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Seeking comments on Crna supervision…
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Anyone have input or insight into what they are trying to accomplish with this? I imagine the AANA will have a comments campaign
cittykat
Full Member
My hunch is that they want to get rid of the physician supervision requirement for CRNAs nationwide. All states would become opt out.
“Operating physician” supervision of CRNAs has always been a joke. What is ortho going to do when a patient arrests or has an airway problem? More ancef?
“Operating physician” supervision of CRNAs has always been a joke. What is ortho going to do when a patient arrests or has an airway problem? More ancef?
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cittykat
Full Member
They state their objective in the title and summary. They likely consider physician supervision to be an obsolete, outdated, and costly administrative requirement.
“ PROPOSED RULE
Medicare and Medicaid Programs: Cutting Administrative Requirements for Excellence in Patient Care
SUMMARY:
This proposed rule would reform Medicare and Medicaid regulations deemed obsolete or excessively burdensome on healthcare providers and suppliers, with the objective of reducing costs, enhancing flexibility in delivering innovative care, and streamlining existing regulations. This reform seeks to enable healthcare professionals to devote more resources to improving patient care by eliminating or minimizing requirements that impede quality patient care or that divert resources away from furnishing high quality patient care.”
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Well I guess it’s been nice….
cittykat
Full Member
Here’s the long description for the possible rule change.
The regulations that address the health and safety provisions for anesthesia services are in Title 42 of the Code of Federal Regulations. The specific requirements for each facility type are located at § 416.42 for ASCs, § 482.52 for hospitals, § 485.524 for REHs, and § 485.639 for CAHs. The regulations vary slightly in structure across the settings but generally include requirements for items such as organization and staffing, the pre-operative anesthesia risk evaluation, anesthesia administration, service delivery, supervision, and a post-operative anesthesia evaluation. The regulations also include the requirements for the process to request a State exemption from the requirement for physician supervision of CRNAs. CMS' longstanding policy is that anesthesia must be administered only by certain qualified practitioners and the requirements vary slightly by setting in which the services are provided. CMS requires that when anesthesia services are administered by a certified registered nurse anesthetist (CRNA), the services must be under the supervision of a physician, such as the operating practitioner or an anesthesiologist who is immediately available. In 2001, CMS amended this policy to permit the Governor of a State to request an exemption from the CRNA supervision requirement if the Governor determined that it is in the best interests of the State's citizens to exercise this exemption. The exemption would permit CRNAs to practice independently if consistent with State law. Since that time, Governors from 26 states and one U.S. territory have exercised the provision to opt out of the Medicare physician supervision requirement. CMS is soliciting comments on this policy, including whether it should be retained, revised, or otherwise modified.
On December 19, 1997, we published a proposed rule entitled, “Hospital Conditions of Participation, Provider Agreements and Supplier Approval,” (62 FR 66726) in the Federal Register . We proposed, among other things, to let State law determine which professionals would be permitted to administer anesthetics, and the level of supervision required for practitioners in each category, recognizing States' traditional domain in establishing professional licensure and scope-of-practice laws. Policy surrounding the proposal was based on the principle that States traditionally regulate practitioner scope-of-practice and the lack of evidence to support maintaining a special Federal requirement for physician supervision of CRNAs that would have the effect of superseding State requirements. We also stated that a fundamental principle was to facilitate flexibility in how a hospital would meet our performance expectations, and to eliminate structure and process requirements unless there was evidence that they improved desired outcomes for patients. This proposal received significant public interest with over 20,000 public comments provided on the topic.
The final rule was published on January 18, 2001 (66 FR 4674) and was to have been effective March 19, 2001. In accordance with the proposed rule, the January 2001 final rule changed the physician supervision requirement for CRNAs furnishing anesthesia services in hospitals, ASCs, and CAHs. Under that rule, State laws would control which professionals would be permitted to administer anesthesia and the level of supervision required for CRNAs. The rule did not prohibit, limit, or restrict in any way the practice of medicine by a physician or anesthesiologist. Hospitals retained the ability to exercise stricter standards than those required by State law.
