NAPA Now in Trouble in Maryland

[Pinkegg]

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

Why would adding an anesthesiologist mean the reimbursement rate should go down? That makes no sense

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[crash2500]

Why would adding an anesthesiologist mean the reimbursement rate should go down? That makes no sense

Wouldn't it be the same bill regardless of crnas only vs medical supervision? Just a difference on the split but maybe I'm mistaken. I'm definitely not a billing guru.

 

[Dr. Rude]

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.

Yes it is true. Absolutely.

 

[OptionOffense]

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.

What are you not meeting? I assume you mean induction and emergence. we are 3 feet away at all times

 

[OptionOffense]

Yes it is true. Absolutely.

QZ billing only can happen when both MDs and CRNAs work for same group

 

[vector2]

Why would adding an anesthesiologist mean the reimbursement rate should go down? That makes no sense

Wouldn't it be the same bill regardless of crnas only vs medical supervision? Just a difference on the split but maybe I'm mistaken. I'm definitely not a billing guru.

With anesthesiologist only, medical direction, or "CRNA only" (QZ), the entirety of the typical charge for the anesthesia (startup, time, modifier units) is collected.

But with medical supervision: "From a Medicare perspective supervision refers to a scenario in which the criteria for medical direction are not met, which means that the physician is only allowed a maximum of four units per case, three base units and one time unit for induction."

Practices with anesthesiologists who aren't meeting the TEFRA steps for direction sometimes bill QZ to collect more money. But to my reading of the CMS rules, engaging in that technically sounds like fraud. Not to mention, it gives ammo to the nurses who like to mouth off about the number of "independent" CRNAs even though a whole mess of these QZ practices have an anesthesiologist firefighter in the wings.

This article explains the topic a bit: What Does the QZ Modifier Really Mean? | Anesthesia Business Consultants

 

[Pinkegg]

With anesthesiologist only, medical direction, or "CRNA only" (QZ), the entirety of the typical charge for the anesthesia (startup, time, modifier units) is collected.

But with medical supervision: "From a Medicare perspective supervision refers to a scenario in which the criteria for medical direction are not met, which means that the physician is only allowed a maximum of four units per case, three base units and one time unit for induction."

Practices with anesthesiologists who aren't meeting the TEFRA steps for direction sometimes bill QZ to collect more money. But to my reading of the CMS rules, engaging in that technically sounds like fraud. Not to mention, it gives ammo to the nurses who like to mouth off about the number of "independent" CRNAs even though a whole mess of these QZ practices have an anesthesiologist firefighter in the wings.

This article explains the topic a bit: What Does the QZ Modifier Really Mean? | Anesthesia Business Consultants

I’ve seen the definitions before but they’ve never made sense to me. So an independent CRNA is able to collect the full billable amount, but if you throw an anesthesiologist into the mix for additional backup or consultation or even a near direction like role, add all of a sudden the billlable amount goes down? It’s backwards.

I’ve heard of practices that use QZ billing but essentially practice direction for the odd time that the ratio slips past 1:4.

 

[DocMcCoy]

I’ve heard of practices that use QZ billing but essentially practice direction for the odd time that the ratio slips past 1:4.

From a legal perspective, I’ve never understood this. My shop currently never exceeds 4:1 yet always QZ bill. It’s an excuse to give the “supervising doc” more responsibilities during the day like running the board and making schedule while giving CRNAs autonomy.

I feel if your ratio is always 4:1 or less, you SHOULD be directing. I can’t imagine a case where something happens to a patient and you try to argue you were operating in a collaborative model under QZ but at the time you 2:1 or 3:1. Seems legally you should have been on the chart and involved in every step. AD, QK, etc No?

 

[IMGASMD]

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.

You give them too much credit. You think they actually know the meanings of the words out of their mouth.
They have zero understanding of schedule, billing, certainly not our liability when **** hits the fan.

 

[Dr. Rude]

QZ billing only can happen when both MDs and CRNAs work for same group

True. My point is that you can still be held liable for the CRNAs actions no matter how it is billed. Even if you didn’t meet the patient. Even if the CRNA didn’t discuss the case with you.

