should pain docs be worried as well?

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darby11 said:
http://www.outpatientsurgery.net/ne...een-Light-to-Perform-Pain-Management-Services
Click to expand...

As anesthesiologist move from billing for income to salary, there is increasing price competition that could drive down income or redistribute it to management/superpartners/thieves.
Anesthesiologists can't start a private practice. By having income from billing rather than salary and the ability to take your patients and leave, pain docs are in a different situation. Nurses could offer cut rate pain management, but you'd compete for patients, not for contracts. Patients, especially insured patients, have no reason to choose a nurse. If pain docs become hospital employees, then their ****ed in the long term too.
The problem isn't so much competition as it is the effective kickback that employers get for choosing nurses and stealing part of the billing.
 
In my state, we have legislation limiting independent pain management practice to physicians. Can nurses write schedule 2's?
 
"Many elderly citizens are one CRNA away from a nursing home because their pain treatment is the only thing that allows them to continue to remain in their own homes."
 
The AANA's position statement "Pain Management," adopted in 1994 and revised most recently in 2005, states that: "By virtue of education and individual clinical experience, CRNAs possess the necessary knowledge and skills to employ therapeutic, physiological, pharmacological, interventional and psychological modalities in the management of acute and chronic pain."[3]

According to Barbara L. Anderson, J.D., the AANA's assistant director of state government affairs, the AANA believes CRNAs can and should be able to perform these duties without physician supervision. While Mitchell H. Tobin, J.D., senior director of state government affairs at the AANA, notes that these statements do not imply that CRNAs are seeking to practice medicine, the American Society of Interventional Pain Management (ASIPP) disagrees. The ASIPP considers practicing interventional pain management to be practicing medicine.[4]

"We do not train CRNAs and do not approve of CRNAs, or any other nonphysicians, performing interventional pain management procedures," said David Schultz, M.D., president of ASIPP.[5]
 
Somnia Anesthesia Blog


.dotimg{float:left;padding:1px;background:url(/hsimages/dot1.gif) repeat;margin:0 .5em .2em 0;}.dotimg1 img{border:3px solid #fff;}.dotimg2{background:url(/hsimages/dot2.gif) repeat;}.dotimg2 img{border:1px solid #fff;}.dotimg3{background:url(/hsimages/dot3.gif) repeat;padding:2px;}.dotimg3 img{border:2px solid #fff;}New Ruling Allows 100% Medicare Reimbursement for CRNAs Treating Pain Management Patients

Posted by Somnia Anesthesia Services on Tue, Jul 10, 2012 @ 11:32 AM

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Debates concerning the scope of practice of Certified Registered Nurse Anesthetists (CRNAs) have been prevalent in the anesthesia services industry for years. The stance on both sides of the aisle has, not surprisingly, been historically dictated by the perceived benefits or consequences from proposed laws. On one side are those who oppose legislation that expand CRNA duties (typically anesthesiologists), arguing that they are not qualified to perform certain procedures. The other side consists of CRNAs who support the proposed scope of practice changes and believe that they are qualified and capable of performing the additional duties outlined.
Wherever you may fall on the spectrum of this debate, it is difficult to argue that the rulings have typically favored the expanded role of CRNAs in the surgical setting, resulting in an increase in the utilization of CRNAs in a care team model. Since 2001, 17 states have opted out for exemption from federal regulation for physician supervision of CRNAs. Now, if a proposed Medicare rule becomes law, nurse anesthetists would also enjoy a major change in the scope of practice in pain management. In April 2011, Noridian, the Medicare contractor for the most of the western United States, imposed a rule that CRNAs would not be reimbursed for pain management service.
The proposed ruling introduced by the Centers for Medicare and Medicaid Services (CMS) allows CRNAs to request independence and receive 100% reimbursement when diagnosing and treating pain management patients as long as it's within the scope of practice in their particular state.
If the CMS ruling is enacted into law, it will be seen as another major victory for CRNAs, as well as a frustrating development for anesthesiologists who staunchly oppose expanded scope of practice legislation.
 
Jets Opinion On Crnas Doing Pain Management
 As you all know, I am not anti_CRNA.

Quite the contrary.

I'm convinced the team-model is the best way to go. Argue at will at my opinion, but lets keep that for another thread.

But CRNAs getting the OK to do pain management?

That is REALLY absurd.

Really.

I mean, AANA, gimme a fu kk ing break.

I am more deft than most MDs out there.

