Colorado Opt's Out, Its official :(

[RxBoy]

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Members don't see this ad.

http://cbs4denver.com/wireapnewsco/Colorado.to.allow.2.1934698.html

Colorado officially becomes the 16th state to allow unsupervised delivery of anesthesia by "advanced" nurses.

Sad day.

Keep your heads high, we need to keep fighting the good fight.

 

[ProRealDoc]

http://cbs4denver.com/wireapnewsco/Colorado.to.allow.2.1934698.html

Colorado officially becomes the 16th state to allow unsupervised delivery of anesthesia by "advanced" nurses.

Sad day.

Keep your heads high, we need to keep fighting the good fight.

Two states in a year. This is what happens when you train and hire CRNAs so you can make a bit more money. Eventually they will eat your lunch.
It is a well-deserved ass-whooping for the geniuses running the ASA who are nothing but chicken-little and always prefer to take the high-road instead of meeting the enemy head-on and without fear.

I never understood the going to court to stop an opt-out deal. If you have to go to court to protect your job then is too late. That needs to start wayyyyyyyyyy before, you know, when the CRNA wants to put that epidural, aline or central line and you let him/her because you want to go to bed.

 

[Taurus]

Everyone should work under the assumption that all 50 states will opt out.

Everyone should also work hard to make sure that all 50 states pass AA legislation. The end game is clear. The strategy is also clear. Hit the CRNA's in their wallets by exacerbating the future CRNA surplus.

 

[countingdays]

Everyone should work under the assumption that all 50 states will opt out.

Everyone should also work hard to make sure that all 50 states pass AA legislation. The end game is clear. The strategy is also clear. Hit the CRNA's in their wallets by exacerbating the future CRNA surplus.

Do you think the end game is MDs doing our own cases and cRNa's doing their own cases? Do you think the end game is cost competition between care teams, MD groups, and nursing anesthesia groups? Maybe its MDs doing big cases and RNs doing bread and butter? MDs doing perioperative management and nurse anesthetists working in the OR? MDs doing perioperative management and supervising a computer doing anesthesia in the OR?

AAs could be a big positive for care team anesthesia. A huge number of AAs (assuming THEY aren't independent) would be great by allowing a care team of 1 MD and 4 AAs to be cost competitive & medically superior to 4 cRNa's, but we'd need to see way more AA programs opening and expanding very soon. Even then, AAs would have to make significantly less than independent nurses to make the care team cost-competitive to the hospital. You have to wonder how attractive AA training would be when potential applicants can look at how easy nursing school is and how much more money they could make going that route. It's not at all clear that AAs will make a difference.

 

[Consigliere]

As predicted....

 

[maceo]

Everyone should also work hard to make sure that all 50 states pass AA legislation. .

Every Anesthesiologist should support this .

 

[deleted307836]

Do you think the end game is MDs doing our own cases and cRNa's doing their own cases? Do you think the end game is cost competition between care teams, MD groups, and nursing anesthesia groups? Maybe its MDs doing big cases and RNs doing bread and butter? MDs doing perioperative management and nurse anesthetists working in the OR? MDs doing perioperative management and supervising a computer doing anesthesia in the OR?

AAs could be a big positive for care team anesthesia. A huge number of AAs (assuming THEY aren't independent) would be great by allowing a care team of 1 MD and 4 AAs to be cost competitive & medically superior to 4 cRNa's, but we'd need to see way more AA programs opening and expanding very soon. Even then, AAs would have to make significantly less than independent nurses to make the care team cost-competitive to the hospital. You have to wonder how attractive AA training would be when potential applicants can look at how easy nursing school is and how much more money they could make going that route. It's not at all clear that AAs will make a difference.

Honest question: Couldn't more AA's ultimately reduce the demand for anesthesiologists? It seems like, in the big picture anyway, that more midlevel anesthesia providers PERIOD provides less opportunities for anesthesiologists. Perhaps I'm wrong.

 

[countingdays]

Honest question: Couldn't more AA's ultimately reduce the demand for anesthesiologists? It seems like, in the big picture anyway, that more midlevel anesthesia providers PERIOD provides less opportunities for anesthesiologists. Perhaps I'm wrong.

In places where Anesthesiologist-AA care teams a substituted for Anesthesiologist-cRNa care teams, no, they'd decrease the demand for cRNas without affecting the demand for MDs.

