RMH,
I allow my CRNA's to float S-G catheters under direct supervision. No big deal. This thread is about two issues 1) Supervision vs. Doing Own Cases and 2) impact of Schwarzeneger's health care plan to Anesthesiology/Medicine.
Blade
Blade,
Since you opened this up a bit more, I can comment on our govenor's plan for healthcare - but, obviously not on the supervision/own case issue.
I'm in N CA & as I said before, I've never worked nor seen a CRNA in the hospitals in which I'm an OR pharmacist - so I'm just familiar with the MD/DOs.
Our state is suffering, as are many border states, from many issues which stretch the healthcare dollars. We have lots & lots of low income/illiterate/illegal & legal immigrants. Don't get me wrong - those are not necessarily all together, but separately they impact our healthcare system. They tend to use the emergency services more, don't know nor find it difficult to utilize access to wellness programs (prenatal care, diabetic & htn monitoring, nutrition, ETOH & tobacco education, etc.) You all know this, of course.
But, we have the dichotomy here of a large insurance industry & HMO influence along with significant small employers (<10 employees) & large employers who are protected from providing benefits by working their employees less than the hours which are legally required for benefits.
So - what has happened with healthcare is - some hospitals have closed, ERs are overburdened & often don't get paid, but can't turn folks away (VMC has a wait time commonly of 4-5 hours), some hospitals like one of the ones I work at won't take trauma at the ER (unless the trauma ER locally is on bypass) because that would mean a likely admmit & possible OR case which may or may not get paid & in some areas - some providers won't take MediCal at all (my husband is a dentist - in Santa Clara County, there is no dentist currently which will take MediCal - the reimbursement is too low).
Will the govenor's plan work? I dont know & I honestly don't think it will pass as its written. But, it has brought up very good & healthy debate about some of the issues some people haven't been aware of.
First - it requires insurers & HMOs to spend 85% of their dollars on healthcare. In CA, that has not been the case. We have huge beautiful buildings in most large cities owned by health insurance companies, their CEO's make tons of money, yet they'll deny Xeloda for breast ca. Might they decrease reimbursement for you since they'll have to spend 85% on claims - thats a hard one to guess. They already limit who & what they are willing to spend their $$s on.
The plan requires employers to provide health insurance for everyone. Now this one is a burden for my husband. He employs 4 people & has never been able to afford to purchase health insurance for them (my job provides it for us). So - it appears to be a burden, but - farther down the list of things - he gets a break on his FICA contributions, with <10 employees he can join a pool & just contribute in which his employees then join & choose how much they want to spend....then there is that whole 2% tax because he is a doctor (4% for hospitals), but there is as yet an unnamed tax break for providers. Its hard, honestly, to sort out how this will affect us, but our taxes are huge here because we have to underwrite all this under & non-insured population.
The big pool of $ contribution is expected to be from business who employ 10 or >employees who do not provide insurance for everyone. They must either provide insurance or pay an "in lieu of" fee of 4% into this pool of coverage. So - you have your Target, Walmart, grocery baggers, part-time & seasonal workers at Macy's, restaurants & other employers who work their people just under the legal limit of hours for benefits now can access insurance & part of it is paid by this 4% tax on large employers who use this method to get out of paying benefits. I expect there will be some push to find a loophole in this.
What will this do to you folks? I don't know. My husband thinks it will be a mixed blessing for dentists. It probably won't increase the # of providers in his field who take MediCal because they will only pay for pulling teeth - not many dentists want to do that without putting in a restoration. It won't pay for crowns, inlays, onlays, etc.. He is worried about the taxes part, but it is not yet clear how that will play out. He won't go anywhere since he's got thousands invested in his business, but anesthesia is more mobile & has more flexible models......so perhaps it will change that.
From our "lounge" discussions in the OR, none of the physicians say they are going anywhere - they stay for lots of reasons & as I said - we're already taxed heavily. If this tax just "shifts" from one place to the next, no problem - thats hard to predict since the details are scarce. But - they wouldn't share their private decisions with me anyway.
The good thing is - it has sparked debate. Lots of people didn't realize how few $s are spent by the insurance industry here on actual claims nor did they realize how many providers have closed or won't take MediCal because of reimbursement. I'm not sure the general public understands how beneficial in the long run it is to pay for diabetic to get regular care rather than slowly treat the effects as they come emergently (amputating a foot or providing care for a stroke...).
Sorry for the long post, but those are my thoughts as a Californian with a provider SO & the governor's plan. I don't think it will happen the way he's got it designed, yes- he's very left...probably not as left as some of our Dems, but far moreso than Reps (after all - he's going after business to underwrite most of this - very antiRep!) - but...it has sparked great debate here on healthcare, who has the "right" to it, who suffers for the lack of it, etc...he can do this since he's got nothing to lose - except perhaps a Senate seat
😉.