Not bragging. Just stating da fact, and setting da stage.

Which certainly means I've got ALL CRNAs covered in knowledge/hand skills.

The CRNA lobbying group wants to make it OK for nurses to do pain management??????

I am board certified. I've got 11 years experience in the busy private practice realm.

I wouldnt even consider marketing myself as a pain guy, at least as my knowledge/hand-skills-at-all-pain-management-techniques sits at the moment.

If I did that I'd be lying to the patients about the product they'd receive, and lying to myself about my own ability.

SO, for an organization (AANA) to move in a direction to legally enforce their ability to work at a profession (pain management) that they are in no way qualified to perform, is no-less-than terrifying.

That move really pisses me off.

I'm glad they lost.

Otherwise I'd have to go egg the AANA building. And pee-pee on their cars.
__________________
Jet MD, LMFAO
 
BLADEMDA said:
Jets Opinion On Crnas Doing Pain Management
As you all know, I am not anti_CRNA.

Quite the contrary.

I'm convinced the team-model is the best way to go. Argue at will at my opinion, but lets keep that for another thread.

But CRNAs getting the OK to do pain management?

That is REALLY absurd.

Really.

I mean, AANA, gimme a fu kk ing break.

I am more deft than most MDs out there.

Not bragging. Just stating da fact, and setting da stage.

Which certainly means I've got ALL CRNAs covered in knowledge/hand skills.

The CRNA lobbying group wants to make it OK for nurses to do pain management??????

I am board certified. I've got 11 years experience in the busy private practice realm.

I wouldnt even consider marketing myself as a pain guy, at least as my knowledge/hand-skills-at-all-pain-management-techniques sits at the moment.

If I did that I'd be lying to the patients about the product they'd receive, and lying to myself about my own ability.

SO, for an organization (AANA) to move in a direction to legally enforce their ability to work at a profession (pain management) that they are in no way qualified to perform, is no-less-than terrifying.

That move really pisses me off.

I'm glad they lost.

Otherwise I'd have to go egg the AANA building. And pee-pee on their cars.
__________________
Jet MD, LMFAO
Click to expand...

I've never actually talked to a cRNA. I didn't have them in residency. I would never let a cRNA ever touch me nor put me to sleep from what I've read on this forum. I work in an all MD/DO practice where I do all my own cases since the first day I finished residency. I think this really shows the AANA people need to be shut down. At some point they will want to expand their pain practices and start doing outpatient spine surgery after participating in weekend courses in China. They'll market themselves as doctors because they have a doctor of nursing/neurosurgery degree from some online course.
 
cincincyreds said:
I've never actually talked to a cRNA. I didn't have them in residency. I would never let a cRNA ever touch me nor put me to sleep from what I've read on this forum. I work in an all MD/DO practice where I do all my own cases since the first day I finished residency. I think this really shows the AANA people need to be shut down. At some point they will want to expand their pain practices and start doing outpatient spine surgery after participating in weekend courses in China. They'll market themselves as doctors because they have a doctor of nursing/neurosurgery degree from some online course.
Click to expand...

Next is the 6 month Critical Care fellowship at Vandy.😉 CRNAs only need 6 months for AANA Critical Care Certification because they have "previous critical care experience." The AANA knows how to sell Horse Meat and call it Filet Mignon.
 
This is totally unethical behavior by the AANA.

Pain Management is a subspecialty fellowship. Physicians go through residencies and then do a fellowship and still not everything is learned in/about Pain Mgt.


I think it's time physicians unionize......
 
PinchandBurn said:
This is totally unethical behavior by the AANA.

Pain Management is a subspecialty fellowship. Physicians go through residencies and then do a fellowship and still not everything is learned in/about Pain Mgt.


I think it's time physicians unionize......
Click to expand...

Unethical Behavior by the AANA....Hmmm, I'm totally shocked!😉
 
Unfortunately that isnt true. Many physicians do pain without more than a 2 day seminar. It exists all over the country. Shouldnt there be legislation against them as well?

PinchandBurn said:
This is totally unethical behavior by the AANA.

Pain Management is a subspecialty fellowship. Physicians go through residencies and then do a fellowship and still not everything is learned in/about Pain Mgt.


I think it's time physicians unionize......
Click to expand...
 
megas123 said:
Unfortunately that isnt true. Many physicians do pain without more than a 2 day seminar. It exists all over the country. Shouldnt there be legislation against them as well?
Click to expand...


