NAPA Now in Trouble in Maryland

[Twiggidy]

I agree the pooled units and paid on time thing is the fairest. Which is harder - pump cv case or running 4 quick turnover rooms in gi? No one will agree. While the GI rooms pay the bills they ability to do the big cases solidifies our necessity to the hospital. We are partners and treat each other as such. No system is perfect but pooling units and time is fairest

Agree. This is something we’ve dealt with in my department and are still somewhat resolving but it’s way better than it used to be

---

Members don't see this ad.

 

[Twiggidy]

It’s definitely not just anesthesia. The surgeon I was working with just today was telling me his practice is having a hard time recruiting potential partners for a lucrative, surgical subspecialty practice. They just can’t compete with the hospitals for recruiting. We didn’t get into specifics about money, but he did concede that maybe the new grads are better off. The writing is on the wall that once hospitals own the surgeons, the private guys will be scrounging for the scraps of block time.

It was thought that surgery centers would save the day for private practice, but again, once the hospitals control the whole healthcare system from primary care all the way to subspecialists, those surgery centers are in danger of languishing…until the hospital system buys it on the cheap and fills it with their surgeons. For every busy surgery center that is successful, there are multiple that have a hard time filling ORs efficiently.

Well the surgical world is interesting because the hospitals are making it more and more a “lifestyle” specialty as opposed to the old school surgeons who basically always on call. We have an old surgeon who complains all the time about this when he’s doing a case at strange hours or weekends and can’t get an assistant. Even surgeons are basically working for hospitals and signing out to each of the “on call” . Why work for a small practice where your phone is always on versus getting a chunk of salary and doing shift work?

 

[Iso4ane]

I agree the pooled units and paid on time thing is the fairest. Which is harder - pump cv case or running 4 quick turnover rooms in gi? No one will agree. While the GI rooms pay the bills they ability to do the big cases solidifies our necessity to the hospital. We are partners and treat each other as such. No system is perfect but pooling units and time is fairest

One can be hard as crap, and the other is full of crap. I know which one I'd rather do. And while I appreciate that GI guys pay help support my salary, the fact that they can call me and I'll be able to step up to the plate to do any (pump runs, liver txs, etc) case is what I bring to the table.

 

[nimbus]

Well the surgical world is interesting because the hospitals are making it more and more a “lifestyle” specialty as opposed to the old school surgeons who basically always on call. We have an old surgeon who complains all the time about this when he’s doing a case at strange hours or weekends and can’t get an assistant. Even surgeons are basically working for hospitals and signing out to each of the “on call” . Why work for a small practice where your phone is always on versus getting a chunk of salary and doing shift work?

“Acute care surgery” is the hospitalist model applied to surgery. I hadn’t even heard the term until 5 years ago.

Introduction

to Acute Care Surgery Fellowship

www.aast.org

 

[OptionOffense]

Like every other industry in America, healthcare has consolidated. It is a consequence of the winner take all reward system of American free market capitalism (which we have exported globally). Behemoth regional hospital systems formed as a result of insurance monopolies. There was no way a single private hospital could negotiate fairly against a national or statewide insurance giant. So it became a game of giants, monopoly vs monopoly. Doctors were left holding their own junk. That’s where PE came in, to form their own monopolies of medical doctors. Now the game is monopoly vs monopoly vs monopoly. All to the detriment of sick people.

Ever wonder why you can’t buy a TV at a mom and pop electronics shop any more? Now you have to go to Target, bestbuy, Amazon, or Walmart. Or why you have a choice of 2-3 cell phone carriers? Or 2 or 3 cell phone brands? Our choices and negotiating power in healthcare are limited too.

THis is a very complicated topic and goes to exactly what is wrong with the direction we are headed. Consolidation IS bad for all of us including healthcare. THE ACA had a lot to do with the consolidation.

 

[jwk]

“Acute care surgery” is the hospitalist model applied to surgery. I hadn’t even heard the term until 5 years ago.

Introduction

to Acute Care Surgery Fellowship

www.aast.org

We call them surgicalists at our place - available 24/7.

