My Plan for Winning

[BLADEMDA]

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Imagine the militant AANA is a Virus like HIV. We are the patient. Our Viral Load is high and we are falling ill to the disease. There is no cure. What can we do?

 

[countingdays]

Imagine the militant AANA is a Virus like HIV. We are the patient. Our Viral Load is high and we are falling ill to the disease. There is no cure. What can we do?

Find a treatment to get the viral load as low as possible without killing the patient?

 

[BLADEMDA]

1. Donate to the ASA PAC- The PAC is our antibiotics against our weakened immune system caused by the AANA. It helps keep secondary bacterial infections at bay. It won't stop the Virus. ASA helps promote our temporary well-being by advocating for us.

2. Court Battles/Legal Challenges- The laws and hospitals rules are the anti-virals to keep the infection in check. We need to work hard at these battles because once "resistance" develops we lose that particular pill (state) forever.

3. AA's- These are are T Cell boosters. Our T Cells are polluted from actually embracing the AANA Virus. We have no immune system of our own because we have allowed the Virus to completely take over (look at our medical centers). AAs represent a boost to our profession.

4. PAs- Maceo is right. We need more T cells than currently being produced to fight off the virus/plague. PAs are the answer. Embrace a 14 month PA to AA degree. Allow PAs to enroll at AA Schools and train at community hospitals under AA-Cs. Do not dilute the certification exam one iota.

5. Develop strong mind set against the Virus/AANA- this means not training SRNA in advanced Regional and making sure the public knows what we do.

We have long ago allowed our bone marrow (Academic centers) to not only become infected with the virus but to become a major source for its actual production. However, the patient doesn't have the back-bone for a bone marrow transplant.

 

[BLADEMDA]

Imagine a Business that is very successful. The owner treats his workers well. In fact, over the past 15 years his workers' salaries have more than doubled. In addition, the worker is treated with respect and has earned quite a reuptation.

But, the worker is jealous of the owner. During the past 15 years the worker has been advocating for the destruction of the owner's business. Every year the worker contributes to a PAC that lobbies for the destruction of the owner's business model. The worker no longer holds back his disdain for his employer; on the contrary, he openly tells others that the owner is useless and provides no value to the business. Since the workers do everything they should own the business and throw the owner out.

Now, if you were the owner would you hire more of these same types of employees? Would you train people who hate/despise you? Or, would you seek out another type of employee? What if there were another potential employee available who supported your business model and you personally?


Think about about our field and those who work for the owners. Has the time not come for a real change? AAs and the PA-AA degree represent the new type of employee we as owners need.

 

[cfdavid]

You know, I think the PA--> AA model could be very successful.

Importantly, it will provide revenue to the myriad of institutions currently training SRNA's. That is, as AA programs are added, they'll need to be sold to the leadership of existing SRNA training programs (not the CRNA leadership, but rather administration) as a means of maintaining revenues or even growing revenues as SRNA #'s level off or decrease as a result of training PA's. Money talks, which is likely one of the reasons that it's been so difficult to stem the flow of new SRNAs where they are currently being trained.

cf

 

[335230]

ok

 

[TecmoBowl]

Blade,

I tell my patients ALL the risks of the procedure (death, stroke, etc) and to be honest with you, I think I make the patients realize our worth one patient at a time.

Next, as for strategy. I have ideas.

Advertise. NY Times? USA Today? Forbes? Pick one or more. We need donations. We need a bunch of us to come together, collect pledges and make it happen.

Next, solicit the assistance of things like the "Gallup Poll". Get the word out. Create a questionnaire.

Expose the Nursing Lobby in general. They try to come of as "Angels". Many nurses ARE angels, but their lobby is a horrendous and evil one.

Let's EXPOSE the DNP. One to two years for a "Phd" in Nursing? When I talk to random people about this, they are scared ****less that someone would call themselves a Doctor and they would not know any better.

EXPOSE THE PATHETIC NATURE OF THE DNP degree.

