CRNAs practicing pain

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Powergrab by AANA.

Checks made out to Lax and Co. ASIPP will need all of our help for this nonsense.

All of us should refuse to see patients that were previously treated by CRnAP.
 
This is getting ridiculous. CRNAs are unqualified to practice pain medicine. Talk about unadulterated greed on the part of the AANA and all of its supporters. Pain management is without question the practice of medicine. It builds on all of the knowledge and skills acquired through medical school, internship, and residency. It requires at least one year of fellowship training--likely 2 years in the near future--to be competent. What the hell is the AANA thinking when they propose legislation like this? How can a nurse with a master's degree and very limited exposure to pain medicine be considered "equivalent" to a board certified physician with a fellowship in pain?

Give me a break. Supporters of the AANA should be ashamed of this behavior. They're putting self interest--i.e., greed--ahead of patient welfare.
 
Members don't see this ad :)
EtherBunny said:
This is getting ridiculous. CRNAs are unqualified to practice pain medicine. Talk about unadulterated greed on the part of the AANA and all of its supporters. Pain management is without question the practice of medicine. It builds on all of the knowledge and skills acquired through medical school, internship, and residency. It requires at least one year of fellowship training--likely 2 years in the near future--to be competent. What the hell is the AANA thinking when they propose legislation like this? How can a nurse with a master's degree and very limited exposure to pain medicine be considered "equivalent" to a board certified physician with a fellowship in pain?

Give me a break. Supporters of the AANA should be ashamed of this behavior. They're putting self interest--i.e., greed--ahead of patient welfare.
Click to expand...

AANA believes nurses are actually superior to doctors in most every way.
 
At some point the greed of the AANA will rear its ugly head and bite them in the ass. Karma has a way of settling the score. It's crazy that health care professionals haven't learned a fundamental lesson about greed in the health care arena--nothing good ultimately comes from it!

When Medicare was launched and doctors started defrauding the federal government to boost their incomes, the result was (drum roll)...more paperwork, more regulation, criminal convictions, and loss of respect. When pain doctors in Florida started opening pill mills to bring in millions of dollars, the result was...that's right: more paperwork, more regulation, criminal investigations, and loss of respect. This sequence of events has happened time and time again in medicine. Anytime something lucrative comes along, everyone and their mother jumps on the bandwagon and tries to exploit it to the fullest, in many cases to a criminal degree.

Nothing good will come from the AANA political agenda. Let's examine some of the lovely repercussions of their agenda:
1. An acrimonious and adversarial relationship between anesthesiologists and CRNAs. The teamwork concept, which has served patients very well over the last few decades, is disintegrating. It won't be good for patients. Instead of having a physician and a nurse caring for each patient--two sets of eyes--there will only be a single person.
2. Increased hiring of AAs, thereby restricting positions for CRNAs in more "traditional" practices (i.e., ACT). Bad news for the "silent majority" of CRNAs who don't' want to practice independently.
3. Increased medico legal exposure and a relative deterioration in overall lifestyle for CRNAs who practice independently because they can no longer take the "no call, no weekends" positions and practice under the umbrella of an anesthesiologist. They have to behave like physicians--crappy hours, full liability, lots of call.
4. Decrease in compensation for all health care professionals in anesthesia because the field is divided in an era of cost containment. If everyone is pitted against one another, the competition will decrease salaries.
5. A brain drain away from anesthesiology because bright medical students will be unwilling to enter the field. In effect, research advances in the field will suffer. All of the leaps in practice that have occurred in the last 50-60 years (the pulse ox, etc.) have been spearheaded by physicians. The field will become relatively stagnant if physicians drop out of the field or a brain drain occurs.

On balance, the AANA agenda is stupid and destructive. It will ultimately accomplish nothing positive.
 
Welcome to the fight PMR. Next time think twice before stating aloud you dont see the difference between a serna and an anesthesiologist providing the anesthesia for your spinal cord implant cases. The vast majority of nurses these days see nursing as a backdoor to practicing medicine and couldn't care less about becoming nurses anymore. And they have no problem legislating their way towards that goal.
 
EtherBunny said:
At some point the greed of the AANA will rear its ugly head and bite them in the ass. Karma has a way of settling the score. It's crazy that health care professionals haven't learned a fundamental lesson about greed in the health care arena--nothing good ultimately comes from it!