On March 19, 2001, the effective date of the final rule was delayed 60 days and published in the Federal Register (see 66 FR 15352). On May 18, the rule was further delayed for 180 days, until November 14, 2001, to explore alternatives for implementation (see 66 FR 27598). We published a new proposed rule on July 5, 2001 (66 FR 35395), which proposed an alternative method for implementing the independent practice proposal in lieu of proposing removal of the requirement. Our alternative proposal established an exemption from the physician supervision requirement by recognizing a Governor's written request to CMS attesting that after consultation with the State's Boards of Medicine and Nursing on issues related to access to and the quality of anesthesia services, and consistent with State law, he or she is aware of the State's right to an exemption from the requirement and has determined that it is in the best interests of the State's citizens to exercise this exemption. This proposed rule again received significant interest with over 28,500 public comments. The final rule was published on November 13, 2001 (66 FR 56762). Under the final rule, the previous physician supervision requirement was maintained, unless the governor of a State, in consultation with the State's Boards of Medicine and Nursing, exercises the option of exemption from this requirement, consistent with State law. In publishing the final rule, CMS stated that we believe these changes would improve the quality of care furnished through Federal programs, while recognizing the States' traditional domain in establishing professional licensure and scope-of-practice laws.
During the COVID-19 PHE, the HHS Secretary utilized authority under Section 1135 of the Act to waive the requirement that CRNAs practice under the supervision of a physician. This waiver authority permits the Secretary to waive requirements to ensure that sufficient health care items and services are available to meet the needs of the public in an area affected by a federally declared PHE. This waiver was one of many requirements that was waived during the PHE. (292) During this period, CRNA supervision was delegated to the discretion of the facility (hospital, CAH, or ASC) and state law provided that it was not inconsistent with a state's emergency preparedness or pandemic plan. This waiver expired at the end of the declared PHE on May 11, 2023.
In implementing this requirement, CMS established a shared commitment to quality care with States and Medicare providers. The shared commitment with States enables each State's Governor to assess the currently available evidence and consider data relevant to their own situation for items such as physician access, hospital and patient characteristics, and the needs of rural areas when considering the best way to deliver anesthesia care. Additionally, hospitals can, and frequently do, exercise stricter standards than required by State law. For instance, many hospitals continue to require physician supervision of CRNA services in states where governors have requested exemption from this requirement.
While licensing of health professions and scope of practice are aspects that are generally deferred to States, there is a lack of definitive evidence related to health and safety to support a singular policy position related to the supervision of CRNA services. This was a consideration at the time of the 2001 final rule and has continued to be a factor that has supported continuation of the current policy. A 2014 Cochrane review assessed studies evaluating the safety and effectiveness of different anesthesia providers. (293) The authors concluded that no definitive statement could be made regarding the superiority of one type of anesthesia care citing the complexity of perioperative care, the low intrinsic rate of complications relating directly to anesthesia services, and the potential confounding effects within the studies reviewed. Additionally, they noted that none of the data were of sufficiently high quality, frequently presented inconsistent findings, and were at risk for bias in interpreting results. Therefore, the shared commitment with states and providers has provided flexibility in enabling states to consider currently available evidence against the unique needs in each state when determining CRNA scope of practice and supervision requirements.
