Minneapolis VA Bylaws Change to Remove Anesthesiologists

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Try having 10 full time PACU nurses show up for work for only 6 patients on the OR schedule. And I'm scratching the surface on those kinda examples.
Not fraud

I do understand where you are coming from with the type of over staffing. But that’s its not fraud by definition.

Fraud by govt standard is different. Like overbilling by contractors.

But staffing ratios is not fraud.

Plastics doc doing 3 carpal tunnel in 8 hrs is not fraud either.
 
Not fraud

I do understand where you are coming from with the type of over staffing. But that’s its not fraud by definition.

Fraud by govt standard is different. Like overbilling by contractors.

But staffing ratios is not fraud.

Plastics doc doing 3 carpal tunnel in 8 hrs is not fraud either.
The example that I gave may not be fraud, but it certainly can be considered waste and in many cases that hurts the taxpayer more than outright fraud cases at VA and could be considered gross malfeasance . Incompetent and inept oversight and leadership was not even mentioned here. that is an entirely different story.
 
Isn’t it also not uncommon VA patients exaggerate or fabricate disabilities, and/or falsely attribute these conditions/disabilities to service for monetary compensation?
As a resident, I worked extra shifts covering the VA ER. The whole "service connected" disability thing is a scam. Thirty percent service connected for lack of a uterus is a real thing. The more trips to the ER you have, the sicker you are and the easier it is to get approval for increased percentage of service connection. So, lots of unnecessary drop ins by the frequent flyers with vague neurologic complaints. I caught so many of them in lies using techniques of distraction that I learned from neurology friends. I know a CRNA who is a veteran and he was going to the VA after work for a check up to try and increase his service connection percentage. For the final 30 minutes of work, he wore gloves that had lidocaine cream inside them so that he could claim diabetic peripheral neuropathy and he could effortlessly pass the hand numbness evaluation portion of the physical exam. They could prick his hands with anything sharp and he didn't flinch. I knew a VA anesthesiologist who would work many OR days never changing into scrubs. Literally did nothing all day.
So, yeah, the whole set up is full of employees and veterans that are scamming the system.
 
Try having 10 full time PACU nurses show up for work for only 6 patients on the OR schedule. And I'm scratching the surface on those kinda examples.
Similar story, I once showed up to a VA only to discover our inpatient chemo unit was unable to give chemo that day because “all the chemo trained nurses scheduled to work today are pregnant.”

I started to ask why they didn’t take that into account when making their schedules but I knew it would go nowhere.
 
I have yet to hear any real fraud for VA.

All these examples are just lazy employees (but not illegal)

An anesthesia employee showing up for work and not changing into scrubs is still legally at work.

As for veterans. They earn their medical benefits via service for our countries and disabilities benefits.

Fraud is clocking in at one VA while working private sector getting paid while legally on the VA clock at the same time

Fraud is calling in sick at VA and working locums jobs. That’s fraud.
 
Fraud is clocking in at one VA while working private sector getting paid while legally on the VA clock at the same time
I definitely saw surgeons doing that - “supervising” a resident then operating somewhere else at the same time. Another thing I saw was being clocked in at the VA then going a few blocks over to do sketchy workers comp evals in an unrelated private facility. I also had low level admins at the VA direct us to change patient statuses to make it look like they weren’t admitted anymore, in an effort to meet some discharge metrics by playing a shell game.
 
As for veterans. They earn their medical benefits via service for our countries and disabilities benefits.
Just for clarification, you think it is a coincidence that the #1 service connected disability happens to be a condition that is 100% based on patient reported symptoms with zero objective measurement?
 
Why is this a surprise. Md rate nationally is 600k+ for 45 hours a week 3 overnight calls a month, 8-10 weeks vacation. Simple. But facilities choose to ignore this. Stubborn admins will try this bandaid crna only, but the will negotiate 3 12s…no call. Refuse cases. May be a little cheaper but not really.

Just accept the economics and quit thinking you can find a cheaper solution, it’s supply/demand. So simple. VA, AMC, Private group. Doesn’t matter.
 
New grad crnas. And I mean fresh new crnas with zero experience demanding 10k ($250/hr/40 hrs a week)

Independent crnas cost the same as md because of the way they are wired to be on hourly and no beeper and no calls and must be paid while on call.
 