 

[aneftp]

What are you not meeting? I assume you mean induction and emergence. we are 3 feet away at all times

So you have dedicated doc covering gi area? Most hospital gi areas are separate from main OR areas. Newer hospitals are immediately next to the Or.

 

[jwk]

True. My point is that you can still be held liable for the CRNAs actions no matter how it is billed. Even if you didn’t meet the patient. Even if the CRNA didn’t discuss the case with you.

THIS!!!

A lot of groups that have plenty of docs as well as CRNAs bill QZ because they still get 100% of the billed amount without the hassles of complying with TEFRA. The liability is still there. Never confuse what is primarily a billing issue with "independent practice". This is one of the confusing things with "opt out" states. Opt out is a billing issue only. "Independent practice" of CRNAs is still controlled at the local group/hospital level, even in opt-out states.

Concern about QZ billing is not a new issue...this is an article from 2011...

Billing for Anesthesia Services and the QZ Modifier: A Lurking Problem | ASA Monitor | American Society of Anesthesiologists

The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and

pubs.asahq.org

Using QZ billing, there is no BILLING record of the involvement of an anesthesiologist. CRNAs use this statistical gift to bolster their argument that they do a far higher number of cases "independently" than they actually do.

 

[crash2500]

THIS!!!

A lot of groups that have plenty of docs as well as CRNAs bill QZ because they still get 100% of the billed amount without the hassles of complying with TEFRA. The liability is still there. Never confuse what is primarily a billing issue with "independent practice". This is one of the confusing things with "opt out" states. Opt out is a billing issue only. "Independent practice" of CRNAs is still controlled at the local group/hospital level, even in opt-out states.

Concern about QZ billing is not a new issue...this is an article from 2011...

Billing for Anesthesia Services and the QZ Modifier: A Lurking Problem | ASA Monitor | American Society of Anesthesiologists

The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and

pubs.asahq.org

Using QZ billing, there is no BILLING record of the involvement of an anesthesiologist. CRNAs use this statistical gift to bolster their argument that they do a far higher number of cases "independently" than they actually do.

So if your hospital has an agreement that you are responsible during qz that's one thing. What about a hospital that states in your contract that you are only responsible for the patients you are sitting cases for? Surely then you wouldn't be liable for situations that sure during a case with a crna practicing independently.

 

[Dr. Rude]

So if your hospital has an agreement that you are responsible during qz that's one thing. What about a hospital that states in your contract that you are only responsible for the patients you are sitting cases for? Surely then you wouldn't be liable for situations that sure during a case with a crna practicing independently.

If they are truly independent, no you are not responsible. But, state law has to allow it, hospital bylaws, your employment contract, the group contract with the hospital also have to allow it. Don’t be surprised that the “independent” CRNA tries to rope you in with a note “case discussed with Dr.
crash2500” also if you try to be a good citizen and respond to a patient who is in trouble that is the “independent” CRNA’s patient.

 

[turnupthegas]

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

Sounds like an Bones only hospital in the valley….

 

[IMGASMD]

So if your hospital has an agreement that you are responsible during qz that's one thing. What about a hospital that states in your contract that you are only responsible for the patients you are sitting cases for? Surely then you wouldn't be liable for situations that sure during a case with a crna practicing independently.

If “anyone” documented that you were there to help/not help…. Just a lot of unnecessary stuff they “may” follow.

 

[<(^_^)>]

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.

It’s genuinely impressive how little is said with so many words.

 

[IMGASMD]

It’s genuinely impressive how little is said with so many words.

MAC was MD only the last time I checked them out…. A few years ago (?).
I guess they’ve moved on from that model as well?

 

[jwk]

If they are truly independent, no you are not responsible. But, state law has to allow it, hospital bylaws, your employment contract, the group contract with the hospital also have to allow it. Don’t be surprised that the “independent” CRNA tries to rope you in with a note “case discussed with Dr.
crash2500” also if you try to be a good citizen and respond to a patient who is in trouble that is the “independent” CRNA’s patient.

A "collaborative" practice is a term coined by CRNAs who want the illusion of having an anesthesiologist around to bail them out when they get in over their heads, but otherwise want absolutely nothing to do with the anesthesiologist. If your name is associated at all with the case, there is potential liability attached. It might not even be on the anesthesia record. It could just be in the nurses notes, maybe just an indication that a given doc was the desgnated "board runner" or "float anesthesiologist" or whatever.