“H. Supervision of Anesthesia Services RFI
CMS is seeking public comments related to requirements for Medicare supervision of anesthesia services provided in hospitals, critical access hospitals (CAHs), rural emergency hospitals (REHs), and ambulatory surgical centers (ASCs).The regulations that address the health and safety provisions for anesthesia services are in Title 42 of the Code of Federal Regulations. The specific requirements for each facility type are located at § 416.42 for ASCs, § 482.52 for hospitals, § 485.524 for REHs, and § 485.639 for CAHs. The regulations vary slightly in structure across the settings but generally include requirements for items such as organization and staffing, the pre-operative anesthesia risk evaluation, anesthesia administration, service delivery, supervision, and a post-operative anesthesia evaluation. The regulations also include the requirements for the process to request a State exemption from the requirement for physician supervision of CRNAs. CMS' longstanding policy is that anesthesia must be administered only by certain qualified practitioners and the requirements vary slightly by setting in which the services are provided. CMS requires that when anesthesia services are administered by a certified registered nurse anesthetist (CRNA), the services must be under the supervision of a physician, such as the operating practitioner or an anesthesiologist who is immediately available. In 2001, CMS amended this policy to permit the Governor of a State to request an exemption from the CRNA supervision requirement if the Governor determined that it is in the best interests of the State's citizens to exercise this exemption. The exemption would permit CRNAs to practice independently if consistent with State law. Since that time, Governors from 26 states and one U.S. territory have exercised the provision to opt out of the Medicare physician supervision requirement. CMS is soliciting comments on this policy, including whether it should be retained, revised, or otherwise modified.
1. Regulatory History
Section 1861(bb) of the Act provides definitions for certified registered nurse anesthetists (CRNAs) and their services. The initial Medicare requirements for anesthesia services were published for the hospital Conditions of Participation (CoPs) on June 17, 1986 (51 FR 22010). The CoPs required that when anesthesia services are administered by a CRNA, those services must be under the supervision of the operating room practitioner or an anesthesiologist who is immediately available, if needed. CMS published similar requirements for other facilities that provide anesthesia services including ASCs in 1992 (57 FR 33899), CAHs in 1995 (60 FR 45851), and REHs in 2022 (87 FR 722293).On December 19, 1997, we published a proposed rule entitled, “Hospital Conditions of Participation, Provider Agreements and Supplier Approval,” (62 FR 66726) in the Federal Register . We proposed, among other things, to let State law determine which professionals would be permitted to administer anesthetics, and the level of supervision required for practitioners in each category, recognizing States' traditional domain in establishing professional licensure and scope-of-practice laws. Policy surrounding the proposal was based on the principle that States traditionally regulate practitioner scope-of-practice and the lack of evidence to support maintaining a special Federal requirement for physician supervision of CRNAs that would have the effect of superseding State requirements. We also stated that a fundamental principle was to facilitate flexibility in how a hospital would meet our performance expectations, and to eliminate structure and process requirements unless there was evidence that they improved desired outcomes for patients. This proposal received significant public interest with over 20,000 public comments provided on the topic.
The final rule was published on January 18, 2001 (66 FR 4674) and was to have been effective March 19, 2001. In accordance with the proposed rule, the January 2001 final rule changed the physician supervision requirement for CRNAs furnishing anesthesia services in hospitals, ASCs, and CAHs. Under that rule, State laws would control which professionals would be permitted to administer anesthesia and the level of supervision required for CRNAs. The rule did not prohibit, limit, or restrict in any way the practice of medicine by a physician or anesthesiologist. Hospitals retained the ability to exercise stricter standards than those required by State law.
On March 19, 2001, the effective date of the final rule was delayed 60 days and published in the Federal Register (see 66 FR 15352). On May 18, the rule was further delayed for 180 days, until November 14, 2001, to explore alternatives for implementation (see 66 FR 27598). We published a new proposed rule on July 5, 2001 (66 FR 35395), which proposed an alternative method for implementing the independent practice proposal in lieu of proposing removal of the requirement. Our alternative proposal established an exemption from the physician supervision requirement by recognizing a Governor's written request to CMS attesting that after consultation with the State's Boards of Medicine and Nursing on issues related to access to and the quality of anesthesia services, and consistent with State law, he or she is aware of the State's right to an exemption from the requirement and has determined that it is in the best interests of the State's citizens to exercise this exemption. This proposed rule again received significant interest with over 28,500 public comments. The final rule was published on November 13, 2001 (66 FR 56762). Under the final rule, the previous physician supervision requirement was maintained, unless the governor of a State, in consultation with the State's Boards of Medicine and Nursing, exercises the option of exemption from this requirement, consistent with State law. In publishing the final rule, CMS stated that we believe these changes would improve the quality of care furnished through Federal programs, while recognizing the States' traditional domain in establishing professional licensure and scope-of-practice laws.
