Question for department chiefs

[Pinkegg]

For heads of departments with care team models, do your credentialing papers for the CRNAs list either you or someone you designate as their supervising/collaborating physician? It seems redundant and inaccurate to me, as whoever is assigned to the crna on any given day is their supervisor for that day, not you. But our hospitals’ generic credentialing paperwork uses this wording. Am I right to be taking issue with this or is it fairly standard?

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[pjl]

Standard

 

[AdmiralChz]

Very standard and it’s the same when groups hire NPs or PAs - not always the same doc of course but they just need a name who will check the box.

 

[pmichaelmd]

Standard, admin just needs a figurehead to have blanket responsibility and to fill in the blanks on the forms.

 

[Pinkegg]

Fair enough. How about with this caveat? The hospital is now switching to essentially independent crna model. The docs, including myself, are all leaving. In the interim while both are still present there are staffing gaps and they want to allow the crnas to start practicing independently while we are still around either essentially directing other rooms but with the qz modifier. I no longer feel comfortable being listed as the blanket supervising physician for every crna in the hospital if some are going to be essentially independent and I will be otherwise occupied. Am I still being unreasonable?

 

[kidthor]

If the hospital is credentialing them to practice independently and then they bill QZ... then they by definition don't need a supervising physician. The hospital can't have it both ways. Especially if you are leaving, what's the upside in enabling their exploitation of physicians?

 

[pmichaelmd]

They can't have it both ways. If you are filling the gaps and on the way out, do so on your terms. They have made their deal with the devil. I would not sign off on supervising under those conditions. I would continue to provide excellent, individual anesthesia services until it is time to go. The hospital will have to figure out how to get sign offs for independent CRNA practice if that is their choice. I suspect they will come to regret that choice, but that is how they learn.
I would also assume the surgeons understand their own liability if they are expected to sign off as the physician for anesthesia services.
Hate that you are going through that.

 

[AdmiralChz]

Agree with the above and that sucks. I would certainly stop signing the credentialing paperwork if you’re leaving and the hospital is going to that model.

Reading between the lines “essentially independent” probably means you’ll have 1 or 2 MDs on staff to put out the fires (and take all the liability, fun!). These positions from what I understand can be very lucrative but they are terrible for our profession as a whole which is why many of us (me included) on this forum denounce those that admit to that work. In a better world national societies would come out against this model of care but that’s another story.

Anyway, y’all are leaving and I’m sure you’ve expressed your concerns to the hospital. It’s their problem getting them credentialed and a further issue is most hospitals require someone on the active medical staff to be a sponsor for mid level providers - your form would probably be invalid when you left anyway.

 

[Pinkegg]

I agree with everything you said. I don’t actually leave until November and I am uncomfortable with me previous signature from when it wasn’t a ****show. I’m wondering if I have a leg to stand on to demand that form is no longer valid, and that’s why I created this post

 

[deleted126335]

Fair enough. How about with this caveat? The hospital is now switching to essentially independent crna model. The docs, including myself, are all leaving. In the interim while both are still present there are staffing gaps and they want to allow the crnas to start practicing independently while we are still around either essentially directing other rooms but with the qz modifier. I no longer feel comfortable being listed as the blanket supervising physician for every crna in the hospital if some are going to be essentially independent and I will be otherwise occupied. Am I still being unreasonable?

what is "essentially independent crna model" If it just means increasing supervision ratios or going from medical direct to QZ or medical supervision model that probably doesn't get you off the hook. Hospital bylaws and policy and procedures manual apply. Not to mention state law.

 

[Pinkegg]

Our current model is qz billing but we practice in a direction model with up to 4 rooms. Qz because we don’t always meet all the present during induction and extinction criteria.

The hospital wants the crnas that aren’t jumping ship to start functioning independently in preparation for the new model.

The crnas that are jumping ship and us docs that are jumping ship don’t feel comfortable with that and will continue to the current direction model.

That leaves my name on the credentialing paperwork as supervisor for the independent crnas who may be functioning without any doc input, but docs will be in house directing the other rooms.

I think it’s shady.

 

[IlDestriero]

I’m not sure what the legal standing would be, but if I were you, I would draft a letter indicating that you are not credentialing any CRNAs to practice independently and that you have not evaluated them for their ability to function independently outside of the care team model. You can also request that your name be removed from their official credentialing paperwork or that a notation be added to your signature noting that your support extends to the care team model only. Then when the stool hits the fan, you have a record of your request for removal from their paperwork, and the limitation on your support of their credentials that you had previously signed off on, and specifically stating you are not evaluating them for or credentialing them for independent practice. You can also request that one of the physicians remaining behind, and/or chief of staff, and/or head of surgery needs to sign any independent practice credentialing for the CRNAs.
It would at least give you a leg to stand on when they try to blame you for their failure.

 

[ryanjmy]

So how did this happen? Did the crna’s privlages not require a supervising anesthesiologist? How can administration decide what thier scope of practice should be and then ask you to sign off on it. If they want to set the scope of practice let them sign the approval. Either they want you to set the standards or they don’t. I’d tell them to **** off.

 

[Planktonmd]

Certain states require NPs to have a (collaborating) physician to sign their protocols in order for them to be licensed.
This might be the issue here.

State-Mandated Collaboration for Nurse Practitioners

Consider the following: a registered nurse with a decade of experience excels in a nurse practitioner graduate program and, after becoming board-certified by a national credentialing body, decides to establish a practice in a medically underserved rural area where it is common for health care...

journalofethics.ama-assn.org

 

[Pinkegg]

Our hospital does have bylaws that require all advanced practice nurses to have a supervisor. In practice in the test of the hospital system this functionally means the NPs and PAs are seeing patients in clinic completely independently. I’ve always thought that was sketchy but it never impacted us in the anesthesia department because we were doing legitimate supervision. Now the admins are mandating that the crnas that want to can practice independently, no input from us whatsoever, but because we are still present in the hospital they are saying it is supervision and that our contract says we agreed to do supervision. My issue is that what they are calling supervision we are calling independence.

 

[ryanjmy]

Our hospital does have bylaws that require all advanced practice nurses to have a supervisor. In practice in the test of the hospital system this functionally means the NPs and PAs are seeing patients in clinic completely independently. I’ve always thought that was sketchy but it never impacted us in the anesthesia department because we were doing legitimate supervision. Now the admins are mandating that the crnas that want to can practice independently, no input from us whatsoever, but because we are still present in the hospital they are saying it is supervision and that our contract says we agreed to do supervision. My issue is that what they are calling supervision we are calling independence.

Administration has no right to tell you how to practice anesthesia. Supervision in relation to anesthesia means more than just being in the building. It means you have the ultimate say in how the anesthetic is carried out and it also means you have the responsibility of making sure its done safe. I’d make it very clear that you will not be listed as the supervising anesthesiologist on those cases. Furthermore make it clear that you wont be bailing those crnas out when things go bad.

I’m not sure why you’re willing to just accept what administration says. What do you have to lose?