 

[aneftp]

Napa usually huffs and puffs demanding shake down non compete pay off money. But I think most places are calling Napa’s bluff. Gbmc (greater Baltimore) is going in house w2 from what I’m told. It’s a complete safe harbor strategy so napa has zero rights to enforce non compete.

Who’s a judge gonna to side with? A non profit hospital in Maryland needing anesthesia people to provide essential services for the community? Or suits from New York based napa company? That’s an easy call

That’s how the North Carolina mednax fiasco got decided as well a few year ago. Even though that North Carolina system did shady things front funding the fake side anesthesia company for that guy to run.

 

[amyl]

I’ve been a hospital employee. I hope that transition never happens. CEOs won’t care about having anesthesiologists around… if they bill the same for crnas they’ll go solo crna. IF it affects their ability to recruit surgeons they may change their minds.

 

[kidthor]

IF it affects their ability to recruit surgeons they may change their minds.

Then they’ll just convert to midlevel “surgeons”!

 

[pgg]

I agree the pooled units and paid on time thing is the fairest. Which is harder - pump cv case or running 4 quick turnover rooms in gi? No one will agree. While the GI rooms pay the bills they ability to do the big cases solidifies our necessity to the hospital. We are partners and treat each other as such. No system is perfect but pooling units and time is fairest

I don't understand why it's so hard for some people to agree that those tasks are both hard and valuable ...

I much prefer solo heart days to GI days (solo or not!), for lots of reasons.

Efficiently and safely sedating a parade of BMI 50+ trainwrecks for endoscopies, whether or not you have to trust some revolving door CRNA-of-the-week you don't know, whether or not you're also running 2 or 3 other rooms, is hard and high risk work. Even ordinary ACT work that isn't especially high turnover can be a very busy, difficult day.

It's funny but the only people I ever hear tell me that doing hearts is easy are people who don't do them. It's usually old farts who don't do hearts any more, but are oddly proud of how they used to do hearts. It's almost as if they are saying "Yeah I could do those hearts that you're doing ... I just don't feel like it." It's a very weird kind of ego flex coming from people who should know better.

A couple days ago I did a solo heart that was booked as a "CABG + possible AVR" ... could the average 4:1 GI center ACT generalist anesthesiologist have done that TEE and made the appropriate measurements and given an informed opinion to replace or not replace the valve to the surgeon? I'm going to guess no. I think that was a hard skill for me to pick up, and one that has value. Still, I value what they do, and respect that they do it well.


All of this is why I'm firmly in the camp of (anesthesiologist paycheck) = (group total revenue) / (time worked) being the most fair arrangement. Time worked should include necessary administrative positions, even if that time doesn't generate billable units. Even if not everybody does every kind of case, even if some people have schedules tilted toward hearts, or OB, or ortho/regional, or neuro, or surgicenter ACT days, everyone should get paid for their time. When I was looking for my post-Navy and hopefully last-job-ever position, I ruled out several otherwise attractive places because they didn't work this way.

 

[DrZzZz]

All of this is why I'm firmly in the camp of (anesthesiologist paycheck) = (group total revenue) / (time worked) being the most fair arrangement. Time worked should include necessary administrative positions, even if that time doesn't generate billable units. Even if not everybody does every kind of case, even if some people have schedules tilted toward hearts, or OB, or ortho/regional, or neuro, or surgicenter ACT days, everyone should get paid for their time.

Agreed. That's how my group does it. Some people cover more OB (and do no hearts), some don't ever set foot on the labor deck, some spend more time in the surgicenter taking care of healthier patients. But everyone takes the same amount of call, same vacation, same $. And if people want to work more or less, they pick up or sell shifts at a group agreed upon rate. Nothing will ever be perfectly fair or even, but this feels like the closest it will get.

 

[aneftp]

I’ve been a hospital employee. I hope that transition never happens. CEOs won’t care about having anesthesiologists around… if they bill the same for crnas they’ll go solo crna. IF it affects their ability to recruit surgeons they may change their minds.

Crna solo/collaboration model is not cheap for the hospital. They know that. That’s why you see very few crna only solo/collaboration hospital base practices in any metro area with population base model more than 500k. You see zero hospital based (that I know) crna solo model in major cities population base greater than 1 million.