During the COVID-19 PHE, the HHS Secretary utilized authority under Section 1135 of the Act to waive the requirement that CRNAs practice under the supervision of a physician. This waiver authority permits the Secretary to waive requirements to ensure that sufficient health care items and services are available to meet the needs of the public in an area affected by a federally declared PHE. This waiver was one of many requirements that was waived during the PHE. (292) During this period, CRNA supervision was delegated to the discretion of the facility (hospital, CAH, or ASC) and state law provided that it was not inconsistent with a state's emergency preparedness or pandemic plan. This waiver expired at the end of the declared PHE on May 11, 2023.
2. Current Status of Anesthesia Supervision
Since the 2001 final rule, Governors from 26 states and one U.S. territory have requested and been approved for the Medicare exemption to physician supervision of anesthesia services. These include Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, Oregon, Montana, South Dakota, Wisconsin, California, Colorado, Kentucky, Arizona, Oklahoma, Michigan, Arkansas, Wyoming, Delaware, Massachusetts, Vermont, Ohio, and Guam. Governors may request an exemption by submitting a letter to CMS signed by the Governor, following consultation with the State's Boards of Medicine and Nursing, requesting exemption from physician supervision of CRNAs. The letter from the Governor must attest that he or she has consulted with State Boards of Medicine and Nursing about issues related to access to and the quality of anesthesia services in the State and has concluded that it is in the best interests of the State's citizens to opt-out of the current physician supervision requirement, and that the opt-out is consistent with State law. CMS only approves the opt-out provision for the entire state and does not selectively apply the provision to certain areas or institutions within the state. Any restrictions to the supervision requirement at the state level must be approved by the State in accordance with state laws and requirements. The request for exemption and recognition of State laws, or the withdrawal of the request may be submitted at any time, and are effective upon submission. Exemption requests should be emailed to: [email protected].In implementing this requirement, CMS established a shared commitment to quality care with States and Medicare providers. The shared commitment with States enables each State's Governor to assess the currently available evidence and consider data relevant to their own situation for items such as physician access, hospital and patient characteristics, and the needs of rural areas when considering the best way to deliver anesthesia care. Additionally, hospitals can, and frequently do, exercise stricter standards than required by State law. For instance, many hospitals continue to require physician supervision of CRNA services in states where governors have requested exemption from this requirement.
While licensing of health professions and scope of practice are aspects that are generally deferred to States, there is a lack of definitive evidence related to health and safety to support a singular policy position related to the supervision of CRNA services. This was a consideration at the time of the 2001 final rule and has continued to be a factor that has supported continuation of the current policy. A 2014 Cochrane review assessed studies evaluating the safety and effectiveness of different anesthesia providers. (293) The authors concluded that no definitive statement could be made regarding the superiority of one type of anesthesia care citing the complexity of perioperative care, the low intrinsic rate of complications relating directly to anesthesia services, and the potential confounding effects within the studies reviewed. Additionally, they noted that none of the data were of sufficiently high quality, frequently presented inconsistent findings, and were at risk for bias in interpreting results. Therefore, the shared commitment with states and providers has provided flexibility in enabling states to consider currently available evidence against the unique needs in each state when determining CRNA scope of practice and supervision requirements.
3. Request for Information
Given this information, CMS invites public comment on the current anesthesia supervision and exemption policy as part of its ongoing review of these requirements. Specifically, CMS is seeking information, detailed sources of data, and peer-reviewed research related to the following questions:- To what extent has the current policy changed practice patterns in States that have opted out of the supervision requirement? Have facilities utilized this flexibility across all geographic areas in these states? What impact has there been on access to anesthesia services?