In places where all-MD anesthesia groups are replaced by MD-AA care teams, yes, they could cut the demand for MDs- probably 50-75%. That's assuming the all-MD groups wouldn't have switched to care team model with cRNas anyway. If they would have, which is likely, then AAs just provide a more loyal employee without affecting the demand for MDs. I don't think that all-MD groups are out there because there is a shortage of mid-levels. They are all-MD by choice. Availability of AAs might make the care team more palatable, but probably would influence the decision to transition from all-MD to care team.


What AAs would do in any scenario is cut the demand for crnas.

 

[maceo]

we should support aa education and aa's. Moreover we should support having physician assistants in the operating room

 

[jwk]

In places where Anesthesiologist-AA care teams a substituted for Anesthesiologist-cRNa care teams, no, they'd decrease the demand for cRNas without affecting the demand for MDs.

In places where all-MD anesthesia groups are replaced by MD-AA care teams, yes, they could cut the demand for MDs- probably 50-75%. That's assuming the all-MD groups wouldn't have switched to care team model with cRNas anyway. If they would have, which is likely, then AAs just provide a more loyal employee without affecting the demand for MDs. I don't think that all-MD groups are out there because there is a shortage of mid-levels. They are all-MD by choice. Availability of AAs might make the care team more palatable, but probably would influence the decision to transition from all-MD to care team.

What AAs would do in any scenario is cut the demand for crnas.

I'm familiar with a number of groups in Georgia who have moved from all-MD to MD-AA only or MD-many AA's-a few CRNA's, and been very successful and happy changing to that model of practice. That change was instituted by the all MD groups, not AA's coming in and asking. In all of them, MD's still do their own cases as well as providing medical direction for cases.

 

[siednarb]

http://www.freep.com/article/20100928/OPINION05/100928030/1322/Keep-anesthesia-doctor-supervised-

 

[leaverus]

I never understood the going to court to stop an opt-out deal. If you have to go to court to protect your job then is too late. That needs to start wayyyyyyyyyy before, you know, when the CRNA wants to put that epidural, aline or central line and you let him/her because you want to go to bed.

👍 +100

Actually even before that - like when spineless academic anesthesiologists taught them how to do those procedures in the first place.

 

[Taurus]

In places where all-MD anesthesia groups are replaced by MD-AA care teams, yes, they could cut the demand for MDs- probably 50-75%. That's assuming the all-MD groups wouldn't have switched to care team model with cRNas anyway. If they would have, which is likely, then AAs just provide a more loyal employee without affecting the demand for MDs. I don't think that all-MD groups are out there because there is a shortage of mid-levels. They are all-MD by choice. Availability of AAs might make the care team more palatable, but probably would influence the decision to transition from all-MD to care team.

In a future where all 50 states opt-out, the all-MD anesthesia group will cease to exist because they won't be able to compete against ACT groups that are more cost-effective. Under Obamacare, the all-MD anesthesia group will cease to exist. Even without Obama, all 50 states probably would have eventually opted out.

You're trying to hold onto something that will disappear easily within our working lifetimes. For a second, put on a business hat and consider what strategy a business person would develop.

You have to accept what is the likely future and adapt to it or become roadkill. Money on the one hand should be spent slowing down the opting out process but the other hand needs to spend money preparing for the future. The future is all 50 states opting out. In such a scenario, would you rather hire a CRNA or AA?

I will go one step further and reiterate my prediction for the future, even beyond CRNA's opting out. I strongly believe that the days of stool sitting is in danger for anyone, including anesthesiologist or AA/CRNA. We're very close to introducing automation in anesthesia delivery. The researchers behind McSleepy in Montreal are working hard at it. Once automation is realized, then I believe that the pendulum swings back to the anesthesiologist because then you truly need a team of anesthesia providers headed by the anesthesiologist, not a bunch of inferiorly trained wannabes.

 

[deleted128562]

Anyone read the comments posted along with the Detroit Free Press article? Pretty typical - seems public sentiment is usually pro-nurse, anti-doctor.

This got me to thinking - WHY? And the answer, I believe, indicates that there may an effective way to change public opinion on CRNA's....

People, (judging by hundreds of comments I've read on all sorts of sites), seem to love nurses because they're perceived as MIDDLE CLASS PUBLIC SERVANTS, and hate doctors because they're perceived as RICH ARROGANT MONEY-MONGERS. What it really comes down to is that many (if not most) people tend to hate and resent those more successful than themselves, financially or otherwise. I guarantee you the minute an RN makes the same cash as an MD, the public will be just as vicious towards RN's.

