siednarb

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Today in the Metro Detroit area it was announced that Beaumont Health - one of the largest health care system in the Detroit area was turning toward Northstar for it's anesthesia services. Attached is the letter from Beaumont's CEO. NAPA recently acquired Mednax's American Anesthesia division which has the physician contract at Beaumont's other main hospitals in the area. I imagine that Beaumont will ask NAPA to take on the CRNAs or risk losing it all to NorthStar. I do not work for this health system but am in the area in one of the remaining private practice groups watching with concern the corporate take over of anesthesia the area.
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vector2

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"Top of their license" ✔

"Collaborative manner" ✔

"MDA" ✔


CEO sounds like a real gem.

And who exactly over the past 10-15 years has been moving to an outsourced model like he says? Mayo, Cleveland Clinic, Ochsner, Geisinger, and almost every other large, integrated health system similar to Beaumont (other than say Northwell) all have in-house anesthesia.

Also, what's going to happen to happen to the anesthesia residency there?
 
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ambiturner

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Beaumont was one of the most respected and desirable practices in the country just ten years ago. A joke at Michigan’s anesthesia department was ‘University of Michigan: we train Beaumont doctors’. One of the more recent ASA presidents works there.

Hard to believe this is going to be a desirable practice going forward...
 
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I’ve never worked in a system where the hospital employs the CRNAS and the group is still independent. How does that work? Do the docs get all the anesthesia billing? Seems like a nightmare from a management perspective (Since you’ve got no control over hiring/firing CRNAs) but a $$$ from a financial perspective.
 

Man o War

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Oh boy- CRNAs are going to hate that. My understanding of this situation is they’ve been trying to offload the nurses for longer than 2 years. They’ve been allowed quite a bit of latitude as far as scheduling, so you can imagine what the OT looks like.
 

cockblockandrun

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WTF is "MDA" (p.s. I know that it means but its infuriating to see the CEO write that).... I guess Deathstar is going to run Michigan to the ground. More locums work for me :)
 
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hypnosMD

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Notice the release never mentions positive feedback from “MDAs” regarding Deathstar. No surprises here. They better get ready for their call burden/hours to go up 50% (oh we are short staffed) and benefits to tank (all of which effectively equates to a massive decrease in hourly compensation).
 

DrZzZz

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I’ve never worked in a system where the hospital employs the CRNAS and the group is still independent. How does that work? Do the docs get all the anesthesia billing? Seems like a nightmare from a management perspective (Since you’ve got no control over hiring/firing CRNAs) but a $$$ from a financial perspective.
I'm sure one practice varies from the next. In my experience, the group and hospital split the anesthesia fees based on some agreement in the contract. Group doesn't have direct say in hiring and firing, of course, but certainly can influence the powers that be if anyone who has been hired is troublesome. Depends on the relationship as to how effective that conversation is. Financially, it's more lucrative than employing the CRNAs, but potentially can be more of a headache dealing with rogue CRNAs since it's harder to get them removed.
 

siednarb

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The original Beaumont (RO and Troy) anesthesia physician practices sold to Mednax ~ 7 years ago
Mednax sold off it's Anesthesia division to NAPA last month as I think most are aware
not sure what is going to happen to RO/Troy hospitals

Beaumont Dearborn and points south are all going to become NorthStar
Many of these hospitals had been with A4 (Ann Arbor group) which sold to a VC firm a year ago - SiroMed
Not sure if A4 is going to try to hold up noncompete against NorthStar

Also Beaumont CRNAs were starting to make overtures to forming a union from rumors I had been hearing

All of these factors I'm sure played a role in Beaumont making this move
The likely result will be decreased quality and devotion by these anesthesia departments to their institution over time

The ASA president who was once part of Beaumont's private practice (later Mednax) moved to Cedars Sinai in LA I think a year or two ago
 
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Southpaw

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I’ve never worked in a system where the hospital employs the CRNAS and the group is still independent. How does that work? Do the docs get all the anesthesia billing? Seems like a nightmare from a management perspective (Since you’ve got no control over hiring/firing CRNAs) but a $$$ from a financial perspective.
The billing is split 50:50 as the hospital will bill for CRNA professional services and the group will bill for physician medical direction (typically). From a money persective, it simply depends on the cost of the CRNAs. Your group income is professional billing fees. Your expenses are overhead (billing, CRNAs, etc.). It's simple math. From a management perspective, it depends on the relationship between the hospital and physician group. Obviously, one can imagine the hospital's incentive in the arrangement.