- What benefits or unintended consequences have emerged from the exemption to the Medicare supervision requirements?
- Are there recent sufficient objective studies assessing the safety of anesthesia services to support a policy change related to the current supervision requirements?
- Do available studies provide the level of precision necessary to make a determination related to outcomes from anesthesia services? What changes in documentation, coding, or other methods would better support assessing outcomes related to anesthesia services?
- What benefits or unintended consequences could arise if the current supervision and exemption policy is retained or eliminated.
- Does the current supervision and exemption policy provide sufficient flexibility to States to opt out of the federal supervision requirements or is the policy excessively burdensome? What changes could be made to the current policy to reduce burden while balancing patient health and safety concerns?
The JAMA study showing increased mortality with higher supervision ratios should be spammed in the cms comments section.
Side note, **** the boomer anesthesiologists that sold out the profession. Some of which are on this forum. You know who you are.
I’m still flabbergasted at the number of hospitals I come across where cardiac cases are done by CRNAs supervised 1:2 by the MD (sometimes higher!) Imagine as a patient, you pay the same whether a fellowship trained cardiac anesthesiologist or a nurse sits your anesthetic. If you were actually properly informed of your options why would you ever choose the nurse? Non profit hospitals that pull this and pocket the savings should be answerable to the community for devolving care. Biggest scam on patients and the MDs should be ashamed for participating.
Side note, **** the boomer anesthesiologists that sold out the profession. Some of which are on this forum. You know who you are.
I’m still flabbergasted at the number of hospitals I come across where cardiac cases are done by CRNAs supervised 1:2 by the MD (sometimes higher!) Imagine as a patient, you pay the same whether a fellowship trained cardiac anesthesiologist or a nurse sits your anesthetic. If you were actually properly informed of your options why would you ever choose the nurse? Non profit hospitals that pull this and pocket the savings should be answerable to the community for devolving care. Biggest scam on patients and the MDs should be ashamed for participating.
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…. And f— the anesthesiologist (boomer and nonboomer) who won’t sit their own cases, won’t retire and think increasing the care team ratios is just fine. You’ve created this mess and perpetuated it. And made it impossible to get a study together to elucidate differences in outcomes.
cittykat
Full Member
I don’t think a complication rate difference of 14% (from 5.06% to 5.75%) will be enough to move the needle. Interestingly the group 1 cohort (with 1:1 supervision) also had a relatively high complication rate of 5.48%. The correlation was not direct.
cittykat
Full Member
Are you talking about anesthesiologists who won’t take locums assignments unless they can get paid for taking call from home while a CRNA sits in-house at the hospital?
I meant the ones that haven’t sat their own cases in years… that take locums assignments with hostile Crnas who “don’t want him there” so he signs charts (like the old guy I met at the nysora conference this summer) or have permanent jobs that sit in the lounge all day and don’t do ****… you know the type. The complicit pieces of **** that make me think hmmm I’d be pissed if I was a crna and had to answer to that.
This may not be the national opt out moment but it wouldn’t surprise me if it is. This administration and the American public have as low an opinion of medicine as I have ever seen, and expanding healthcare got a lot of airtime (even if it wasn’t a primary driver) in the midterms. As cost pressures continue to mount they won’t hesitate to turn every screw they can unilaterally turn.
That said, it’s hard to predict what would actually happen if there were a national opt out as opt out states still have plenty of MD jobs in both supervisory and solo MD/CRNA practices, and neither are seeing lower salaries. But the intention is clear.
That said, it’s hard to predict what would actually happen if there were a national opt out as opt out states still have plenty of MD jobs in both supervisory and solo MD/CRNA practices, and neither are seeing lower salaries. But the intention is clear.
"Opt-out" is only possible where a state's nurse practice act authorizes independent CRNA practice. That's in the upper-20s of states I believe.