So the solution in my mind is simple. How about ad campaigns that go something like this:

(Grim-voiced announcer): "Last year, little Johnny's pediatrician correctly diagnosed a rare condition, and told his parents that his life could be saved by a surgery. When he arrived at the OR, little Johnny was put under not by a doctor, but by Susie Q. Nurse Anesthetist. Little Johnny never woke up.... little Johnny never made it home. Shocking enough for you? Well wait until you hear this: Last year, Susie Q. Anesthetist made over $200,000.... almost twice as much as the pediatrician - the doctor - who was trying to save little Johnny's life. Yet CRNA's are trying to tell your legislators that they want independent practice rights - and worse yet, claim to be doing so to save the health care system money. Ask yourself this: Do you think a group of nurses making twice as much as your child's doctor is looking out for you? Call congress. Tell them that an overpaid nurse won't cut it when your child's life is on the line".

I'm telling you - highlight to people the fact that CRNA's are making more than their kid's doctor, and I think you'll see a real quick change in public opinion. It's all about the $$$$$. (Yes, I know comparing CRNA to pediatrician is different than comparing CRNA to MDA. So what? All the public will care is having it pointed out that CRNA's are making more than some doctors. It will be the end of the sympathy for them, IMHO, and that could lead to some real changes I think).

 

[Arch Guillotti]

I wish the ASA would get down and dirty. I am sure they have considered it but the political ramifications are I guess too great.

I am sure a bunch of those half baked comments are from the militant nurses themselves.

I thought the article itself was pretty succint and well written although the author really didn't play hardball.

Anyone read the comments posted along with the Detroit Free Press article? Pretty typical - seems public sentiment is usually pro-nurse, anti-doctor.

This got me to thinking - WHY? And the answer, I believe, indicates that there may an effective way to change public opinion on CRNA's....

People, (judging by hundreds of comments I've read on all sorts of sites), seem to love nurses because they're perceived as MIDDLE CLASS PUBLIC SERVANTS, and hate doctors because they're perceived as RICH ARROGANT MONEY-MONGERS. What it really comes down to is that many (if not most) people tend to hate and resent those more successful than themselves, financially or otherwise. I guarantee you the minute an RN makes the same cash as an MD, the public will be just as vicious towards RN's.

So the solution in my mind is simple. How about ad campaigns that go something like this:

(Grim-voiced announcer): "Last year, little Johnny's pediatrician correctly diagnosed a rare condition, and told his parents that his life could be saved by a surgery. When he arrived at the OR, little Johnny was put under not by a doctor, but by Susie Q. Nurse Anesthetist. Little Johnny never woke up.... little Johnny never made it home. Shocking enough for you? Well wait until you hear this: Last year, Susie Q. Anesthetist made over $200,000.... almost twice as much as the pediatrician - the doctor - who was trying to save little Johnny's life. Yet CRNA's are trying to tell your legislators that they want independent practice rights - and worse yet, claim to be doing so to save the health care system money. Ask yourself this: Do you think a group of nurses making twice as much as your child's doctor is looking out for you? Call congress. Tell them that an overpaid nurse won't cut it when your child's life is on the line".

I'm telling you - highlight to people the fact that CRNA's are making more than their kid's doctor, and I think you'll see a real quick change in public opinion. It's all about the $$$$$. (Yes, I know comparing CRNA to pediatrician is different than comparing CRNA to MDA. So what? All the public will care is having it pointed out that CRNA's are making more than some doctors. It will be the end of the sympathy for them, IMHO, and that could lead to some real changes I think).

 

[Consigliere]

Mr. Hat, that's the best idea I've heard so far!

 

[foxtrot]

I think the ASA and the Colorado Association of Anesthesiologists should create a media blitz and put up billboards on the highway. I think physicians who know of hospitals that don't have anesthesiologists on staff and only hire CRNA's should notify the media or local newspapers in the town so that the public is made aware of this. The gloves are off folks. This medical specialty is going to be obsolete in 10 years if patients are not made aware of this. The public should also be made aware that a midlevel nurse makes just as much or more as most primary care docs. Then the backlash may begin.

 

[Don8455]

It has nothing to do with misinformation. The militant CRNA's make it their job to scour the web to "comment" on any and every article. I'm not sure how that Mike guy finds the time, with his busy "independant" schedule and all. Hey, if they type it enough maybe it will come true. The battle is not being fought on the web but in the pre- and post-op areas every day. Talk to your patients. It is only there that each and every one of us can provide the public with the truth.