 

[GravelRider]

A "collaborative" practice is a term coined by CRNAs who want the illusion of having an anesthesiologist around to bail them out when they get in over their heads, but otherwise want absolutely nothing to do with the anesthesiologist. If your name is associated at all with the case, there is potential liability attached. It might not even be on the anesthesia record. It could just be in the nurses notes, maybe just an indication that a given doc was the desgnated "board runner" or "float anesthesiologist" or whatever.

Do we have any actual cases of anesthesiologists being sued in cases like these? I hear all these urban legends of being named in lawsuits for cases you had nothing to do with, but are there actual cases of this happening?

It makes me think about hospitalist coverage. You have the primary hospitalist during the day, but the night guy might be cross-covering 60 patients and there to put out fires and respond to inane pages. If the night guy orders a Tylenol on a cross coverage patient and down the line the patient sues for misdiagnosis, does the night hospitalist have some liability risk?

 

[DrZzZz]

Do we have any actual cases of anesthesiologists being sued in cases like these? I hear all these urban legends of being named in lawsuits for cases you had nothing to do with, but are there actual cases of this happening?

It makes me think about hospitalist coverage. You have the primary hospitalist during the day, but the night guy might be cross-covering 60 patients and there to put out fires and respond to inane pages. If the night guy orders a Tylenol on a cross coverage patient and down the line the patient sues for misdiagnosis, does the night hospitalist have some liability risk?

I know of an anesthesiologist who got sued for not acting on an EKG that was ordered as part of a standard preop workup by a preadmissions nurse and put the order under his name. He never actually saw the EKG in question since he never took care of the patient. He was very quickly removed from the lawsuit.

 

[IMGASMD]

Do we have any actual cases of anesthesiologists being sued in cases like these? I hear all these urban legends of being named in lawsuits for cases you had nothing to do with, but are there actual cases of this happening?

It makes me think about hospitalist coverage. You have the primary hospitalist during the day, but the night guy might be cross-covering 60 patients and there to put out fires and respond to inane pages. If the night guy orders a Tylenol on a cross coverage patient and down the line the patient sues for misdiagnosis, does the night hospitalist have some liability risk?

Hahaha. I cross covered more than 100 at one point, overnight. There is absolutely no way, I remember or knew anything…. especially after that night.

I think another point is that even it’s frivolous, you’d still have to spent time, energy and possibly money to sort it out.

 

[kidthor]

Do we have any actual cases of anesthesiologists being sued in cases like these? I hear all these urban legends of being named in lawsuits for cases you had nothing to do with, but are there actual cases of this happening?

It makes me think about hospitalist coverage. You have the primary hospitalist during the day, but the night guy might be cross-covering 60 patients and there to put out fires and respond to inane pages. If the night guy orders a Tylenol on a cross coverage patient and down the line the patient sues for misdiagnosis, does the night hospitalist have some liability risk?

I've seen many physicians who've been named in a suit after being only peripherally involved with something or coming to provide help during a disaster. It absolutely happens.

 

[Dr. Rude]

I've seen many physicians who've been named in a suit after being only peripherally involved with something or coming to provide help during a disaster. It absolutely happens.

Yup. I knew a doc that was not working that day and came in for a meeting. Responded to a code in the PACU. She was sued and took part of the hit in her name and got a databank entry. Not sure of the details or allegations against her.

 

[GravelRider]

I know of an anesthesiologist who got sued for not acting on an EKG that was ordered as part of a standard preop workup by a preadmissions nurse and put the order under his name. He never actually saw the EKG in question since he never took care of the patient. He was very quickly removed from the lawsuit.

I guess I should qualify my question…has anyone not just been named in a lawsuit, but had to settle or pay out? Any malpractice lawsuit will have doctors who are named and technically sued, but they are usually dropped quickly from a lawsuit. I’m wondering if anyone has had these situations where an essentially independently practicing CRNA who committed malpractice and there was an anesthesiologist in the vicinity or “collaborating,” and had to pay out on a lawsuit?

