CRNA Supervision Question

[StillAwake]

I practice in a state that requires CRNAs to administer anesthesia "in the immediate presence" of a physician. I was talking with a friend in the same state, their group staffs a 2 OR surgery center with 1 anesthesiologist and 1 CRNA and bill as QZ. Anyone have experience with this type of staffing? We had a discussion as to who's the supervising physician. Does the surgeon have to be the supervising physician or can the anesthesiologist be the supervising physician even though the anesthesiologist is doing cases in the other room? If the surgeon has two rooms, and is in OR 1 with the anesthesioligst doing the case, and the CRNA is in OR 2, if the surgeon can be the supervising physician, why not the anesthesiologist if they are both tied up in the other room?

To be clear, I'm not talking about "medical direction" vs. "medical supervision" billing requirements, but the state requirement that the CRNA works under the supervision of a physician.

---

Members don't see this ad.

 

[anbuitachi]

My guess is under the supervision of surgeon when anesthesiologist is in the other room. Can't be under supervision when anesthesiologist is doing own case..

 

[deleted126335]

If you don't know who the pigeon at the table is, it is you.

 

[anbuitachi]

If you don't know who the pigeon at the table is, it is you.

when they say CRNAs require physician supervision. does it have to be a boarded physician? Can it be a MD who hasnt done residency?

 

[StillAwake]

My guess is under the supervision of surgeon when anesthesiologist is in the other room. Can't be under supervision when anesthesiologist is doing own case..

Just to play the Devil's advocate, how is the anesthesiologist doing own case different from the surgeon operating in another room?

 

[Psai]

Just to play the Devil's advocate, how is the anesthesiologist doing own case different from the surgeon operating in another room?

What lol

 

[anbuitachi]

Just to play the Devil's advocate, how is the anesthesiologist doing own case different from the surgeon operating in another room?

lol what?

surgeons run multiple rooms all the time in the real world. dont need surgeons to keep patients alive.. thats why anesthesiologist has to be in every room.
Though the surgeon always gets the credit for keeping a patient alive.
Just read an article the other day talking about how a surgeon skillfully revived a patient who was having a massive bleeding. No where was anesthesiologist mentioned.

It's these articles that fool the public into thinking anesthesiologists just put ppl to sleep. Ive had people ask me if we just put the pt to sleep, go somewhere to chill, and come back and wake patient up when surgery is done loll

 

[StillAwake]

What lol

Perhaps I'm not explaining my question well enough.

Scenario A. Two operating rooms, one surgeon, two CRNAS. The operating surgeon is the supervising physician. Room 1 starts at 7am, the surgeon and CRNA #1 are in room. One hour into the case, the second case goes back to OR2 with CRNA #2. So now there are two cases in the ORs and the surgeon is operating in one of them. If something happens during induction, the operating physician who is the surgeon, is working in OR 1, but he is still the supervising physician.

Scenario B. Two operating rooms, one surgeon, one CRNAS and one Anesthesioloigst. Room 1 starts at 7am, the surgeon and the anesthesiologist are in room. One hour into the case, the second case goes back to OR2 with CRNA. As in scenario A, there are now two cases in the ORs with the surgeon and anesthesiologist busy in OR 1. How is the surgeon acting as the supervising physician, any different than he surgeon acting at the supervising physician? I suppose you can make an argument that the surgeon can step away to assist the CRNA in the other room, but that won't always be the case.

 

[StillAwake]

lol what?

surgeons run multiple rooms all the time in the real world. dont need surgeons to keep patients alive.. thats why anesthesiologist has to be in every room.
Though the surgeon always gets the credit for keeping a patient alive.
Just read an article the other day talking about how a surgeon skillfully revived a patient who was having a massive bleeding. No where was anesthesiologist mentioned.

It's these articles that fool the public into thinking anesthesiologists just put ppl to sleep. Ive had people ask me if we just put the pt to sleep, go somewhere to chill, and come back and wake patient up when surgery is done loll

The anesthesiologist doesn't have to be in every room. In fact, in CRNA only practices, there is never an anesthesiologist in a room. My question is really about the legal requirements not who is more skilled in saving patients. We all know that answer.

 

[anbuitachi]

The anesthesiologist doesn't have to be in every room. In fact, in CRNA only practices, there is never an anesthesiologist in a room. My question is really about the legal requirements not who is more skilled in saving patients. We all know that answer.