There is a solo/collaboration model in the southwest. Metro 30-40 mile radius area is a little over 1 million but the actual area is less than 500k. The crna get 425-450k working around 50 hours a week. The docs aren’t much more at 500-525k but they have to do more calls. So at that point. It’s like. What’s the actual cost savings for hospital?

 

[aneftp]

Look. I have worked 1099 , 1099 with guaranteed monthly income, w2 state/academics/federal

Nothing is perfect.

My family members have done pure fee for service , schedule K, w2 hospital, academics

They all bitch and complain. So everything is relative. And of course they all think the are middle class with net worth over 10 digits.

Everyone is looking for thar perfect work/life/pay.

 

[Dr. Rude]

Look. I have worked 1099 , 1099 with guaranteed monthly income, w2 state/academics/federal

Nothing is perfect.

My family members have done pure fee for service , schedule K, w2 hospital, academics

They all bitch and complain. So everything is relative. And of course they all think the are middle class with net worth over 10 digits.

Everyone is looking for thar perfect work/life/pay.

That's a billion.

 

[amyl]

Crna solo/collaboration model is not cheap for the hospital. They know that. That’s why you see very few crna only solo/collaboration hospital base practices in any metro area with population base model more than 500k. You see zero hospital based (that I know) crna solo model in major cities population base greater than 1 million.

There is a solo/collaboration model in the southwest. Metro 30-40 mile radius area is a little over 1 million but the actual area is less than 500k. The crna get 425-450k working around 50 hours a week. The docs aren’t much more at 500-525k but they have to do more calls. So at that point. It’s like. What’s the actual cost savings for hospital?

Where do crnas make 425-450? I have never heard of this

 

[OptionOffense]

Crna solo/collaboration model is not cheap for the hospital. They know that. That’s why you see very few crna only solo/collaboration hospital base practices in any metro area with population base model more than 500k. You see zero hospital based (that I know) crna solo model in major cities population base greater than 1 million.

There is a solo/collaboration model in the southwest. Metro 30-40 mile radius area is a little over 1 million but the actual area is less than 500k. The crna get 425-450k working around 50 hours a week. The docs aren’t much more at 500-525k but they have to do more calls. So at that point. It’s like. What’s the actual cost savings for hospital?

How does collaborative practice work? You wait for a drive by consult by the CRNA? WHo consents the patients? blocks? writes orders in the PACU? Are you liable for disasters since no physician patient relationship is established!

 

[thinkorswim]

That's a billion.

He’s using Rubles.

 

[aneftp]

That's a billion.

Oops. I meant 8 digits (13-15 million range). My fault.

 

[kidthor]

That's a billion.

Inflation is out of control these days…

 

[nimbus]

Crna solo/collaboration model is not cheap for the hospital. They know that. That’s why you see very few crna only solo/collaboration hospital base practices in any metro area with population base model more than 500k. You see zero hospital based (that I know) crna solo model in major cities population base greater than 1 million.

There is a solo/collaboration model in the southwest. Metro 30-40 mile radius area is a little over 1 million but the actual area is less than 500k. The crna get 425-450k working around 50 hours a week. The docs aren’t much more at 500-525k but they have to do more calls. So at that point. It’s like. What’s the actual cost savings for hospital?

We have one CRNA only hospital in my city (SoCal major metro, population>3mil). But that is because no anesthesiologist is willing to work there. For a while, the medical director of anesthesia was a spine surgeon, but that doctor has moved to Florida so I don’t know who does it now.

FWIW, this is the payor mix there…

 

[nimbus]

That's a billion.

Only if you don’t include decimals.

 

[anbuitachi]

Where do crnas make 425-450? I have never heard of this

hospital around here crna make 600k but they also work 60 hr a week and minimal benefits. w2 position partial benefits

 

[GassYous]

We have one CRNA only hospital in my city (SoCal major metro, population>3mil). But that is because no anesthesiologist is willing to work there. For a while, the medical director of anesthesia was a spine surgeon, but that doctor has moved to Florida so I don’t know who does it now.