I did a few VA months as a resident. One day we had 2 THAs scheduled my room. The first case took over 4 hours and we didn’t leave the room until noon. Because the 2nd case wouldn’t start until at least 13:00 due to the 1hr+ VA turnover and “there is no overtime at the VA”, the 2nd case was cancelled. Everyone just sat around until 3pm when their shift ended and then went home. At that time if an elective case wasn’t on track to finish by 3pm it wouldn’t get started.
This is exactly what will happen if we get nationalized care. All of you that think “medicare for all” is the answer will get this instead.
 
This is exactly what will happen if we get nationalized care. All of you that think “medicare for all” is the answer will get this instead.
That's insane, but at the same time I really do understand it. Those who are opposed to capitalism don't understand that is what has made America what it is today. Capitalism provides the incentive for advancement and it provides the incentive for us to work harder and more efficiently.
 
This is exactly what will happen if we get nationalized care. All of you that think “medicare for all” is the answer will get this instead.

That's insane, but at the same time I really do understand it. Those who are opposed to capitalism don't understand that is what has made America what it is today. Capitalism provides the incentive for advancement and it provides the incentive for us to work harder and more efficiently.


If I’m paid by shift or hourly, I still want to work as little and do as little as possible whether my boss is a capitalist or a socialist. The only motivation to hustle is if I am my own boss and/or if I have adequate incentive to move faster. I’m not “moving the meat” (which I think is a perverse CCF term, correct me if I’m wrong) unless adequately incentivized.
 
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That's insane, but at the same time I really do understand it. Those who are opposed to capitalism don't understand that is what has made America what it is today. Capitalism provides the incentive for advancement and it provides the incentive for us to work harder and more efficiently.
Modern Healthcare reimbursement is not true capitalism in its current forum.

Without Medicare (the hospitals and insurers don’t depend on Medicaid or chip)

Without Medicare hospitals and insurers would be bankrupt in their current forums.

I don’t agree with the your working working hard and more efficient with current reimbursement of healthcare.

Because the us health system is designed to reimburse for more procedures. Like spine surgery. Probably 25-30% of those surgeries are unnecessary
 
If I’m paid by shift or hourly, I still want to work as little and do as little as possible whether my boss is a capitalist or a socialist. The only motivation to hustle is if I am my own boss and/or if I have adequate incentive to move faster. I’m not “moving the meat” (which I think is a perverse CCF term, correct me if I’m wrong) unless adequately incentivized.
Correct. I never understood the usap “partnership” model after the buyout. The partners still give up 20% to private equity forever. So the more the partners worked. The more private equity gets a 20% cut of the extra work you do.

Same with any employed model
 
That's insane, but at the same time I really do understand it. Those who are opposed to capitalism don't understand that is what has made America what it is today. Capitalism provides the incentive for advancement and it provides the incentive for us to work harder and more efficiently.
No capitalist system would pay me 600k a year to “supervise” experienced CRNAs doing routine surgery. Careful what you wish for.
 
No capitalist system would pay me 600k a year to “supervise” experienced CRNAs doing routine surgery. Careful what you wish for.
Maybe. In some sense we live in a revived microcosm of healthcare capitalism with the hospitals giving stipends and supply and demand driving prices (well beyond whatever the arbitrary anti capitalist reimbursement levels are). So in a way the current system really is working on a supply and demand level, especially since the system could select for independent CRNAs.

All that said the system is totally busted and F’ed up. We’re probably riding a mini bubble right now.
 
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No capitalist system would pay me 600k a year to “supervise” experienced CRNAs doing routine surgery. Careful what you wish for.
How much do you think you should be paid for that? Free? 1/2 price? 1/3 price?
 
Maybe. In some sense we live in a revived microcosm of healthcare capitalism with the hospitals giving stipends and supply and demand driving prices (well beyond either the arbitrary anti capitalist reimbursement levels are). So in a way the current system really is working on a supply and demand level, especially since the system could select for independent CRNAs.

All that said the system is totally busted and F’ed up. We’re probably riding a mini bubble right now.
Independent crnas want the same money as docs. That’s the goal. It’s no longer how much cheaper crnas are. The aana no longer promotes cost savings

Aana promotions “nurse anesthesiologist “ with the ultimate goal of just dropping the nurse from the time. We all see the long game from a mile away

Notice they promote the length of training. Moreso pump the bsn years of training as equivalent to MD years of school.
 
Maybe. In some sense we live in a revived microcosm of healthcare capitalism with the hospitals giving stipends and supply and demand driving prices (well beyond either the arbitrary anti capitalist reimbursement levels are). So in a way the current system really is working on a supply and demand level, especially since the system could select for independent CRNAs.

