before and I'll say it again on this forum, California blows! The state is in ruins. And, Schwarzenegger is about as Republican as Aleister Crowley was a born-again Christian.

-copro

 

[CoolWhipp]

I'm curious to know why the insurance companies aren't speaking up to save their own *****es. Even though they probably won't care much about the CRNA takeover, they might be able to at least stall the "reform." Or, am I missing something?

 

[BLADEMDA]

A few years ago I was arguing with a resident on this forum about opt-outs. He argued that because the existing states that opt-outed constituted sparsely populated states that anesthesiologists shouldn't worry about this issue. I took the opposite view that even 1 opt-out state was too many. I wonder what that resident would say today about the most populous state in the union opting out.

I agree with Blade that we should assume that all states will opt-out. However, even if this happens, it is not the end of medical anesthesiology because most operating centers will want an anesthesiologist available. It is too risky liability-wise otherwise. Furthermore, there are only so many opportunities for CRNA's to practice without anesthesiologist supervision. If CRNA's don't want to work with anesthesiologists in an ACT model, then kick them out and replace them with AA's. Let the CRNA's compete among themselves for the few solo gigs out there. That will only drive down their own earning opportunities. At this moment, it is critical to expand the AA's. Open more AA programs. Get more states to pass AA licensure laws. Every anesthesiology residency program is equipped to train AA's and should consider opening AA training programs.

Remember that Politics 101 Class I proposed be mandatory for all Residents a few months ago? You just got an A+.

Blade