When Medicare was launched and doctors started defrauding the federal government to boost their incomes, the result was (drum roll)...more paperwork, more regulation, criminal convictions, and loss of respect. When pain doctors in Florida started opening pill mills to bring in millions of dollars, the result was...that's right: more paperwork, more regulation, criminal investigations, and loss of respect. This sequence of events has happened time and time again in medicine. Anytime something lucrative comes along, everyone and their mother jumps on the bandwagon and tries to exploit it to the fullest, in many cases to a criminal degree.

Nothing good will come from the AANA political agenda. Let's examine some of the lovely repercussions of their agenda:
1. An acrimonious and adversarial relationship between anesthesiologists and CRNAs. The teamwork concept, which has served patients very well over the last few decades, is disintegrating. It won't be good for patients. Instead of having a physician and a nurse caring for each patient--two sets of eyes--there will only be a single person.
2. Increased hiring of AAs, thereby restricting positions for CRNAs in more "traditional" practices (i.e., ACT). Bad news for the "silent majority" of CRNAs who don't' want to practice independently.
3. Increased medico legal exposure and a relative deterioration in overall lifestyle for CRNAs who practice independently because they can no longer take the "no call, no weekends" positions and practice under the umbrella of an anesthesiologist. They have to behave like physicians--crappy hours, full liability, lots of call.
4. Decrease in compensation for all health care professionals in anesthesia because the field is divided in an era of cost containment. If everyone is pitted against one another, the competition will decrease salaries.
5. A brain drain away from anesthesiology because bright medical students will be unwilling to enter the field. In effect, research advances in the field will suffer. All of the leaps in practice that have occurred in the last 50-60 years (the pulse ox, etc.) have been spearheaded by physicians. The field will become relatively stagnant if physicians drop out of the field or a brain drain occurs.

On balance, the AANA agenda is stupid and destructive. It will ultimately accomplish nothing positive.
Click to expand...

👍👍👍👍
 
guys we really need to rally around an organization and Thwart this.


I know lots of us are getting emails from ASIPP (like the one from Lax and Falco today).

We really need to get political. We need to defend our turf, our specialty, and our patients. As an anesthesiologist, I've seen the ravage that occurred within Anesthesia d/t CRNAs. We can not permit that in Pain.

If you are hospital based, we need to really get involved with credentialing,etc in hospitals. That's one way to stop the trespass.

Also if you are doing a Stim, V-plasty,etc and rquire 'anesthesia', ask for an Anesthesiologist, not a CRNA.
 
Several years ago when this came up, ASIPP developed a policy statement regarding CRNAs that was placed on the website and in print. Since that time, the policy was taken off the website and queries to ASIPP about the location of the policy and as to why it was removed went unanswered.
Perhaps the clarion call of CRNAs now approaching the pain issue through the back door of the CMS will rekindle the policy statements from ASIPP.
The CMS position is not carved in stone: it is currently in the comment period so we should all chime in. This change in CMS policy is supported only by nursing associations and hospital associations.....this tells you the hospital associations don't really give a flip about quality of patient care, they only want more $$$$$$ they derive from these inept ersatz nurses trying to learn how to do invasive procedures without any formal training in their CRNA programs.
The Indiana Pain Society has standards of care, not simply guidelines or policies, but STANDARDS that will serve as a legal backbone for practice in our state. It excludes many physicians without appropriate training, all non-physicians, and requires fellowship training for any physician beginning pain practice after July 2012.
Write the CMS and voice your opinion before they unleash an onslaught of untrained nurses doing surgical procedures on an unwitting public.
 
Members don't see this ad :)
algosdoc said:
Several years ago when this came up, ASIPP developed a policy statement regarding CRNAs that was placed on the website and in print. Since that time, the policy was taken off the website and queries to ASIPP about the location of the policy and as to why it was removed went unanswered.
Perhaps the clarion call of CRNAs now approaching the pain issue through the back door of the CMS will rekindle the policy statements from ASIPP.
The CMS position is not carved in stone: it is currently in the comment period so we should all chime in. This change in CMS policy is supported only by nursing associations and hospital associations.....this tells you the hospital associations don't really give a flip about quality of patient care, they only want more $$$$$$ they derive from these inept ersatz nurses trying to learn how to do invasive procedures without any formal training in their CRNA programs.
The Indiana Pain Society has standards of care, not simply guidelines or policies, but STANDARDS that will serve as a legal backbone for practice in our state. It excludes many physicians without appropriate training, all non-physicians, and requires fellowship training for any physician beginning pain practice after July 2012.
Write the CMS and voice your opinion before they unleash an onslaught of untrained nurses doing surgical procedures on an unwitting public.
Click to expand...
In his email, Lax and Falco made it VERY clear Pain Medicine is NOT the practice of nursing and is for physicians. I hope they put it on their website.