Our leaders stepped it up in Colorado, but only after it was WAY too late. When will they realize they need to do that (billboards, radio spots, etc) in EVERY state? Regardless of opt-out status.

 

[maceo]

Take a look at some of the misinformed comments in this article:

"Posted by: Bob Location: Ohio on Sep 6, 2010 at 06:24 PM
It is astonishing, that the general public is unaware greater than 2/3 of all anesthetics administered in the U.S. are done by a Nurse Anethetist. CRNA's have had intensive training in anesthetic management, some even hold PhD's. Yes some cases, are supervised, some are not, some are done soley by a physician. But the question you should be asking is- who is in the room making sure the anesthetic is adequate- is it someone who does this on a daily basis or a MD/DO wh is "overseeing" 3 to 4 rooms and is not "hands on" as the public presumes. The MD/DO's are not the person intubating the airway or managing the changes that occur during the procedure,they typically are the one saying " hello" in the pre-op consultation. As for if you have money comment, you still get the Nurse anesthetist regardless, no B team --Nurse anesthestists treat patients. I would say the best question to ask is how many solo anesthetics the provider does daily. Its simple-- the more you do the better you get!"

This guy who wrote this is a tool. the heavy lifting in anesthesia is not sitting in the room monitoring the patient giving muscle relaxants when there is 3 twitches, turning up the vapor, giving reversal.. watching monitors. Anybody can be trained to do that. If he believes that. it is clear.. very clear why he is a nurse and not a physician .

i have been doing my own cases for the past 7 years. when i do ind contractor work on my vacation i have to supervise.. and I cringe at how limited the crna understanding is.

we need to support the legislation of AAs in every state and get PAs involved as anesthetists.

 

[aneftp]

I really don't understand the ASA's management of the whole CRNA opt out.

As others have stated, they have poor media advisors.

Just a simple ad: "Anesthesia fees collected is independent of providers" So there no cost-savings. Who's the most well educated and trained to oversee anesthesia" A doctor with 4 years of medical school and an additional 4-5 years of residency training or a nurse with a B.S. degree (or associates converted to Bachelors), and 2 years of anesthesia school?

It's that simple.

 

[racerx]

Mr. Hat,

That is one of the best ideas in a long time.👍👍

Wars are never won taking the high road. Sun Tzu's axiom of becoming your enemy (it's a metaphor, people) as a tool to defeat them needs to be enacted in this struggle. They are willing to get dirty, and so should we.

Anyone read the comments posted along with the Detroit Free Press article? Pretty typical - seems public sentiment is usually pro-nurse, anti-doctor.

This got me to thinking - WHY? And the answer, I believe, indicates that there may an effective way to change public opinion on CRNA's....

People, (judging by hundreds of comments I've read on all sorts of sites), seem to love nurses because they're perceived as MIDDLE CLASS PUBLIC SERVANTS, and hate doctors because they're perceived as RICH ARROGANT MONEY-MONGERS. What it really comes down to is that many (if not most) people tend to hate and resent those more successful than themselves, financially or otherwise. I guarantee you the minute an RN makes the same cash as an MD, the public will be just as vicious towards RN's.

So the solution in my mind is simple. How about ad campaigns that go something like this:

(Grim-voiced announcer): "Last year, little Johnny's pediatrician correctly diagnosed a rare condition, and told his parents that his life could be saved by a surgery. When he arrived at the OR, little Johnny was put under not by a doctor, but by Susie Q. Nurse Anesthetist. Little Johnny never woke up.... little Johnny never made it home. Shocking enough for you? Well wait until you hear this: Last year, Susie Q. Anesthetist made over $200,000.... almost twice as much as the pediatrician - the doctor - who was trying to save little Johnny's life. Yet CRNA's are trying to tell your legislators that they want independent practice rights - and worse yet, claim to be doing so to save the health care system money. Ask yourself this: Do you think a group of nurses making twice as much as your child's doctor is looking out for you? Call congress. Tell them that an overpaid nurse won't cut it when your child's life is on the line".

I'm telling you - highlight to people the fact that CRNA's are making more than their kid's doctor, and I think you'll see a real quick change in public opinion. It's all about the $$$$$. (Yes, I know comparing CRNA to pediatrician is different than comparing CRNA to MDA. So what? All the public will care is having it pointed out that CRNA's are making more than some doctors. It will be the end of the sympathy for them, IMHO, and that could lead to some real changes I think).