I feel that as with all Specialties and subspecialties in the year 2012, one should do a ACGME accredited Pain Fellowship. Furthermore, the quack CRNAs doing pain mgt have a 'certificate' from Am Acad of Pain Mgt. This 'certification' isnt anything and is not ABMS designated.

The only ABMS certification is through the ABA (for anesthesiologists). Unfortunately, patients do not know this.

The issue as with all these midlevel providers is that there is no transparency. Patients are getting dooped. These CRNAs through words like "doctor, board certified" and the like around and the common person has no idea. They think it's = to being a MD.
 
Fake-Rolex.jpg


One is Fake the other is Genuine. This is similar to a Pain CRNA vs a Board Certified Anesthesiologist having done a Pain Fellowship.
 
BLADEMDA said:
Fake-Rolex.jpg


One is Fake the other is Genuine. This is similar to a Pain CRNA vs a Board Certified Anesthesiologist having done a Pain Fellowship.
Click to expand...

Sounds like a case of "you get what you (or don't) pay for"

It may look the same, it may look pretty, but the quality just isn't up to snuff as the real thing.
 
Doctor4Life1769 said:
Sounds like a case of "you get what you (or don't) pay for"

It may look the same, it may look pretty, but the quality just isn't up to snuff as the real thing.
Click to expand...
yes..one doesnt last. one is just window dressing.

The issues is that the public needs to know about this. I wish the ASA and Pain Societies would broadcast this through public media outlets, signs, news,etc....

Otherwise, wht is the use of us paying money to the ABA, getting certified, going through this schooling and paying all these dues. On top of that, I wouldnt want my mom, dad, or someone I love being taken care of by someone with suboptimal education. The same standard is what the public should realize.
 
BLADEMDA said:
Unethical Behavior by the AANA....Hmmm, I'm totally shocked!😉
Click to expand...

As am I.

"A cadet will not lie, cheat, steal, or tolerate those who do." The AANA could use some lessons from the cadets at West Point.
 
BLADEMDA said:
Fake-Rolex.jpg


One is Fake the other is Genuine. This is similar to a Pain CRNA vs a Board Certified Anesthesiologist having done a Pain Fellowship.
Click to expand...


Do you know which one is real?
 
BLADEMDA said:
http://www.protectmypaincare.com/

Click on the link. Well what do you think? I'm just as qualified to do Cardiac stent placements as CRNAs are to do pain management.
Click to expand...

Well, let's all do as the site says -- TAKE ACTION.

http://www.protectmypaincare.com/site/action

Use their CMS administrator letter against them.

Here are my comments, feel free to cut and paste!

Don't forget to edit the subject line too.

"As a board certified anesthesiologist with subspecialty certification by the ABA in Pain Medicine -- one who has gone through all the APPROPRIATE training to practice in the field in a SAFE AND EFFECTIVE manner -- I find it irresponsible that CMS would consider a rule placing CRNAs on equal footing from the point of view of payment for services rendered. It is a FACT that pain management procedures can lead to catastrophic complications such as paralysis and death when performed improperly. Proper assessment of chronic pain is highly complex and allowing non-physicians to function in this capacity will lead to a waste of resources as patients receive medical procedures that are NOT INDICATED and based on flawed reasoning. Perhaps most critical of all is to recognize is that the performance of pain management procedures requires split second decisions about anatomical placement of needles, what to inject, and when to STOP. PRESERVATION OF PATIENT SAFETY DEMANDS THE TRAINING AND JUDGMENT OF AN APPROPRIATELY TRAINED PHYSICIAN WHEN SELECTING AND PERFORMING THESE PROCEDURES."
 
powermd said:
Well, let's all do as the site says -- TAKE ACTION.

http://www.protectmypaincare.com/site/action

Use their CMS administrator letter against them.

Here are my comments, feel free to cut and paste!

Don't forget to edit the subject line too.

"As a board certified anesthesiologist with subspecialty certification by the ABA in Pain Medicine -- one who has gone through all the APPROPRIATE training to practice in the field in a SAFE AND EFFECTIVE manner -- I find it irresponsible that CMS would consider a rule placing CRNAs on equal footing from the point of view of payment for services rendered. It is a FACT that pain management procedures can lead to catastrophic complications such as paralysis and death when performed improperly. Proper assessment of chronic pain is highly complex and allowing non-physicians to function in this capacity will lead to a waste of resources as patients receive medical procedures that are NOT INDICATED and based on flawed reasoning. Perhaps most critical of all is to recognize is that the performance of pain management procedures requires split second decisions about anatomical placement of needles, what to inject, and when to STOP. PRESERVATION OF PATIENT SAFETY DEMANDS THE TRAINING AND JUDGMENT OF AN APPROPRIATELY TRAINED PHYSICIAN WHEN SELECTING AND PERFORMING THESE PROCEDURES."
Click to expand...