FWIW, this is the payor mix there…


View attachment 357809

I thought my payor mix was bad

 

[aneftp]

hospital around here crna make 600k but they also work 60 hr a week and minimal benefits. w2 position partial benefits

This is why the asa is so dumb or they know about ur but want to protect the few remaining lucrative act models with good private insurance.

My older colleagues routinely made 1 million plus working 45 hours a week in act model. There is only so few ways you can make 1 million plus not working that hard. It’s the act model with good payor mix plus under paying crna (and or partnertrack new grads you have zero intention of ever making partner).

We have one CRNA only hospital in my city (SoCal major metro, population>3mil). But that is because no anesthesiologist is willing to work there. For a while, the medical director of anesthesia was a spine surgeon, but that doctor has moved to Florida so I don’t know who does it now.

FWIW, this is the payor mix there…


View attachment 357809

That's why highly paid professionals making over 1 million pay a 1% california state income tax surcharge on mental health in addition to the 2% income tax surtax on those making 500K. It's crazy like 12-13% state income tax for high earners. This is why the hollywood celebrities have "primary homes" in wyoming, texas, florida. All the hard working higher paid professionals like doctors are paying for all these medi-cal (medicaid) services.

 

[<(^_^)>]

I feel one reason the private forum exists is to discuss salaries candidly. Probably doesn’t help to give the public falsely elevated perception of compensation for anesthestic services. How many CRNA make 600k? I am willing to bet literally less than 1%.

Remember it’s not the post someone makes about being on call 24 hours on Christmas Day and losing a peds trauma patient that will be remembered by the powers that be. It’s the posts about extreme outliers in compensation.

And as noted previously radiologist reimbursement was cut in part due to forum posts discussing how much money they made. Food for thought…

 

[marr65]

This is why the asa is so dumb or they know about ur but want to protect the few remaining lucrative act models with good private insurance.

My older colleagues routinely made 1 million plus working 45 hours a week in act model. There is only so few ways you can make 1 million plus not working that hard. It’s the act model with good payor mix plus under paying crna (and or partnertrack new grads you have zero intention of ever making partner).

That's why highly paid professionals making over 1 million pay a 1% california state income tax surcharge on mental health in addition to the 2% income tax surtax on those making 500K. It's crazy like 12-13% state income tax for high earners. This is why the hollywood celebrities have "primary homes" in wyoming, texas, florida. All the hard working higher paid professionals like doctors are paying for all these medi-cal (medicaid) services.

Ummm...the celebrities with homes elsewhere still have to pay California state income taxes if their incomes come from the state of California. It’s the same concept in professional sport where players pay taxes to the state that they played in. I’m not sure where you getting your info about celebrities with obvious tax evasion schemes but if it’s legit you should sue them and you will get a life altering payment.

 

[abolt18]

And as noted previously radiologist reimbursement was cut in part due to forum posts discussing how much money they made. Food for thought…

Is this true? You have a reference for this?

 

[aneftp]

Ummm...the celebrities with homes elsewhere still have to pay California state income taxes if their incomes come from the state of California. It’s the same concept in professional sport where players pay taxes to the state that they played in. I’m not sure where you getting your info about celebrities with obvious tax evasion schemes but if it’s legit you should sue them and you will get a life altering payment.

True. Depends where the work location is done. But there are savvy accountants. Look what Derek jeter of the Yankees did when he played baseball to avoid high New York State and city taxes. It’s all a tax game as states get desperate for more tax revenue.

Derek Jeter Flees New York, Tax Savings Soon To Follow

During Derek Jeter’s historic 16-year run as shortstop for the New York Yankees, he’s bagged five world championships, 13 All-Star appearances, 3000 hits, and more would-be starlets and hopeful models than can be counted.

www.forbes.com

Tom Hanks did the same thing with New York State taxes. Celebrities have different life styles. Why do you think Jlo has a primary home in florida.

So yes. They gotta pay state income taxes where they actually earn the money like California. But most will try to claim primary elsewhere with established homes if they can to avoid the full tax.

As for locums docs. They gotta do the same thing. But how many locums docs/nurses paid New York State income taxes say during the pandemic when hospitals were paying them $$$ ($10k for RN and 20-30k for docs each week). Remember you are suppose to pay state income taxes there even if u live in florida. But the locums companies cut a lot of checks from Texas. Many are riding under the table and not reporting state income taxes especially when they live in Texas or florida. It’s a well known fact that many locums do that. They take their chances. That 1099 check is from a no state income state. Sent to a non income state resident home address in florida or Texas.