It's easy to envision a scenario where reimbursement stagnates (already has happened...) and yet CRNA demands (salary, benefits, overtime, etc.) increase leaving groups who employ CRNAs few options aside from 1) paying physicians less, 2) asking the hospital for a CRNA subsidy, or 3) asking the hospital to employ the CRNAs. One can also imagine how that scenario plays out and what position it puts the physician group in.

If a physician group is unwilling to do the cases themselves or if they are unable or unwilling to bring in AAs then they make the equation more difficult for themself.
 

Southpaw

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The original Beaumont (RO and Troy) anesthesia physician practices sold to Mednax ~ 7 years ago
Mednax sold off it's Anesthesia division to NAPA last month as I think most are aware
not sure what is going to happen to RO/Troy hospitals

Beaumont Dearborn and points south are all going to become NorthStar
Many of these hospitals had been with A4 (Ann Arbor group) which sold to a VC firm a year ago - SiroMed
Not sure if A4 is going to try to hold up noncompete against NorthStar

Also Beaumont CRNAs were starting to make overtures to forming a union from rumors I had been hearing

All of these factors I'm sure played a role in Beaumont making this move
The likely result will be decreased quality and devotion by these anesthesia departments to their institution over time

The ASA president who was once part of Beaumont's private practice (later Mednax) moved to Cedars Sinai in LA I think a year or two ago
Your prediction of decreased quality and devotion is fact as it's been proven time and time again. Physicians will not perform well, long-term, in environments where corporate executives are constantly trying to find ways to profit off of them. They're smart people and they figure it out. Guess who REALLY suffers in the end? Communities and patients.

Corporate medicine is bad for everyone.
 

chocomorsel

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and that letter was signed by a physician, the CMO of the system. One MD calling another MDA, as if it means something less. If we don't stand up for ourselves no one will.
I do locums in a place where all the OR staff including the anesthesiologists are all very familiar and comfortable with MDA. It’s also a place with rogue and rude CRNAs and wimpy docs. The doc who stood up to some of the surgeons got pushed out.
 
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dannyboy1

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I do locums in a place where all the OR staff including the anesthesiologists are all very familiar and comfortable with MDA. It’s also a place with rogue and rude CRNAs and wimpy docs. The doc who stood up to some of the surgeons got pushed out.
The surgeons will be respected and catered to because they bring in $$. We are an expense, a necessary evil. The CRNA can get away with rude and obnoxious behavior because they are paid less then us therefore are more valuable. These are the realities of life in anesthesia. We are not special. There are plenty of us who can do the job safely and effectively while also kissing @ss. The only thing that you should work for is a paycheck. If you expect anything else you will be disappointed.....
 

chocomorsel

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The surgeons will be respected and catered to because they bring in $$. We are an expense, a necessary evil. The CRNA can get away with rude and obnoxious behavior because they are paid less then us therefore are more valuable. These are the realities of life in anesthesia. We are not special. There are plenty of us who can do the job safely and effectively while also kissing @ss. The only thing that you should work for is a paycheck. If you expect anything else you will be disappointed.....
Plenty of other places I have worked where this is not the norm. Where anesthesiologists are treated respectfully and called doctors not MDAs. I am at such a place now.

I don’t have to kiss ass, I don’t have to be rude. And I don’t take well to being treated like crap if I can help it.
 

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Not sure what the deal is with NAPA in my area but I have been getting almost daily texts or calls from them. They must be desperate to fill some vacant spots because they definitely aren’t expanding in my region.
 

aneftp

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Sounds like the mednax scope anesthesia fiasco in North Carolina. Where hospital retain cRna billing rights. So had all the power to just give the contract to the scope anesthesia/fake 3rd party subsidy.
 

IMGASMD

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Many, but not all of those who use the term know that it irritates us.


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I thought FL use that term a lot.

I was talking to someone who has been working for a long time In the NE, used that term as if it’s nothing.
 

MoMoGesiologist

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Does anyone else not really care about the term MDA? so much easier than saying/typing “AnEsThesIOLoGist” (a whole 7 syllables!)
 

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Does anyone else not really care about the term MDA? so much easier than saying/typing “AnEsThesIOLoGist” (a whole 7 syllables!)
If it stood alone, I wouldn't give a sh!t. But it doesn't stand alone. It must be viewed in the totality of our place in the Jungle and how that place is changing.
 