The govt is going to pay Nurses the same as a Board Certified Pain Specialist to do procedures. How sad is that for patients and aspiring Doctors? Why go through all the training it takes to become a Board Certified Anesthesiologist with Special Qualifications in Pain when an Advanced Nurse with no formal training whatsoever is paid exactly the same fee? This makes a mockery of the entire field.
 
BLADEMDA said:
The govt is going to pay Nurses the same as a Board Certified Pain Specialist to do procedures. How sad is that for patients and aspiring Doctors? Why go through all the training it takes to become a Board Certified Anesthesiologist with Special Qualifications in Pain when an Advanced Nurse with no formal training whatsoever is paid exactly the same fee? This makes a mockery of the entire field.
Click to expand...


Question is what can we do NOW??

can we unionize?

can we strike?

I'm sure if a lot of us got together and did this, even 50% of us, it could create some waves, especially with social media, mainstream media,etc . Sort of a grass roots cause.
 
CRNAs are blatantly unqualified to practice Pain Medicine on patients. Any Interventional procedure beyond a Steriod injection, Facet injection, etc should be performed by a Physician with extensive clinical experience and preferably, Board Certification in Pain Medicine.
 
Interesting article recently from Health Affairs about the clinical equivalence between the care provided by anesthesiologists and CRNAs. The article concludes by advocating that CRNAs be given permission to practice anesthesiology without physician supervision. It's more cost effective. And there is no compromise to the quality of care delivered to patients.

We recommend CMS return to its original intention of allowing nurse anesthetists to work independently of surgeon or anesthesiologist supervision without requiring state governments to formally petition for an exemption," they conclude. "This would free surgeons from the legal responsibilities for anesthesia services provided by other professionals. It would also lead to more cost-effective care as the solo practice of certified registered nurse anesthetists increases." The study was funded by the American Association of Nurse Anesthetists.


http://www.kevinmd.com/blog/2010/10/crnas-practice-anesthesiology-physician-supervision.html

A couple of caveats. One, the study was conducted by the American Association for Nurse Anesthetists (sort of like a study claiming that Jeff Parks is the smartest man on earth being conducted by "friends and family and hired sycophants of Dr. Parks"). Also, the study admits that CRNA's tend to work on less complex cases than MD anesthesiologists.

The main thrust of papers like this is to delve into the essence of what it means to be a "doctor." Are all doctors alike? Is the orthopod who replaces 350 knees a year the same as the internist cranking through 30 patients a day with complex medical problems? Is it fair or unfair to further categorize the various specialties according to some sort of intellectual hierarchy? Do some specialties verge perilously close to being mere technicians, thereby inviting the sort of turf war salvo sounded by the above referenced paper?

In reality, I think it goes beyond anesthesiology (although anesthesiologists are an arguably easier target). Most of the work done by a family practitioner can probably be adequately performed by a NP or PA without adverse effects. If you trained a physically gifted person to take out gallbladders and that's all he did, day after day, I bet you would be able to find a paper demonstrating that the non-MD surgeon has a similar complication rate as a formally trained general surgeon. But then what is that automaton going to do when he encounters a cholecysto-colonic fistula or when the cholangiogram shows he has cut the common bile duct? What is the NP going to do when she has to manage a patient with diabetes, heart disease, peripheral vascular disease, and obesity who comes into the office with abdominal pain? Would any CRNA accept the responsibility and stress of running a CABG solo?

The bottom line is, most of the time you don't*need a doctor until you really need one. But you never know when that day is going to be. You never know when that seemingly normal patient who walks into the ER ends up turning into a complete disaster. My advice to these non-doctors seeking legitimacy and complete autonomy: be careful of what you wish for.

Jeffrey Parks is a general surgeon who blogs at Buckeye Surgeon.

Submit a guest post and be heard.
 