States don’t have the resources to go after everyone.

 

[RemyMcswain]

hospital around here crna make 600k but they also work 60 hr a week and minimal benefits. w2 position partial benefits

What hospital are CRNAs making 600k?

 

[<(^_^)>]

Is this true? You have a reference for this?

Looking back it’s hard to find a source for this (partially because there have been so many cuts). A couple radiologists told me this in medical school and I did see a couple of people mention it on SDN, but again without a source. So this may be untrue…although you can also bet that discussions of making millions off of infusion centers/dialysis centers/imaging centers have not gone unnoticed. The deficit reduction act in 2006 had a pretty significant impact on radiologists and wasn’t an accident. Same with stark law.

Either way I don’t think it’s productive to discuss absurd outliers as if they’re the norm. I know at my hospital a CRNA making 600k would have to work about 100 hours a week, every week.

 

[jwk]

Looking back it’s hard to find a source for this (partially because there have been so many cuts). A couple radiologists told me this in medical school and I did see a couple of people mention it on SDN, but again without a source. So this may be untrue…although you can also bet that discussions of making millions off of infusion centers/dialysis centers/imaging centers have not gone unnoticed. The deficit reduction act in 2006 had a pretty significant impact on radiologists and wasn’t an accident. Same with stark law.

Either way I don’t think it’s productive to discuss absurd outliers as if they’re the norm. I know at my hospital a CRNA making 600k would have to work about 100 hours a week, every week.

Even as an outlier I'd have a hard time believing $600k. CRNAs are flocking to locums positions now in the $175-200/hr range, and that's pretty rare air equating to $350-400k per year. Even adding $800-1000/wk for per diems doesn't get anywhere close to that. And even if there is, nobody is going to publicize or admit that they're paying that absurd amount.

 

[BLADEMDA]

Where do crnas make 425-450? I have never heard of this

Amyl, I have heard reports from my CRNAs that in Indiana and Kansas there are "collaborative" agreement practices where CRNAS are not supervised with salaries in the $400-$425K range. I am surprised you have never heard this before since you did time in Indiana.

 

[BLADEMDA]

Even as an outlier I'd have a hard time believing $600k. CRNAs are flocking to locums positions now in the $175-200/hr range, and that's pretty rare air equating to $350-400k per year. Even adding $800-1000/wk for per diems doesn't get anywhere close to that. And even if there is, nobody is going to publicize or admit that they're paying that absurd amount.

Locums rate for CRNAs in my area, very wide area of over 2 million people, is $175 per hour with extra stipend for housing, car, etc. Please do the math at $175 per hour:

$175 x 48 hours per week- $8400 x 48 weeks= $403,200. I didn't even bother with the stipend money. This is 1099 income without any benefits.

 

[OptionOffense]

Amyl, I have heard reports from my CRNAs that in Indiana and Kansas there are "collaborative" agreement practices where CRNAS are not supervised with salaries in the $400-$425K range. I am surprised you have never heard this before since you did time in Indiana.

What is a collaborative practice? What are our requirements? Do we have to see the patient or be available for consultation? How is this reimbursed?

 

[BLADEMDA]

https://achi.net/wp-content/uploads/2018/01/State-Approaches-to-Scope-of-Practice-Certified-Registered-Nurse-Anesthetists.pdf

FAQs on Operating Room Efficiency and Anesthesia Staffing Models

As a full-service anesthesia management company, DPI fields many questions surrounding the various types of anesthesia staffing models and how they impact operating room efficiency.

dpianes.com

 

[BLADEMDA]

What is a collaborative practice? What are our requirements? Do we have to see the patient or be available for consultation? How is this reimbursed?

Depends on state law and hospital by-laws. If the state and hospital permit it, then the CRNA can practice 100% independently without any legal agreement. In other hospitals, the CRNA "collaborates" with a physician to discuss the case prior to the anesthetic if needed. Reimbursement varies from QZ to CRNA only billing.