I hope that all the organizations (ISIS, ASRA,etc) all can rally together.
 
algosdoc said:
Several years ago when this came up, ASIPP developed a policy statement regarding CRNAs that was placed on the website and in print. Since that time, the policy was taken off the website and queries to ASIPP about the location of the policy and as to why it was removed went unanswered.
Perhaps the clarion call of CRNAs now approaching the pain issue through the back door of the CMS will rekindle the policy statements from ASIPP.
The CMS position is not carved in stone: it is currently in the comment period so we should all chime in. This change in CMS policy is supported only by nursing associations and hospital associations.....this tells you the hospital associations don't really give a flip about quality of patient care, they only want more $$$$$$ they derive from these inept ersatz nurses trying to learn how to do invasive procedures without any formal training in their CRNA programs.
The Indiana Pain Society has standards of care, not simply guidelines or policies, but STANDARDS that will serve as a legal backbone for practice in our state. It excludes many physicians without appropriate training, all non-physicians, and requires fellowship training for any physician beginning pain practice after July 2012.
Write the CMS and voice your opinion before they unleash an onslaught of untrained nurses doing surgical procedures on an unwitting public.
Click to expand...

do you have any particular words of advice on how to write to CMS? a website/link? or better yet a contact person within CMS?
 
algosdoc said:
Several years ago when this came up, ASIPP developed a policy statement regarding CRNAs that was placed on the website and in print. Since that time, the policy was taken off the website and queries to ASIPP about the location of the policy and as to why it was removed went unanswered.
Perhaps the clarion call of CRNAs now approaching the pain issue through the back door of the CMS will rekindle the policy statements from ASIPP.
The CMS position is not carved in stone: it is currently in the comment period so we should all chime in. This change in CMS policy is supported only by nursing associations and hospital associations.....this tells you the hospital associations don't really give a flip about quality of patient care, they only want more $$$$$$ they derive from these inept ersatz nurses trying to learn how to do invasive procedures without any formal training in their CRNA programs.
The Indiana Pain Society has standards of care, not simply guidelines or policies, but STANDARDS that will serve as a legal backbone for practice in our state. It excludes many physicians without appropriate training, all non-physicians, and requires fellowship training for any physician beginning pain practice after July 2012.
Write the CMS and voice your opinion before they unleash an onslaught of untrained nurses doing surgical procedures on an unwitting public.
Click to expand...

Surgical procedures. I believe this is the key. If we can get the talking heads to understand that the practice of Pain Medicine is more akin to surgery than it is to anesthesia then MAYBE we can thwart the CRNA tsunami. Maybe.:xf:
 
algosdoc said:
Several years ago when this came up, ASIPP developed a policy statement regarding CRNAs that was placed on the website and in print. Since that time, the policy was taken off the website and queries to ASIPP about the location of the policy and as to why it was removed went unanswered.
Perhaps the clarion call of CRNAs now approaching the pain issue through the back door of the CMS will rekindle the policy statements from ASIPP.
The CMS position is not carved in stone: it is currently in the comment period so we should all chime in. This change in CMS policy is supported only by nursing associations and hospital associations.....this tells you the hospital associations don't really give a flip about quality of patient care, they only want more $$$$$$ they derive from these inept ersatz nurses trying to learn how to do invasive procedures without any formal training in their CRNA programs.
The Indiana Pain Society has standards of care, not simply guidelines or policies, but STANDARDS that will serve as a legal backbone for practice in our state. It excludes many physicians without appropriate training, all non-physicians, and requires fellowship training for any physician beginning pain practice after July 2012.
Write the CMS and voice your opinion before they unleash an onslaught of untrained nurses doing surgical procedures on an unwitting public.
Click to expand...
Algosdoc, I agree with your argument. Before I write a formal complaint to http://www.regulations.gov/#!submitComment;D=CMS-2012-0083-0001

I want to have all the key pieces in it that will persuade a healthcare policy maker into banning, from now until armageddon, a CRNA from doing any interventional pain management in the USA. Every argument posted so far is great, however, I believe that if we were to get some traction with the CMS lawmakers, we would need to center our arguments on the patient. Lawmakers don't really care about the sacrifices we had to make to be able to do our craft compared to the CRNA; you know, 4 yrs of undergrad, 4 yrs of med school, 4 yrs of residency, and a yr of fellowship (just to have a CRNA take a short-cut and have the authority to do the same thing we do and get 100% compensation from it).