And, hospital privileging bylaws can always be more restrictive than state law, ie, mandating physician supervision even if the state nurse practice act allows it.
This is also the stuff which drives anesthesia billing folks insane. There are ~7 different Medicare anesthesia billing modifiers based on who's sitting on the stool and if it's independent practice or supervision. Medicare is known to audit suspicious dollar amounts whether innocent clerical mistakes or fraud.
Thanks @amyl for bringing this to our attention.
I took a few minutes to submit an objective, thoughtful reply, and hopefully you all do too.
Ironic they are pushing CRNA independence for "flexibility" but don't mention nationwide expansion of CAAs.
I took a few minutes to submit an objective, thoughtful reply, and hopefully you all do too.
Ironic they are pushing CRNA independence for "flexibility" but don't mention nationwide expansion of CAAs.
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Most who “supervise” eventually fall into this habit.
1. You will never be able to quantify that physician led anesthesia is superior to CRNA
2. Unfortunately, once most CRNAs get some experience, there is significant overlap/equality in the skillsets of good CRNAs and weak to average MD’s
3. While anything can happen during any case, it is relatively easy to predict which cases will likely go smoothly and you can therefore hide a weaker provider.
I kind of feel we are where EM was 10 years ago. Great salary and benefits then, but the explosion of residency slots and mid levels killed the field, and it went from a desirable specialty to one of the worst overnight. Would advise med students that the good times will not last and graduating residents would do well to do a cardiac or peds fellowship.
The only saving grace is the Crnas are even greedier than the other arnp
Are arnp in ER demanding $300hr??
I think most will work for $100-150/hr
Once arnp in ED start demanding $300/hr u will have bigger issues.
They are producing a hell of a lot of them. Supply and demand are undefeated
National opt out will definitely drive our salaries down… it may not happen over night but it will trend that way
Crnas don’t even want crna income when it’s all crna replacing the md supervision model.
Center switching contracts in January.
Center tried to get rid of md making 475k/8 weeks for 1:4 coverage
And proposed all crna
Crna full time was making 250k a year/8 weeks off (market rate for now call no weekends done at 3pm (90% plus of the time)
No calls no weekend.
Now Crnas will get 375k each /8 weeks off gurantee 1099 contract
But none of Crnas want to do 10-15 blocks per day unless they get paid another 100k
So now the center is having to pay (4) Crnas 375k a year PLUS still try to pay the doc 475k/8 weeks off.
We're ground zero for midlevels. We had em Way before EM had them. Most of my bad outcomes blindsided me
Individual anecdotes abound…. Near me-
Rural hospitals in my employer are Crna only - the main hospital is the only place we still do medical direction (except for tee’s which they do Crna only/supervised by the cardiologist which I was unaware of when I signed and might have reconsidered- it’s a slippery slope). It’s been proposed that GI go Crna only prior to my arrival - it didn’t happen but was seriously considered. In a meeting of anesthesiologists one of our senior cardiac doctors proposed running GI with loose supervision (something he will almost never have to do as cv staff and will probably die anyway before the lawsuit would come about as he is in his 70s).
I said “if that’s the plan consider this my 90 days notice.” Thankfully there were a few anesthesiologist who were willing to back me up. I know first hand what a slippery slope this is - Now we run Gi 3:1. We have to stand up and say no and walk if need be. The call oftentimes comes from inside the house - we need to call out and say f*** you to these anesthesiologists. We have a very strong chief who is likely the only reason we have a good job.
hospital admins will do whatever they can get away with…. A national CMS opt out will legitimize Crna only care and will create less opportunities for anesthesiologists leading to supply and demand flipping the other way and lowering our salaries.
People have been talking about the Crna takeover for years…. If this goes forward this is a giant step towards that happening. If you’ve been sleeping on this here’s your wake up call….
Many anesthesiologists think they’re at the end of their careers so it doesn’t matter…. Well you’ll be a patient lots longer than you’ll be a doctor. How long do you think hospitals will pay doctors to take trauma call when they can just pay Crnas… especially when trauma typically doesn’t reimburse well. Better drive carefully on those road trips….