 

[HemeOncHopeful19]

Looking back it’s hard to find a source for this (partially because there have been so many cuts). A couple radiologists told me this in medical school and I did see a couple of people mention it on SDN, but again without a source. So this may be untrue…although you can also bet that discussions of making millions off of infusion centers/dialysis centers/imaging centers have not gone unnoticed. The deficit reduction act in 2006 had a pretty significant impact on radiologists and wasn’t an accident. Same with stark law.

So basically you're making it up...

You do realize that the government doesn't need to come to an internet forum to figure out how much money doctors are making?

They're the government. They pay us. Somewhere in a server is a spreadsheet with exactly how much they spend on Radiology, Dialysis, Infusion centers, etc.

In fact in 2022 now that most docs are employed I would wager the government has a better idea than doctors do about how much they're paying for the work physicians do. The ONLY people hurt by not talking about how much we're worth is our colleagues and by extension ourselves when our colleagues then go out and take crappy jobs that make the job market worse for all of us.

 

[<(^_^)>]

So basically you're making it up...

You do realize that the government doesn't need to come to an internet forum to figure out how much money doctors are making?

They're the government. They pay us. Somewhere in a server is a spreadsheet with exactly how much they spend on Radiology, Dialysis, Infusion centers, etc.

In fact in 2022 now that most docs are employed I would wager the government has a better idea than doctors do about how much they're paying for the work physicians do. The ONLY people hurt by not talking about how much we're worth is our colleagues and by extension ourselves when our colleagues then go out and take crappy jobs that make the job market worse for all of us.

Well that’s one perspective. On the other hand the government is defrauded all the time. It’s not like PPP went smoothly. I just googled “Medicare fraud” and someone indicted last week apparently stole 174M and took 4 years to be caught.

My main point was that it isn’t prudent to exaggerate compensation (or focus on extreme outliers) on a public board when the #2 concern for the American public is reducing healthcare costs. Someone gets a bill after surgery and starts looking up how much surgeons/anesthesiologists make and stumbles on a thread talking about how we know a guy that knows a guy that makes 7 figures (albeit locums in Montana/North Dakota/Wyoming/Alaska) and 80 hours a week 4-8:1 or nights only) or a CRNA that makes 600k (by blade’s math 75 hour weeks moving around the country going wherever pays best - living out of a holiday inn all year) and thinks “wow they all make absurd amounts!” and that must be why his insurance is so much!

Somehow “Probably doesn’t help to give the public falsely elevated perception of compensation for anesthestic services.” has become “never discuss compensation”.

 

[amyl]

Amyl, I have heard reports from my CRNAs that in Indiana and Kansas there are "collaborative" agreement practices where CRNAS are not supervised with salaries in the $400-$425K range. I am surprised you have never heard this before since you did time in Indiana.

Yea she made 200 no call no weekends. Not 400!

 

[OptionOffense]

In other hospitals, the CRNA "collaborates" with a physician to discuss the case prior to the anesthetic if needed. Reimbursement varies from QZ to CRNA only billing.

How are we involved legally though? What's in it for us? Is it like me coming into your room and saying hey Blade, would you do an epidural for this next guy hes been off of his eliquis for 71 hours and his plateles are 89? You give me your opinion but i sure as **** dont involve you in the care or decisionmaking legally on the chart? In a collaborative agreement, what do I document? From what I can see there really is no upside in getting involved collaboratively.

 

[kidthor]

How are we involved legally though? What's in it for us? Is it like me coming into your room and saying hey Blade, would you do an epidural for this next guy hes been off of his eliquis for 71 hours and his plateles are 89? You give me your opinion but i sure as **** dont involve you in the care or decisionmaking legally on the chart? In a collaborative agreement, what do I document? From what I can see there really is no upside in getting involved collaboratively.

Just them documenting "Discussed with Dr. OO" is enough to get you named in the suit. From there you'll be stuck trying to argue how you weren't involved despite the CRNA documenting you were, and the plaintiff's attorney wanting a piece of your deep pocket.

So basically I don't see any way to avoid liability in the so called collaborative model.