Here are my key pieces to a persuasive argument to CMS lawmakers on this issue, please help me with your own ideas in order for all of us to benefit from them and write one great letter in the defense of our specialty:

1. Patient centered: patents benefit from better care from a qualified pain doctor vs CRNA.

2. Accountability: pain doctor is better prepared to be accountable for patient complications arising from interventional (and non-interventional) therapy. Let's not wait for a tragic outcome to happen in the hands of a CRNA to realize that a patient's well being would have been handled better in the hands of a qualified physician.

3. Pain management is without question the practice of medicine. It builds on all of the knowledge and skills acquired through medical school, internship, and residency. It requires at least one year of fellowship training (thanks to EtherBunny for this insight).

4. The mission and purpose of advanced training in pain management: There is a reason why institutions accredited by the ACGME and included in the ABMS were made solely dedicated to the care of patients suffering from chronic pain: pain management fellowships. These fellowships have very strict inclusion criteria for applicants because of the complexity inherent in the care of patients suffering from chronic pain. Applicants must have a background in one of the following specialties to be eligible: PM&R, anesthesia, psychiatry, neurology; and in some cases ER and IM. All the leadership in a pain management fellowship see the need for a doctor with either one of these backgrounds precisely because of the complexity of care involved with this patient population. A CRNA performing pain management with all its implications is substandard of care medicine and unacceptable for these patients.

5. The interventional aspect of pain medicine is a skill set reserved for those with the aforementioned background. The decision to perform a procedure on a patient suffering from a chronic ailment is not made in a vacuum. First of all, a detailed history of present illness, physical exam, pertinent images and labs have to be made before the diagnosis is made. No professional in the medical field without the background of a pain management physician is more qualified to adequately diagnose a patient's condition after the above mentioned tasks are done. Then, treatment options are offered to the patient. Again, no one is better qualified at offering the chronic pain patient a detailed up-to-date treatment option plan than the pain management physician. If the patient is a candidate for an interventional treatment option and he or she agrees to it, no one is more qualified to perform the procedure than the physician who diagnosed and offered the best treatment options available to the patient. The CRNA, with no formal training in the field of pain management, is left with opting to diagnose the patient with a clinical judgement that is not founded on evidence-based medicine. Because of this poor background in pain management, the CRNA's treatment options will be limited to less than what really can be offered to the patient. There is a higher likelihood that a treatment option with more reimbursement yield, such as an interventional treatment, will be selected by the CRNA considering the lack of knowledge of other non-interventional options available. In the end, if an interventional procedure is selected for the patient by the CRNA, with no formal accredited institutionalized training in these procedures, the efficacy of such treatment is questionable at best.
 
See my post on x ray techs doing epidurals-if u really want to get annoyed. Two years training after high school-wow, he probably knows the names of some of the anatomical structures he's violating😡 But no fear he was under the "direct supervision " of the radiologist. I told my RN the other day to proceed without me. I have cameras in the rooms and she will be under my direct supervision while I'm on SDF. I mean really, why am I the only one getting out of my chair :laugh:There apparently is no training program for radiology PAs. An X ray tech can just call himself that and start doing surgery, for real. This is some kind of loophole, confirmed by the state society and brought to the attention of the medical board in AZ. This joker is still doing spinal procedures. If the tech is under "direct supervision" why the heck didn't he just get some gloves and do it himself? Unbelievable
 
not to allow you to hijack the thread, but im gonna get back to CRNAs, facet.

Specifically, im not sure how many ppl have read the actual report. to summarize, the report, on page 230 onwards, makes comments that chronic pain management is an evolving field, and certain states have allowed CRNAs to bill for and perform interventional therapy. Because some states are allowing this, and there seems to be a difference between CRNAs and NPs that require (at present) supervision, the rule was revised - or recommended.

of note, and i think this should be an emphasis of what we write to CMS, to me, was this paragraph:

"Simply because the State allows a certain type of health care professional to furnish
certain services does not mean that all members of that profession are adequately trained to
provide the service. In the case of chronic pain management, the IOM report specifically noted
that many practitioners lack the skills needed to help patients with the day-to-day selfmanagement
that is required to properly serve individuals with chronic pain."

i believe that an emphasis that the skills required to treat a chronic pain patient cannot be learned in any fly by night course, and requires an ABMS certified/regulated fellowship program, as the complexities of chronic pain include not only the intervention itself, but the day-to-day management of these chronic pain patients, including their psychological, neurobiological and anatomic makeup.

finally, "As with all
practitioners who furnish services to Medicare beneficiaries, CRNAs practicing in States that
allow them to furnish chronic pain management services are responsible for obtaining the
necessary training for any and all services furnished to Medicare beneficiaries."