Why is anyone surprised about this. They have made headway in trying to replace us and get rid of us.
if only the ASA was doing as much something about it …
Day by day the field is being watered down and eroded.
No one will care about hospital bylaws requiring it bc the hospital bean counters look at money not bylaws
Our seniors sold us out along time ago to the nurses
if only the ASA was doing as much something about it …
Day by day the field is being watered down and eroded.
No one will care about hospital bylaws requiring it bc the hospital bean counters look at money not bylaws
Our seniors sold us out along time ago to the nurses
I agree with much of the resentment here about past supervision/reimbursement decisions in our field.
But doing nothing under the guise of "there's no point" is no different than the older generation you're complaining about. You won't take a few minutes to craft a reply to this thing, just like those guys don't leave the lounge to go be involved in their case.
Some of these proposed changes are malicious, but many are just uninformed, and they are literally asking for direction. Standing by and doing nothing is akin to endorsing them to follow the path of least resistance.
But doing nothing under the guise of "there's no point" is no different than the older generation you're complaining about. You won't take a few minutes to craft a reply to this thing, just like those guys don't leave the lounge to go be involved in their case.
Some of these proposed changes are malicious, but many are just uninformed, and they are literally asking for direction. Standing by and doing nothing is akin to endorsing them to follow the path of least resistance.
Arch Guillotti
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lol I don’t mean to pick at you but when you signed on the job it was the greatest thing since sliced bread.
What is ASA doing about this and in general about keeping our profession around ?
The public isn’t going to care that more possible sim scenarios are being added to OSCE I can tell you that much….
The CRNA lobby will just keep spreading their ongoing lies saying their training skill set and other hogwash is the equivalent to physicians along with there bs we were nurses in a icu for x amount of years so yea we are basically physicians
They seemingly are avoiding the elephant in the room. I just see more useless articles in the ASA monitor none mentioning the biggest threat to us
We shouldn’t be involved in training our replacements either.
The public isn’t going to care that more possible sim scenarios are being added to OSCE I can tell you that much….
The CRNA lobby will just keep spreading their ongoing lies saying their training skill set and other hogwash is the equivalent to physicians along with there bs we were nurses in a icu for x amount of years so yea we are basically physicians
They seemingly are avoiding the elephant in the room. I just see more useless articles in the ASA monitor none mentioning the biggest threat to us
We shouldn’t be involved in training our replacements either.
I’m in the northeast and a large GI group now is only crnas
name and shame
This is almost 100 percent true except the reason why this should infuriate you is not because it lowers our salaries because it diminishesthe quality of care firstly..and secondly it lowers our salaries.
The ASA has been having parties with your dues
They know how to play the game well and they get away with it
clearly they are sitting idle focused on everything but the core issues at play
It is a great job - I can’t find better- it’s great because they actually listened to me…. my point really was that the old lazy guys are ubiquitous and keep undermining anesthesiologists roles whenever they can…. We have one even here…
They really piss me off.
CMS opt out is inevitable, whether it is completed at the national level or states continue to slowly opt out. Physicians have gained ZERO ground on this front.
An area where we could gain ground is in hospital accreditation guidelines. Admins love accreditations.
There is precedent for this in pediatrics. The american college of surgeons has established standards that require pediatric anesthesiologist staffing and 24/7 pediatric anesthesia availability for higher-level pediatric surgical centers.
Why aren't we pushing for similar requirements in cardiac surgery, trauma, transplant, and other high-acuity specialties? Hospitals seeking these designations should be required to demonstrate appropriate anesthesiologist staffing.
Politicians and administration do not understand the value anesthesiologist add. We are only an added cost in their eyes. We need to convince our surgical colleagues that physician-led anesthesia adds value to their programs, improves perioperative care, and is an essential component of the surgical services they want to offer.