Ensure Patient Access to Pain Care
*
The American Association of Nurse Anesthetists represent over 44,000 Certified Registered Nurse Anesthetists (CRNAs) and student nurse anesthetists who deliver over 32 million anesthetics in the United States each year and who provide anesthesia and analgesia care in every setting, as well as pain management services. *CRNAs predominate in rural America, with 100 percent of anesthesia and pain care in many U.S. counties provided solely and safely by nurse anesthetists, and in our military and Veterans health systems. *
*
• A critical aspect of the anesthesia care continuum is pain management, and providing acute and chronic pain management services is within CRNA professional scope of practice. *A recent Institute of Medicine analysis of pain in the U.S. found that 116 million Americans suffer from chronic intractable pain at an annual healthcare and economic cost near two thirds of a trillion dollars, and that not nearly enough healthcare professionals are available to assess and care for those patients effectively.
*
• For well over a decade Medicare has reimbursed CRNAs directly for essential chronic pain management services, and referring physicians, especially in rural areas, rely on CRNA expertise in caring for their patients. *
*
• This longstanding payment policy came into question in 2011 when the Medicare agency let stand two Medicare Administrative Contractor (MAC) bulletins denying direct reimbursement of CRNA chronic pain services. These two decisions by the Noridian and WPS MACs have had significant impact on care for patients with chronic pain in rural and other medically-underserved areas of the upper Midwest and Rocky Mountain states where CRNAs are the primary providers of chronic pain care. *
*
• The Centers for Medicare & Medicaid Services (CMS) is reviewing the issues raised in the MAC bulletins and is expected to respond through rulemaking within the next few months. *
*
To ensure patient access to chronic pain care services, the AANA urges the CMS to resume direct reimbursement of CRNA chronic pain care services, reverse the inconsistencies created by the recent MAC bulletins, and remove barriers to CRNAs providing pain management services. The IOM made a similar recommendation: *"…the constraints of outdated policies, regulations, and cultural barriers, including those related to scope of practice, will have to be lifted, most notably for advanced practice registered nurses." *It would not be new payment policy, and it does not expand the scope of practice, but rather reflects CRNA scope determined by states.
*
Action for Congress: Write HHS and Medicare and urge the agency to protect patient access to pain care services and resume direct reimbursement of CRNA services, reflecting longstanding Medicare reimbursement policies in place for more than a decade. *
 
How are these CMS people chosen or elected? What kind of education background or experience do they need to get these jobs? What if we say to these people...CMS jobs can now be filled and paid by all the unemployed and uninsured people because obviously they have made enough visits to CMS offices that they know everything about the field. And if they take a 2 week course..thats a bonus. This will be good for the economy and will work in their "affordable care" plans. Lets see how they feel about that.

The problem is first it effects the integrity of our profession by allowing others without the educational background to do exactly what we do. Like many others said...why the hell would I have sacrificed my 20s and worked my butt off and gone through med school and residency when I could have been getting paid right now for 1/10th the work and 1/gazillionth the sacrifices. Its actually an insult to us and to be honest if dont do anything about it we are not being fair to ourselves. So the question is what are we doing about it. Who is heading our fight? What exactly are they doing/who are they talking to? Can we do anything?
 
gasorrad said:
How are these CMS people chosen or elected? What kind of education background or experience do they need to get these jobs? What if we say to these people...CMS jobs can now be filled and paid by all the unemployed and uninsured people because obviously they have made enough visits to CMS offices that they know everything about the field. And if they take a 2 week course..thats a bonus. This will be good for the economy and will work in their "affordable care" plans. Lets see how they feel about that.

The problem is first it effects the integrity of our profession by allowing others without the educational background to do exactly what we do. Like many others said...why the hell would I have sacrificed my 20s and worked my butt off and gone through med school and residency when I could have been getting paid right now for 1/10th the work and 1/gazillionth the sacrifices. Its actually an insult to us and to be honest if dont do anything about it we are not being fair to ourselves. So the question is what are we doing about it. Who is heading our fight? What exactly are they doing/who are they talking to? Can we do anything?
Click to expand...

hate to break it to you, but "hard work" and "sacrifice" didn't get you to where you are today. You got a lot of help from infrastructure that other people didn't have access to...so now you should give up a bit of what you've been given to make things more fair, ok?

(SARCASM)
 
I don't know how CMS is run, but the IOM report that pushed for independent practice for NPs/CRNAs a year ago was written by a committee half full and chaired by academic nursing faculty. I am willing to bet that CMS is run by similarly qualified people.
 
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