The above response wasn't responding to your thread topic. And I guess to be clear, i meant anesthetic provider has to be in every room so in your case. Surgical provider does not

Perhaps I'm not explaining my question well enough.

Scenario A. Two operating rooms, one surgeon, two CRNAS. The operating surgeon is the supervising physician. Room 1 starts at 7am, the surgeon and CRNA #1 are in room. One hour into the case, the second case goes back to OR2 with CRNA #2. So now there are two cases in the ORs and the surgeon is operating in one of them. If something happens during induction, the operating physician who is the surgeon, is working in OR 1, but he is still the supervising physician.

Scenario B. Two operating rooms, one surgeon, one CRNAS and one Anesthesioloigst. Room 1 starts at 7am, the surgeon and the anesthesiologist are in room. One hour into the case, the second case goes back to OR2 with CRNA. As in scenario A, there are now two cases in the ORs with the surgeon and anesthesiologist busy in OR 1. How is the surgeon acting as the supervising physician, any different than he surgeon acting at the supervising physician? I suppose you can make an argument that the surgeon can step away to assist the CRNA in the other room, but that won't always be the case.

But yes surgeon can leave and assist in the other room. Anesthesiologist cant. Usually what the surgeon is doing is not THAT urgent. unless poked a hole in the aorta (can't think of any other true surgical emergencies in the OR). It's a risk the surgeon will have to take. It's the same as anesthesiologist supervising multiple CRNA. What happens if 2 emergencies happen at the same time? It's a risk, and the chance of that happening is far higher than two true surgical emergencies at the same time.

 

[StillAwake]

But yes surgeon can leave and assist in the other room. Anesthesiologist cant. Usually what the surgeon is doing is not THAT urgent. unless poked a hole in the aorta. It's a risk the surgeon will have to take. It's the same as anesthesiologist supervising multiple CRNA. What happens if 2 emergencies happen at the same time? It's a risk, and the chance of that happening is far higher than two true surgical emergencies at the same time.[/QUOTE]

My question is really about the legal requirement of physician supervision and if anyone has experience with staffing 2 ORs with one anesthesiologist and one CRNA.

 

[Hoya11]

But yes surgeon can leave and assist in the other room. Anesthesiologist cant. Usually what the surgeon is doing is not THAT urgent. unless poked a hole in the aorta. It's a risk the surgeon will have to take. It's the same as anesthesiologist supervising multiple CRNA. What happens if 2 emergencies happen at the same time? It's a risk, and the chance of that happening is far higher than two true surgical emergencies at the same time.

My question is really about the legal requirement of physician supervision and if anyone has experience with staffing 2 ORs with one anesthesiologist and one CRNA.[/QUOTE]


Maybe this is whats happening (happens all the time):

One surgeon flipping in two rooms.

One CRNA, One Anesthesiologist.

Anesthesiologist does pre-op, is present for induction with CRNA, CRNA stays in the room and does the case, anesthesiologist goes back out to preop holding area and does more preops and/or blocks.

Anesthesiologist goes into the second room alone with the second patient when instructed to by the surgeon based on timing. Does induction himself, OR staff preps and drapes, surgeon walks in and makes incision. Meanwhile the other CRNA wakes up/drops off the patient in the PACU. Then the CRNA relieves the anesthesiologist in the other room with the second patient already started, CRNA stays in the OR and anesthesiologist returns to preop area for more blocks and preops. Repeat.

This works fine when you have only one surgeon flipping. The time you are in the room with the patient asleep WHILE the CRNA is in the room with the patient asleep is minimal, 10 minutes? Usually its no time if done right. Meaning, you look next door to see if the LMA is out and all is well before you push the prop in your room. Or you stabilize the person under GA early in the second room, so if anything goes down in the first room during wake-up, you just pop over and the CRNA covers the second now sleeping guy and you deal with the issue. Usually the rooms in this situation are right next to each other and have a window looking in. Usually its MAC eyes or basic LMA ortho cases anyhow.

So for billing, you just time your anesthesia records accordingly with your CRNA so that there is no overlapping time. Based on your start time of the second case, they time their end time a few minutes before. You may eat a few minutes of billable time but doing more cases is more important. So your billing looks like you do cases continuously separated by one or two minutes. Its not ideal... but it happens

 

[waterbottle10]

So basically it's not allowed since no time overlap allowed