 

[aneftp]

This sentiment cannot be overstated. The younger generation is coming out onto a landscape where they feel sold out by the older guys, coupled with a very uncertain future for reimbursement and employment model. Although they are just starting to earn a decent income, they find themselves farther behind the curve than those before them, with buying a house being more difficult than ever. You can’t fault them for valuing a higher income earlier in their career. This is one of the reasons the traditional partnership buy in is dying a slow death in my opinion.

This article dates 07/25/2022 Q and A by radiologist sums up how privacy equity has ruined a lot of medicine. Especially how younger docs feel. It’s a 5 min read. Radiology anesthesiology and emergency medicine all pretty much in the same boat (no or very little overhead). Primarily hospital based. Private equity goal is to sweep in. And flip for profit in 3-5 years. Leverage debt.

Everyone is seeing what we are all seeing. No buyers for private equity flipping. They do not want to be stuck managing companies. It’s like us buying a 1 million dollar home with 5% down with a 3 year ballon payment due. 50k and flipping it for 1.5 million in 3 years years.

50k down nets 500k (in theory) that’s a hell of a return.

Now imagine Envison 9 billion dollar deal. They had to restructure debt 2 months ago. Kicked the cab down the road. Problem is that 9 billion KKR leverage may only be worth half or even less. I see no way out for KKR. Write it down. No intention of paying off the debt. And wind it down. KKR is like a homeowner from 2009-2015. They just collect as much rent as they can and have no intention of paying down the mortgage. And will let it go. No skin off their back.

 

[DrZzZz]

I guess I should qualify my question…

I knew what you were asking, but like IMGASMD said above,

even it’s frivolous, you’d still have to spent time, energy and possibly money to sort it out.

 

[Iso4ane]

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.

One man’s trash is another man’s treasure. I do hearts because I don’t like doing GI, and they do GI because they don’t like doing hearts. But, if GI days paid significantly more than the other, I would be fighting over it too.

 

[pro-propofol]

One man’s trash is another man’s treasure. I do hearts because I don’t like doing GI, and they do GI because they don’t like doing hearts. But, if GI days paid significantly more than the other, I would be fighting over it too.

They do!

 

[GravelRider]

I knew what you were asking, but like IMGASMD said above,

Right, but that’s just the risk of being a doctor. The surgeon can f*ck up and you’ll be named in a lawsuit and ultimately dropped. My point is, everyone is always talking about the liability burden that these free range CRNAs put on us, but is it actually anymore than just coming to work everyday? I’m not so sure it is, but I’m willing to hear about cases that suggest otherwise.

 

[Dr. Rude]

Right, but that’s just the risk of being a doctor. The surgeon can f*ck up and you’ll be named in a lawsuit and ultimately dropped. My point is, everyone is always talking about the liability burden that these free range CRNAs put on us, but is it actually anymore than just coming to work everyday? I’m not so sure it is, but I’m willing to hear about cases that suggest otherwise.

It is emotionally more toxic.

 

[vector2]

One man’s trash is another man’s treasure. I do hearts because I don’t like doing GI, and they do GI because they don’t like doing hearts. But, if GI days paid significantly more than the other, I would be fighting over it too.

I don't care if GI paid $50k more per year. I would still take one or two hearts a day over being the preop monkey for 4 busy GI rooms.

 

[thinkorswim]

One man’s trash is another man’s treasure. I do hearts because I don’t like doing GI, and they do GI because they don’t like doing hearts. But, if GI days paid significantly more than the other, I would be fighting over it too.

Why not have both?

At my group the lucrative GI days are picked first by higher call numbered people. The heart cases go to either a separate heart call person or someone at a lower call position, so they will be doing a heart instead of some boring spine or robotic cases. The end result is everyone gets to do something they like while having the opportunity to generate a similar income.

 

[OptionOffense]

Right, but that’s just the risk of being a doctor. The surgeon can f*ck up and you’ll be named in a lawsuit and ultimately dropped. My point is, everyone is always talking about the liability burden that these free range CRNAs put on us, but is it actually anymore than just coming to work everyday? I’m not so sure it is, but I’m willing to hear about cases that suggest otherwise.

When getting involved with CRNAs they have to do the anesthetic that you prescribe and feel comfotable shouldering the liability for. If they do not I would say your liability if pretty great with these 'free range crnas'

 

[OptionOffense]

I don't care if GI paid $50k more per year. I would still take one or two hearts a day over being the preop monkey for 4 busy GI rooms.