 

[OptionOffense]

Just them documenting "Discussed with Dr. OO" is enough to get you named in the suit. From there you'll be stuck trying to argue how you weren't involved despite the CRNA documenting you were, and the plaintiff's attorney wants your deep pockets.

So basically I don't see any way to avoid liability in the so called collaborative model.

Is that how the collaborative model works? Discussed with Dr SDN? I was contacted by a recruiter a few months ago about a surgery center that was like that. Collaborative. I asked if they have a crna that is "autonomous" according to what the recruiter told me why do you need me? Just find another CRNA... I dont get it.. She never explained it to me so I blocked her number.

 

[crash2500]

How are we involved legally though? What's in it for us? Is it like me coming into your room and saying hey Blade, would you do an epidural for this next guy hes been off of his eliquis for 71 hours and his plateles are 89? You give me your opinion but i sure as **** dont involve you in the care or decisionmaking legally on the chart? In a collaborative agreement, what do I document? From what I can see there really is no upside in getting involved collaboratively.

You can either do medical supervision which is billing qz like blade said or you do full independent practice.

Supervision entails doing a pre-op and discussing the plan with anesthetist but not needing to meet all the requirements for standard medical direction. Basically you never have to see the patient again. If the crna needs your help they can call you because you're ultimately responsible for the outcome. You can not sit your own cases while doing this. Basically with be running 1:8 supervision doing this.

Full independent practice means you do your own cases and have nothing to do with the crnas. They are on their own. You might still be obliged to help if you're in the hospital and not doing anything in any emergent situation but you're ultimately not responsible. We had a poster here who was in the middle on the west coast. He mentioned that when he wasn't in a case he'd leave the hospital so he wouldn't get called into these emergent situations.

I've never worked in either setup so please correct me if I'm wrong.

 

[kidthor]

Reshaping the Future Anesthesiology Model of Care

Here's an envision subsidiary explaining what the "Collaborative Anesthesiology Team" is. It's as nebulous and sketchy as you'd think.

 

[OptionOffense]

Reshaping the Future Anesthesiology Model of Care

Here's an envision subsidiary explaining what the "Collaborative Anesthesiology Team" is. It's as nebulous and sketchy as you'd think.

Do i sign the chart or not?

 

[vector2]

You can either do medical supervision which is billing qz like blade said or you do full independent practice.

Supervision entails doing a pre-op and discussing the plan with anesthetist but not needing to meet all the requirements for standard medical direction. Basically you never have to see the patient again. If the crna needs your help they can call you because you're ultimately responsible for the outcome. You can not sit your own cases while doing this. Basically with be running 1:8 supervision doing this.

Full independent practice means you do your own cases and have nothing to do with the crnas. They are on their own. You might still be obliged to help if you're in the hospital and not doing anything in any emergent situation but you're ultimately not responsible. We had a poster here who was in the middle on the west coast. He mentioned that when he wasn't in a case he'd leave the hospital so he wouldn't get called into these emergent situations.

I've never worked in either setup so please correct me if I'm wrong.

Medical supervision is not QZ. AD is medical supervision. QZ is CRNA only, and practices who bill QZ even when anesthesiologists are present (just to collect a higher rate) are engaging in fraud.

 

[crash2500]

Medical supervision is not QZ. AD is medical supervision. QZ is CRNA only, and practices who bill QZ even when anesthesiologists are present (just to collect a higher rate) are engaging in fraud.

View attachment 357862

Oh ok got it. I got it backwards. Qz is independent crna.

 

[Dr. Rude]

Oh ok got it. I got it backwards. Qz is independent crna.

Independent for billing purposes. Not necessarily per employment contract or institutional bylaws.

 

[aneftp]

Medical supervision is not QZ. AD is medical supervision. QZ is CRNA only, and practices who bill QZ even when anesthesiologists are present (just to collect a higher rate) are engaging in fraud.

View attachment 357862

All GI cases should be billed as qz. But I betcha most places do not. Considering you aren’t meeting all 7 requirements of Medicare for direction with GI.

 

[crash2500]

Independent for billing purposes. Not necessarily per employment contract or institutional bylaws.

So qz billing good still be liable for a bad outcome? Can't be true. Your don't get anything when a crna bills qz.