All that said the system is totally busted and F’ed up. We’re probably riding a mini bubble right now.


Without Medicare volume would drop like a rock, hospitals would have no money for stipends, and most of our hospitals would close. How many retirees could afford health insurance without Medicare? How many would just be uninsurable? Doctors would be paid in eggs, chickens, and tomatos from the garden like the good old days. What we have now in healthcare is capitalism bolstered by socialism. Not every industry is so lucky to have a socialist backstop.

We love to criticize hospital administrators for chasing the latest profitable service lines but they pay the bills, one of which is our stipends.
 
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Independent crnas want the same money as docs. That’s the goal. It’s no longer how much cheaper crnas are. The aana no longer promotes cost savings

Aana promotions “nurse anesthesiologist “ with the ultimate goal of just dropping the nurse from the time. We all see the long game from a mile away

Notice they promote the length of training. Moreso pump the bsn years of training as equivalent to MD years of school.


Independent CRNAs are willing to work outpatient surgicenters for $350k in our VHCOL area. No anesthesiologist would work for that.
 
Without Medicare volume would drop like a rock, hospitals would have no money for stipends, and most of our hospitals would close. How many retirees could afford health insurance without Medicare? How many would just be uninsurable? Doctors would be paid in eggs, chickens, and tomatos from the garden like the good old days. What we have now in healthcare is capitalism bolstered by socialism. Not every industry is so lucky to have a socialist backstop.

We love to criticize hospital administrators for chasing the latest profitable service lines but they pay the bills, one of which is our stipend

Without Medicare volume would drop like a rock, hospitals would have no money for stipends, and most of our hospitals would close. How many retirees could afford health insurance without Medicare? How many would just be uninsurable? Doctors would be paid in eggs, chickens, and tomatos from the garden like the good old days. What we have now in healthcare is capitalism bolstered by socialism. Not every industry is so lucky to have a socialist backstop.

We love to criticize hospital administrators for chasing the latest profitable service lines but they pay the bills, one of which is our stipends.
The ultimate goal is to get us all working for the government anyway in the next 15 years or so. How else can you explain the reimbursement rate decrease in the last 20 years. I mean it is horrendous. A friend of mine is a general dentist. She charges 300 for a simple extraction. Medicaid/Medicare reimburses 45 dollars. You cant even get your tire on your car mounted and balanced for 45 dollars. And they wonder why dentists don't accept govt payors.
 
The ultimate goal is to get us all working for the government anyway in the next 15 years or so. How else can you explain the reimbursement rate decrease in the last 20 years. I mean it is horrendous. A friend of mine is a general dentist. She charges 300 for a simple extraction. Medicaid/Medicare reimburses 45 dollars. You cant even get your tire on your car mounted and balanced for 45 dollars. And they wonder why dentists don't accept govt payors.
A more ominous goal is for those in power to get us all working for private equity... with private equity taking all the government money while pretending that they're making things "efficient".
 
A more ominous goal is for those in power to get us all working for private equity... with private equity taking all the government money while pretending that they're making things "efficient".
Nah, the powers that be don't care about pvt equity either. They'll throw them a bone to make it look l ike they do but they dont. How else can you explain the death blow they passed when they abolished surprise billing. That was the industry cash cow. They want them gone too.
 
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Nah, the powers that be don't care about pvt equity either. They'll throw them a bone to make it look l ike they do but they dont. How else can you explain the death blow they passed when they abolished surprise billing. That was the industry cash cow. They want them gone too.
That just shows the insurance lobby is more powerful than medical private equity robber barons, not that politicians aren’t perfectly happy to sell out to anyone and everyone with money to spread around.
 
That just shows the insurance lobby is more powerful than medical private equity robber barons, not that politicians aren’t perfectly happy to sell out to anyone and everyone with money to spread around.
Why do you guys think I defend usap all the time in the Colorado lawsuit. That ftc lady was in way over her head and over step her authority forcing usap to give up Colorado. Because United healthcare lobbied her to death. For as smart as she is on paper. She’s dumb as rocks how medicine works.

And there are a lot of dumb policy makers in any administration democratic or republican influenced by deeper pockets.

United healthcare is always fighting with big hospitals corporations nationwide with nasty ads everywhere why they are pulling out of certain markets.

The AHA are no angles either but they can fight United healthcare better than usap.
 
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