Of course you would because there is less work. No offense. That is how the typical heart anes thinks.

 

[undalay]

We used to have one guy make all the daily assignments. I thought he did an excellent job and was very fair. However, some people still complained. So we went to a system where we pick our own schedules. Now if we don’t like a lineup, we can only blame ourselves.

But your point is of historical interest. Until the 1980s a lot of hospitals in California and the rest of the west were staffed by individual anesthesiologists. They bought their own anesthesia machines and anesthesia carts and wheeled them from room to room. 2 of my coresidents did this in the mid 1990s. People just applied for hospital privileges, introduced themselves to surgeons, and hoped for the best. Often they would pick up scraps in the evenings until they became more established. Some places had no groups per se. They didn’t apply for “jobs.” It was more like a surgeon putting up a shingle and waiting for business to roll in.

Wow, I learn something new every day

 

[GravelRider]

When getting involved with CRNAs they have to do the anesthetic that you prescribe and feel comfotable shouldering the liability for. If they do not I would say your liability if pretty great with these 'free range crnas'

I’m talking specifically about the “collaborative” model or the firefighter model. Do we have cases where an independently practicing CRNA committed malpractice and the anesthesiologist “board runner” or guy doing his own case in another room was sued successfully?

 

[vector2]

Of course you would because there is less work. No offense. That is how the typical heart anes thinks.

It is more "work" in a sense, but the kind of work it is is what matters. Innumerable GI preops (especially the healthier outpatient kind) is mindless time-consuming busywork. Actually providing/doing anesthesia is what I was trained to do, and doing that is a 100x more interesting and fulfilling. A type A dissection / circ arrest case requiring MTP after coming off pump or a liver TX gone bad is a ****ton of "work" both mentally and physically, but I'd much rather be doing that than filling out preops and signing charts for the CRNAs.

 

[OptionOffense]

It is more "work" in a sense, but the kind of work it is is what matters. Innumerable GI preops (especially the healthier outpatient kind) is mindless time-consuming busywork. Actually providing/doing anesthesia is what I was trained to do, and doing that is a 100x more interesting and fulfilling. A type A dissection / circ arrest case requiring MTP after coming off pump or a liver TX gone bad is a ****ton of "work" both mentally and physically, but I'd much rather be doing that than filling out preops and signing charts for the CRNAs.

Even pushing the propofol personally on 18 different outpatients the typical heart anes would scoff at. It's just too much. If it were so easy people would want to do it.

 

[vector2]

Even pushing the propofol personally on 18 different outpatients the typical heart anes would scoff at. It's just too much. If it were so easy people would want to do it.

Personally pushing prop for endo is easy from an anesthetic perspective (outside of the occasional ASA 3.5 or 4). The "difficult" part is the annoyance of having to turn over the room, clean the monitors, pull up the meds, etc 18 times. That is, to say, the part that makes it difficult is the part that doesn't necessarily require an anesthesiologist's expertise. I'm not trying to make it a pissing contest, but the reality is I can do that job if I wanted to- I would just rather choose not to. For most cardiac cases, you (non cardiac folks) can't do my job even if you wanted. There lies the difference.

 

[kidthor]

Personally pushing prop for endo is easy from an anesthetic perspective (outside of the occasional ASA 3.5 or 4). The "difficult" part is the annoyance of having to turn over the room, clean the monitors, pull up the meds, etc 18 times. That is, to say, the part that makes it difficult is the part that doesn't necessarily require an anesthesiologist's expertise. I'm not trying to make it a pissing contest, but the reality is I can do that job if I wanted to- I would just rather choose not to. For most cardiac cases, you (non cardiac folks) can't do my job even if you wanted. There lies the difference.

I really hate doing adult endo - just like you said it's a bunch of turnover. Where I am it's mostly complicated ASA 3.5-4 patients (ESLD, LVADs, severe cardiac pathology, etc) for ERCPs and advanced interventional stuff with the GI docs arguing about why I won't do "MAC", and overlords unsatisfied with 1:3 now wanting 1:4. No thanks.

