huh? how does a crna change the overall reimbursement for a case? this doesn't mean that the money being paid out is less.
I am not sure if this is true or not but I suppose it depends upon who is paying, private insurance vs. medicare etc.
the fact is that most crnas are hospital employees who get paid a salary out of what the hospital collects as reimbursement for their services. this doesn't mean payers will pay less because a crna is signed-on to a case, at least from a federal government perspective.
This may or may not be true, but it would be cheaper for the hospital to hire a CRNA to do the cases than it would be for them to hire an anesthesiologist. If they get paid the same for either, why would they pay more to have an M.D., provided that outcomes are similar.
The hospital is then free to transfer whatever the price difference is to another portion of the budget as needed. Unfortunately if you provide a service that people
need and there is someone else who can do it cheaper, you lose. I think our system is having to do much more with much less, and using cheaper labor is one way that the system is going to reduce costs and become more efficient. It sucks to be the M.D. who can be replaced, but it is unfortunately inevitable as our system looks for ways to stay afloat.
with independent practice rights, crna's will just get to collect what anesthesiologists collect.
Highly doubtful. No one is going to pay a nurse as much as they pay a doctor to do the same job. If anything I would think the CRNA's would see a fairly large paycut as independent practitioners. The only reason they are making what they are now is because they are employees and currently generate far more income than they are paid. If the CRNA's suddenly become eat what you kill practitioners, they can no longer be paid from the $17k per hour or whatever that the hospital gets paid just to have a patient in the OR. If the hospital dips into that money and the CRNA isn't an employee its called fee sharing or kickback, which is illegal.
there is a very small portion of unhealthy, sick, and elderly people who pay little into the system and use up the lions share of cost. most of these people, if you just look around your average hospital, are low socioeconomic status and have complex problems, much of which are brought on by their lifestyle and habits.
Agreed.
we have tried to push for preventive care for these folks. we can't force them to pay higher premiums because they don't have the money. both of these tacts have been tried, and they simply don't pay or change their behavior. yet, they still show-up on the hospital's doorstep.
Yeah when I was in medical school that was all the rage. A lot of idiots went into primary care thinking they were going to save the world, have lots of free time and maybe stop whaling in Japan. Its damn hard to make ends meet with a 90K salary and 250K medical school debt. Ouch.
as i said before, you revamp the system to require that physicians collect a set-fee each year from the government and, for that fee, they have to treat indigent and non-paying patients.
I am sorry I am somewhat new to the forums so I haven't seen many of your posts. If this is old ground please accept my apology and thank you for helping me get up to speed.
What you are talking about is
very very very dangerous ground. Giving the government the power to demand that you provide free care for a 'set-fee' is the beginning of the end. If you can't see where that would go, I would be happy to explain further in another post. Unfortunately I think that something like this will eventually happen. The money will probably almost be worth it to begin with and the time commitment will be minimal. Gradually the money will decrease and the time commitment will increase. Eventually no MD's would want to participate and the gov. would start tying medical licensing to participation in that sort of a scheme. I believe a couple states are already attempting something similar to that. If you accept that you can be forced to do something, anything, for less than it is worth than you have already lost the battle.
people that have cancer or need a heart operation or have severe cardiac problems but don't have the money will just have to wait their turn to get access to the system.
Yeah and the first time a 45 year old single welfare mother of 12 dies waiting for a CABG, Oprah will be waiting along with Barbra Wawwa and all of the other vultures to "expose" the evils of the system. Same exact pattern was followed with silicone breast implants (hello Connie Chung).
sounds cruel, but i don't know of any other country in the world where someone with no ability to pay can walk in with chest pain and get a full cardiac work-up and intervention in the same day.
This isn't the rest of the world. Uncle Sugar saw to that when he linked health insurance to employment after WW2. Now you've had 2 generations with the entitlement mentality. Good luck ever getting rid of it.
so, you have an obese, unemployed drinker/smoker that comes into your ER with chest pain, you demand payment up front. if they can't pay, then tough cookies. you evaluate them and then give them an appointment at the next free clinic to be followed-up.
This all sounds great but wait until she dies leaving 12 orphans and Oprah finds out about it. Or even better, wait until Edwards finds out about it and sues the living crap out of you and then uses it as a demogogue issue to get elected and further force you into the service for free role.
it's really simple, but requires some tough love on our profession's part.
The problem is that the profession sold out long ago. The first time a doctor accepted $45 dollars from an insurance company when his fee was $60, that doctor sold himself and everyone who came after out. Once you buy into the argument that someone can pay part of your bill and get away with it you have essentially declared your own slavery moral.
I am not trying to be contentious with my posts. Believe me when I tell you that we are on the same side.
or, maybe you're "working" tonight? i bet that's it. you're covering that tough holiday shift collecting your $85/hr for sitting on your ass surfing a doctor's forum with every other nurse in the hospital wishing they were you... but that's not good enough... there you are still wishing you had the last twenty years of your life back... oh what you would've done differently... so, instead you're going to do everything you can now to get what you perceive is that last little slice of the respect pie you think you deserve. (what motivates you guys is all so transparent.)