Outlaw "weekend" courses for training. dont allow certification by organizations that allow anyone to become a pain management doctor. make the CRNAs go to a pain fellowship that is monitored and regulated like any surgical specialty, or put them under the direct supervision only of a physician who is qualified.
 
Ducttape, you make excellent points in your argument. Just make sure you submit them to
http://www.regulations.gov/#!submitComment;D=CMS-2012-0083-0001
We can vent all we want in this forum, but if we only voice our opinions here, nothing will change. I just emailed all my co-fellows from my program as well as some that are in training to do the same. The more people we get on board, the bigger the impact that we'll have.

As far as states allowing CRNAs to do pain, it speaks to the lack of success of pain physicians changing policy in those states, be it for lack of effort, indifference, or god knows what.
 
..thats great, but does the Indiana Pain Society have any type of authority over medical practice in the state?
 
I think, According to the changes postulated by CMS, the individual states can determine who can practice pain.

I saw that ASIPP was, self-professed, instrumental to keeping CRNAs from practicing in Louisiana. I'll bet NH doesn't have these restrictions. Indiana hopefully can regulate who can practice pain in their own state...
 
Isn't the fundamental problem the fact that nurses are not governed by the medical board? In my state, the medical societies have defined the practice of medicine and surgery but the nurse lobbies' response is that we may define the practice of medicine, but they are free to define the practice of nursing. They define the practice of nursing as including all types of interventional spinal procedures. This has been an ongoing problem for at least 25 years, they were trying to put PA caths in then. We have no jurisdiction over them. Some fundamental changes need to occur addressing not just interventional pain but the practice of nursing, which by definition is a supportive role. Surgery is not within a nurses scope of practice period, whether it is performing an interventional spinal procedure and removing an appendix, they both have surgical codes and are surgical procedures
 
Yes, the Pain Society does have legal standing. That is the point. With over 50% membership of all pain doctors, and each pain doctor in the pain society having agreed to meet the standards and testify in court to support the standards, then the standard of care for the state IS equivalent to the IPS standards.
 
facets said:
Isn't the fundamental problem the fact that nurses are not governed by the medical board? In my state, the medical societies have defined the practice of medicine and surgery but the nurse lobbies' response is that we may define the practice of medicine, but they are free to define the practice of nursing. They define the practice of nursing as including all types of interventional spinal procedures. This has been an ongoing problem for at least 25 years, they were trying to put PA caths in then. We have no jurisdiction over them. Some fundamental changes need to occur addressing not just interventional pain but the practice of nursing, which by definition is a supportive role. Surgery is not within a nurses scope of practice period, whether it is performing an interventional spinal procedure and removing an appendix, they both have surgical codes and are surgical procedures
Click to expand...

isnt CMS addressing the issue whether CRNAs will get reimbursed? that seems to be the emphasis here. currently, CRNAs cant get paid for pain procedures in most states. The change advocated seems to be that they can now be reimbursed by care/caid, pending individual state requirements.

So its not a licensing issue, its an issue of whether to allow CRNAs to get reimbursed for their pain procedures on medicare beneficiaries.
 
Ducttape said:
isnt CMS addressing the issue whether CRNAs will get reimbursed? that seems to be the emphasis here. currently, CRNAs cant get paid for pain procedures in most states. The change advocated seems to be that they can now be reimbursed by care/caid, pending individual state requirements.

So its not a licensing issue, its an issue of whether to allow CRNAs to get reimbursed for their pain procedures on medicare beneficiaries.
Click to expand...


CRNAs doing procedures is egregious enough in itself; getting reimbursed for it is an attempt to leave another black eye in the face of pain management physicians. But I believe the ppl at CMS still haven't made up their minds yet regarding the legitimacy of CRNAs doing PM; the jury's still out on that. This also shows the poor communication among the CMS policymakers, on the one hand they're cutting reimbursements on our procedures due to abuse and yet they're wondering if it's ok to have an army of CRNAs abuse those codes some more.
 
That's awkward, but if they get accepted into a PM fellowship, they'd be playing by the rules. Good luck for them getting into a fellowship though.
 
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