I don't do cardiac myself but I'd rather focus on one or two big cases vs caring for a ton of ultra sick patients with a sketchy coverage ratio.

And really the proceduralist arguing to do "MAC" (TIVA GA unprotected airway) vs intubating someone with ESLD and CHF for a prone 2 hour ERCP is enough reason for me to never want to go to GI.

 

[anaesthetic]

Even pushing the propofol personally on 18 different outpatients the typical heart anes would scoff at. It's just too much. If it were so easy people would want to do it.

I do both on any given week. It’s not “too much.” It’s just annoying.

 

[thinkorswim]

As someone who does both GI and cardiac, the perfect “anesthesia day” in my mind is three 2-2.5 hour cases (ortho, spine, gyn-onc, cath lab, etc). It just seems to have the best balance without too much stress.

The "difficult" part is the annoyance of having to turn over the room, clean the monitors, pull up the meds, etc 18 times.

I really hate doing adult endo - just like you said it's a bunch of turnover.

You guys really have to turn over your own rooms and clean monitors? Ouch.

 

[IMGASMD]

Right, but that’s just the risk of being a doctor. The surgeon can f*ck up and you’ll be named in a lawsuit and ultimately dropped. My point is, everyone is always talking about the liability burden that these free range CRNAs put on us, but is it actually anymore than just coming to work everyday? I’m not so sure it is, but I’m willing to hear about cases that suggest otherwise.

Is it more than the risk of coming to work? Maybe not.

But if I were to take any responsibilities for a group of “independent” CRNAs (who claim to be as good as me) vs one of my partners/colleagues/physician…. It’s not the same. Especially in a “collaborative” care model, when I am not even financially benefiting.

I was searching for crna lawsuits and came across this.

404 Page not found | Painter Law Firm Medical Malpractice Attorneys

Painter Law Firm Medical Malpractice Attorneys

painterfirm.com

Maybe not exactly what you’re looking for, but I’d say there are cases out there.

I find it very difficult to know who in the group has been sued. It’s certainly not something that people like to bring up…. Or it may be settled and kept out of the public views.

 

[vector2]

You guys really have to turn over your own rooms and clean monitors? Ouch.

The tech situation is here is dire. We're very short techs and the ones that are here don't do ****. The residents and CRNAs very frequently have to restock their room in the morning and then do 100% of their turnover as cases progress. There's also not many premade drips/sticks nor is there an OR pharmacy, which means for pump cases the resident's gotta get here like 2+ hrs before roll time.

 

[sevoflurane]

The tech situation is here is dire. We're very short techs and the ones that are here don't do ****. The residents and CRNAs very frequently have to restock their room in the morning and then do 100% of their turnover as cases progress. There's also not many premade drips/sticks nor is there an OR pharmacy, which means for pump cases the resident's gotta get here like 2+ hrs before roll time.

that is pretty awful experience for the residents.

 

[abolt18]

that is pretty awful experience for the residents.

It's "learning."

 

[sevoflurane]

I’m talking specifically about the “collaborative” model or the firefighter model. Do we have cases where an independently practicing CRNA committed malpractice and the anesthesiologist “board runner” or guy doing his own case in another room was sued successfully?

absolutely there is increased risk for you to get roped into a law suit.

Collaborative model about 30 minutes from us recently had a relatively healthy beach chair position shoulder stroke out and lawyers are grabbing anybody they can.

You “may” get dropped, but what a PITA, especially if you have to give sworn testimony. It’s not always monetary damages. It’s the stress of being served that also accounts for the difficulty of these situations.

 

[coffeebythelake]

Using QZ billing, there is no BILLING record of the involvement of an anesthesiologist. CRNAs use this statistical gift to bolster their argument that they do a far higher number of cases "independently" than they actually do.

Yes. With QZ billing (100% fee schedule) the patient gets a single anesthesia bill so it is less confusing to the patient.
Lots of places that do ACT model do QZ billing for that reason. So the patient doesn't complain about being double billed.
The correct way would be QX (50%) for CRNA and QK (50%) for the medical directing MD
The total billing is the same.

 

[vector2]

that is pretty awful experience for the residents.

Indeed, not to mention it absolutely hurts our CRNA retention or the ability to hire docs to do MD only (or 75/25 solo/supervision).