This means working with the ACS, surgical specialty societies, and accrediting organizations rather than exclusively lobbying CMS or state legislatures. Surgeons have considerable influence over the standards governing their respective programs, and we need them advocating alongside us. If cardiac surgeons, trauma surgeons, and transplant surgeons advocate for these requirements, hospitals will have a much harder time ignoring them.
Rather than continuing to fight a losing battle of CMS opt out, we should focus on establishing anesthesiologist staffing requirements as a requirement for accreditation as a "insert subspecialty" surgical center.
An area where we could gain ground is in hospital accreditation guidelines. Admins love accreditations.
There is precedent for this in pediatrics. The american college of surgeons has established standards that require pediatric anesthesiologist staffing and 24/7 pediatric anesthesia availability for higher-level pediatric surgical centers.
Why aren't we pushing for similar requirements in cardiac surgery, trauma, transplant, and other high-acuity specialties? Hospitals seeking these designations should be required to demonstrate appropriate anesthesiologist staffing.
Politicians and administration do not understand the value anesthesiologist add. We are only an added cost in their eyes. We need to convince our surgical colleagues that physician-led anesthesia adds value to their programs, improves perioperative care, and is an essential component of the surgical services they want to offer.
This means working with the ACS, surgical specialty societies, and accrediting organizations rather than exclusively lobbying CMS or state legislatures. Surgeons have considerable influence over the standards governing their respective programs, and we need them advocating alongside us. If cardiac surgeons, trauma surgeons, and transplant surgeons advocate for these requirements, hospitals will have a much harder time ignoring them.
Rather than continuing to fight a losing battle of CMS opt out, we should focus on establishing anesthesiologist staffing requirements as a requirement for accreditation as a "insert subspecialty" surgical center.
We can do both.
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Do you know why there is this particular carve out? Seems awfully strange to direct everything and then have nothing to do with what can be some of the worst patients.
Bittersteel
Full Member
Hello from EM.
Eesh the tone in this thread reminds me of the tone in EM just before 2020, then COVID was the accelerant.
Government, private payors, and hospitals took what used to be a reasonable specialty and destroyed it.
I'm an owner in a private group. We're continuously assaulted on all fronts. The midlevel question isn't as proximal for us as it is you guys as we employ our own midlevels, use them as true physician extenders and supervise them very carefully.
The threat however is that the hospital can trash our contract and use cheap midlevel labor to replace us.
Eesh the tone in this thread reminds me of the tone in EM just before 2020, then COVID was the accelerant.
Government, private payors, and hospitals took what used to be a reasonable specialty and destroyed it.
I'm an owner in a private group. We're continuously assaulted on all fronts. The midlevel question isn't as proximal for us as it is you guys as we employ our own midlevels, use them as true physician extenders and supervise them very carefully.
The threat however is that the hospital can trash our contract and use cheap midlevel labor to replace us.
I think it was decided by our cv guys - likely led by sellout old cv guy and I wasn’t here yet to be a bitch about it yet.
It’s really depressing how they continue to sell out our field.
It’s really depressing how they continue to sell out our field.
That’s always the threat, right? A CMS national opt out for Crnas is the first step… then NPs…. Slippery slope faster than anyone realizes.
The issue is the Crnas want MD level pay.
If you extrapolate per hour worked (and Crnas loathe to be on “beeper” ) and account for premiums paid for over 40 hr and weekends. Crna and md pay is less than 15% these days. And Crnas give way less flexibility than md.
So are arnp making within 15% of EM docs??
So why are you paying dues?
cittykat
Full Member
so you are supporting an organization you feel is ineffective at best and totally ****iing corrupt at worst! is that a fair assessment?
cittykat
Full Member
cittykat
Full Member
Maybe that’s true in some places but that’s not true everywhere. There are independent CRNAs in our area happy to work for $350k doing daytime eyes/cystos/pain/podiatry at freestanding surgicenters. It’s about $200/hr or $8k/week.