 

[Ronin2258]

Mr. Hat,

That is one of the best ideas in a long time.👍👍

Wars are never won taking the high road. Sun Tzu's axiom of becoming your enemy (it's a metaphor, people) as a tool to defeat them needs to be enacted in this struggle. They are willing to get dirty, and so should we.

Perhaps:
* Highlighting cases of bad outcomes with CRNA-only care as start? I know there was one suit posted here, but there have to be more, and the fallout of that happening.
* Bad outcomes where CRNAs were even involved in care vs. MD anesthesiologists alone? The "adding more 'cooks' to the mix" as it were.
* Standardizing rates of mishaps and near misses as x per 100,000 cases in all parties? All I have seen is bulk number of lawsuits, not a rate per cases involving only MD anesthesiologists, MD/CRNA teams, MD/AA teams, and CRNAs alone?

I believe that the numbers would hold us up.

This is from someone who is champing at the bit to be in the field.

 

[BLADEMDA]

Did you all read Gov. Ritter's opt-out letter? CRNAs like DeepZ won't be practicing "solo" in Denver any time soon. Ritter listed the hospitals where CRNAs may practice "solo." The major cities of Colorado were NOT on the list.

However, a few nice rural towns like Vail and Aspen were on the list. These all MD practices are probably going to go ACT in the future if they are subsidized practices.

 

[Coastie]

Did you all read Gov. Ritter's opt-out letter? CRNAs like DeepZ won't be practicing "solo" in Denver any time soon. Ritter listed the hospitals where CRNAs may practice "solo." The major cities of Colorado were NOT on the list.

However, a few nice rural towns like Vail and Aspen were on the list. These all MD practices are probably going to go ACT in the future if they are subsidized practices.

Awesome. So governors pick and choose which hospitals fall under what rules. Sounds like a situation ripe for fraud and corruption. But hey, as long as patients get their nurses, right?

I think DeepZ will be lucky to practice in Nome, Alaska "solo" by the time patients figure out the scam the AANA is pulling on them.

 

[Apollyon]

However, a few nice rural towns like Vail and Aspen were on the list. These all MD practices are probably going to go ACT in the future if they are subsidized practices.

So gazillionaires will go to Vail and Aspen, and blow out a knee, and need/want an urgent repair. If ANYONE wouldn't want "good enough", but the best, it would be the rich POS's - and these are the rich rich (like, they don't have to go to work every day, and still have money).

That is the market where the word of mouth has to be passed, and billboards, and any way to let people know that you want the doctor, not the noctor.

 

[countingdays]

Perhaps:
* Highlighting cases of bad outcomes with CRNA-only care as start? I know there was one suit posted here, but there have to be more, and the fallout of that happening.
* Bad outcomes where CRNAs were even involved in care vs. MD anesthesiologists alone? The "adding more 'cooks' to the mix" as it were.
* Standardizing rates of mishaps and near misses as x per 100,000 cases in all parties? All I have seen is bulk number of lawsuits, not a rate per cases involving only MD anesthesiologists, MD/CRNA teams, MD/AA teams, and CRNAs alone?

I believe that the numbers would hold us up.

This is from someone who is champing at the bit to be in the field.

Chart reviews are going to dramatically underestimate complications making crna care appear safer than it is. Could be counterproductive. The worse you are at documenting complications, the safer you seem to be.

 

[Ronin2258]

Chart reviews are going to dramatically underestimate complications making crna care appear safer than it is. Could be counterproductive. The worse you are at documenting complications, the safer you seem to be.

Nice counter, and good point.

I'm just thinking of ways to attack the issue with their own tools. It seems nursing lives and dies on paperwork and an OCD regarding documentation. I've seen it in write-ups with upper levels and at least one intern in my previous program.

 

[pgg]

Chart reviews are going to dramatically underestimate complications making crna care appear safer than it is. Could be counterproductive. The worse you are at documenting complications, the safer you seem to be.

Agreed, chart reviews are garbage. It's not like you can count on them to notice 10 minutes of ST segment depression, let alone document it. The little hashy mark thing to record a BP of 70/20 will be nudged up toward the 90 line because it was an 'artifact' ...

I'd bet $ that all of us have relieved people at the end of the day, with an hour of surgery left, only to find that the case has been pre-charted to the point that emergence, extubation, and "transported to PACU, report given" is already written on the record.

If there's one thing nursing school universally and effectively drills into students, it's chart buffing.