karizma098

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i like how the anesthesiologist explained the BS between the lines, while the CRNA just pointed a finger at the anesthesiologist.

i don't know how they put up with this crap.
 

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While I know this is common, I do not understand this employment arrangement. (Hospital contracts with an indepedent anesthesia group and then directly employs the CRNA's that they will supervise.) How does it happen? and who benefits? How can this result in anything other than antagonistic working conditions?

I would never work for a group/department if they did not also employ any mid-levels I would be supervising
 

Planktonmd

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While I know this is common, I do not understand this employment arrangement. (Hospital contracts with an indepedent anesthesia group and then directly employs the CRNA's that they will supervise.) How does it happen? and who benefits? How can this result in anything other than antagonistic working conditions?

I would never work for a group/department if they did not also employ any mid-levels I would be supervising
Here is how it goes:
The CRNA's work for the hospital but the hospital and other physicians don't want to be liable for the CRNA's actions so they hire anesthesiologists (individuals or a group) to sign the charts and share the liability.
It could work if you make it clear from the very beginning to your CRNA's and to the hospital that you make all the clinical plans and decisions if you are expected to sign a chart.
 

karizma098

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yeah, stupid way for the hospital to be run.

in my experience, academic and larger hospitals here in chicago will usually directly hire both MD's and CRNA's, and they work together in the ACT environment. the hospital handles the billing and what not, MD's supervise while CRNA's run cases, usual set up, and not a ton of problems.

community hospitals usually contract an anesthesiology group for the OR, in which case the anesthesiology group has the option to hire CRNA's internally. some do so on a locum basis to save money, others are MD only, some have a few CRNA's, so on.

both of these plans work out - i don't see how an independent MD group working 'with' CRNA hospital employees would ever work out... the interests of the MD's and CRNA's have to be from a common source ( either both hospital employees or both working for a private practice group ) or there will be problems.
 

kmurp

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In CRNA heavy groups, CRNA costs can get to 50%. The fact that these guys were often collecting 100% seems bogus. I can't imagine why the hospital would take that hit. Seems as if they should have forced the anesthesia group to take on the crnas ( or replace them with docs).
 

urge

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First of all, Louisiana...

Where I work CRNAs are employed by the hospital. It is less than ideal. Double billing is an issue. Plus the line of command is broken at multiple levels and nothing can get done unless 20 meetings happen.

Plank is right. You are there to take the liability.

People should pay cash for non emergencies. I'm happy to see groups dropping out of insurance carriers.
 

kmurp

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First of all, Louisiana...

Where I work CRNAs are employed by the hospital. It is less than ideal. Double billing is an issue. Plus the line of command is broken at multiple levels and nothing can get done unless 20 meetings happen.

Plank is right. You are there to take the liability.

People should pay cash for non emergencies. I'm happy to see groups dropping out of insurance carriers.
Just a quick question. Why do the hospitals employ the CRNAs? Is this not a headache and financial drain on them? The large billing company ABC, says that this is the ideal financial setup for an anesthesia group (hospital employed CRNAs). It would seem to me that it is, therefore, bad for the hospital.
There are certainly many companies around now that will take over anesthesia departments. This could be one cause ( as well as stipends, inability to staff enough locations due to being "physician heavy" etc).
Perhaps these hospitals already have solved the cost per location problem with very low to non-existent MD:CRNA ratios?
 

urge

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I'm not an expert on this side of anesthesia, but from my limited knowledge I know that some groups cook up deals with the hospital where instead of an incentive to anesthesiologists, the hospital pays for the crnas. I imagine a management company would like this.
 

chocomorsel

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Here is how it goes:
The CRNA's work for the hospital but the hospital and other physicians don't want to be liable for the CRNA's actions so they hire anesthesiologists (individuals or a group) to sign the charts and share the liability.
It could work if you make it clear from the very beginning to your CRNA's and to the hospital that you make all the clinical plans and decisions if you are expected to sign a chart.

So are the CRNA's working on a salary paid by the hospital? Or are they billing independently for their services but still considered hospital employees? If they are already getting paid by the hospital, sounds to me like a case of greedy double dipping. They should only be getting reimbursed by one source right?
 

urge

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So are the CRNA's working on a salary paid by the hospital? Or are they billing independently for their services but still considered hospital employees? If they are already getting paid by the hospital, sounds to me like a case of greedy double dipping. They should only be getting reimbursed by one source right?
Hospital keeps whatever they make. Same with employed anesthesiologists.
 

gasaddict54

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the reimbursement is the same for MDs and crnas,,,,,,thats the problem the crap is out of the horse etc
 

kmurp

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the reimbursement is the same for MDs and crnas,,,,,,thats the problem the crap is out of the horse etc
It's certainly a problem for a group in this situation with more physicians than CRNAs. They wouldn't be able to survive. A group that is very CRNA heavy on the other hand, could do Ok in this situation, if their operating costs were low.