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Southpaw

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Does anyone else not really care about the term MDA? so much easier than saying/typing “AnEsThesIOLoGist” (a whole 7 syllables!)
the funny thing about the term MDA is that I've only seen it used in places with CRNAs, which leads me to believe that they start it for nefarious reasons. I'd love to be proven wrong. So if any of you MD only peeps out there get called MDA at your place, then let us hear it.
 

chocomorsel

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the funny thing about the term MDA is that I've only seen it used in places with CRNAs, which leads me to believe that they start it for nefarious reasons. I'd love to be proven wrong. So if any of you MD only peeps out there get called MDA at your place, then let us hear it.
Absolutely true.
 

chocomorsel

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I’ve never been called an MD(A).
I’ve never supervised in the 10+ years i’ve been out of residency.
You are a lucky, lucky man. My friends who used to not supervise are now supervising. I avoid it in practice as much as I can. Rather work collaboratively with nurses than supervise them.
 

narcotics999

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You are a lucky, lucky man. My friends who used to not supervise are now supervising. I avoid it in practice as much as I can. Rather work collaboratively with nurses than supervise them.
What is the meaning of "collaboratively"? You still cover their axx when $hit hits the fan? Are you liable for their mistakes if they ask your help?
 

chocomorsel

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What is the meaning of "collaboratively"? You still cover their axx when $hit hits the fan? Are you liable for their mistakes if they ask your help?
As in they do their cases completely on their own and I do my own cases completely on their own. That is my definition of it. Instead of running around like a chicken with my head cut off putting out fires and dealing with bad attitudes. And I would not be liable for any of their problems. Just my own.
Of course, in the real world, when a room is in crisis and calls for help, then everyone usually goes running to assist. This happened to me recently in a case with an emergency. I do think that this could create a problem for a physician though who goes to help a room staffed by a CRNA simply because we are seen as having deeper pockets. Of course you would hope that as someone running to assist, you aren't named in a lawsuit. I don't put people's names down on paper when they come to help me. I just write "called for help and assistance arrived."
A nurse though is taught differently and I wouldn't put it past them to try and throw someone else, a helping doc under the bus.
 
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MoMoGesiologist

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As in they do their cases completely on their own and I do my own cases completely on their own. That is my definition of it. Instead of running around like a chicken with my head cut off putting out fires and dealing with bad attitudes. And I would not be liable for any of their problems. Just my own.
Of course, in the real world, when a room is in crisis and calls for help, then everyone usually goes running to assist. This happened to me recently in a case with an emergency. I do think that this could create a problem for a physician though who goes to help a room staffed by a CRNA simply because we are seen as having deeper pockets. Of course you would hope that as someone running to assist, you aren't named in a lawsuit. I don't put people's names down on paper when they come to help me. I just write "called for help and assistance arrived."
A nurse though is taught different and I wouldn't put it past them to try and throw someone else, a helping doc under the bus.
Is that why the circulator always asks for my name anytime I go into a room? Nurses are always writing down names, writing up people. Is there a course in nursing school on how to eff other people over? Maybe it’s called “Not on my license 101l
 
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chocomorsel

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Is that why the circulator always asks for my name anytime I go into a room? Nurses are always writing down names, writing up people. Is there a course in nursing school on how to eff other people over? Maybe it’s called “Not on my license 101l
Probably. They document it. Pay attention next time.
We were always taught, document document document to CYA. Anytime you call a or communicate w doctors about something, document.
 

IMGASMD

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Probably. They document it. Pay attention next time.
We were always taught, document document document to CYA. Anytime you call a or communicate w doctors about something, document.
They don’t ever want to be caught “practicing medicine” without a license. I document what’s “necessary” to get paid, unless it’s a very bad case....

If that’s too big of a word for you, then how ‘bout you just say “Doctor”.
What about doctor of nursing practice?!
 

Lecithin5

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As in they do their cases completely on their own and I do my own cases completely on their own. That is my definition of it. Instead of running around like a chicken with my head cut off putting out fires and dealing with bad attitudes. And I would not be liable for any of their problems. Just my own.
Of course, in the real world, when a room is in crisis and calls for help, then everyone usually goes running to assist. This happened to me recently in a case with an emergency. I do think that this could create a problem for a physician though who goes to help a room staffed by a CRNA simply because we are seen as having deeper pockets. Of course you would hope that as someone running to assist, you aren't named in a lawsuit. I don't put people's names down on paper when they come to help me. I just write "called for help and assistance arrived."
A nurse though is taught differently and I wouldn't put it past them to try and throw someone else, a helping doc under the bus.
That’s kind of the annoying thing about helping someone who documents names- for example, if I am asked to help place a difficult epidural after a colleague attempted God knows how many times, only for them to document “Dr Lecithin5 came to help place epidural...”. Great, thanks a lot
 
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