Public awareness is key.

Let's gather our troops.

See you in the private forum. How do I get access by the way?

 

[pgg]

How do I get access by the way?

Send a PM to Arch Guillotti.

 

[Mman]

Blade,

I tell my patients ALL the risks of the procedure (death, stroke, etc) and to be honest with you, I think I make the patients realize our worth one patient at a time.

You tell them "ALL the risks"? What are all the risks? There are risks of things happening that I probably can't imagine and it'd be a 15 minute rattling off of possible complications if I even came close.

The doctrine of informed consent does not require that you disclose every possible complication.

For example, I tell people there is "a small risk of injury to lips, teeth, or airway" when we are going to instrument the airway. I don't get into many details on that one unless they ask. I stick to broad categories of risks and mention ways we are going to attempt to minimize those risks. However, I find it unproductive to overly emphasize details of potential complications.

 

[TecmoBowl]

No, typically something to the sort of you're having minor surgery but there are always risks involved that go from one end of the spectrum to the other. I don't tell them a recital of things! I just say listen a lot of things can happen and that's why I'm here to do my best to take care of you. Then I detail specifics like stroke/cva for sitting position surgeries, blindness for prone position etc etc

Essentially, when you don't minimize what we do, then one patient at a time will realize why WE are there and why we have to go through so much training.

I hope you get the gist of what I'm saying. It would be impractical and the hospital would be out of versed if you went through a "list". It's a feeling you're conveying.

 

[Gardner]

Blade,

Next, as for strategy. I have ideas.

Advertise. NY Times? USA Today? Forbes? Pick one or more. We need donations. We need a bunch of us to come together, collect pledges and make it happen.

Next, solicit the assistance of things like the "Gallup Poll". Get the word out. Create a questionnaire.

I actually like these ideas better than donating to the ASA. I'm a new resident and don't have a history of the ASA, but I get the impression they might not be as aggressive as what we need for this fight.

 

[BLADEMDA]

You all do realize that studies based on billing data can be flawed. Over 30-40% of all "QZ" billed cases are actually supervised by an Anesthesiologist. Hence, using billing data to compare outcome simply isn't valid. Many Groups simply bill "QZ" or CRNA only to avoid TEFRA; meanwhile, the CRNA is really being supervised.

The ASA estimated 30% of CRNA only/solo billing is actually MD(A) supervised anesthesia. That was in 2001. IN 2010 my opinion is the estimate is 40-50% of CRNA only billing is actually supervised by an MD (A).



What do the data show about use of the –QZ modifier?
As anesthesiologists became ever more concerned with compliance with Medicare medical direction rules, ASA suspected that many groups would choose to bill all or most care-team services as "CRNA service without medical direction," using the –QZ modifier. Taking the example of cataract surgery, 6,098,604 cataract anesthetics were performed by anesthesiologists in 1999 (and fewer than 30,000 of these were performed in physicians' private offices, incidentally). A startling total of 230,000 cataract anesthetics were billed by other physicians. Almost half of the anesthesia services for cataracts were billed with the –QZ modifier. Similar proportions are showing up for other CPT codes. This seems to validate our hypothesis that many anesthesiologists who employ nurses (and are thus able to collect Medicare payments on their behalf) are using –QZ, which pays the full Medicare allowable even when they are in fact supervising the nurses.
It is perfectly understandable that anesthesiologists do not want to risk having a Medicare auditor determine that they did not fulfill perfectly all of the requirements for submitting a "medical direction" claim. Fortunately, CMS is aware of this unforeseen use of the –QZ modifier and knows that the huge majority of anesthesia services continues to involve supervision by an anesthesiologist. It is, however, an unintended use of –QZ, not necessarily an improper one as far as CMS is concerned. CMS has never issued any statement on whether a practice may, or may not, use –QZ for incomplete medical direction.

 

[proman]

Hey Blade, are you going to write a letter to Health Affairs? You should write a rebuttal.