Support AAs in Arizona - HB 2457

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Anesthesia_Guy

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Blow up these emails and phone numbers. It's what the CRNAs do.

  1. Representative Beverly Pingerelli, Chair ([email protected]) (602) 926-3396
  2. Representative David Marshall, Vice Chair ([email protected]) (602) 926-3579
  3. Representative David Cook ([email protected]) (602) 926-5162
  4. Representative Lupe Diaz ([email protected]) (602) 926-4852
  5. Representative Liz Harris ([email protected]) (602) 926-4153
  6. Representative Michelle Peña ([email protected]) (602) 926-3696
  7. Representative Jennifer Pawlik ([email protected]) (602) 926-3193
  8. Representative Nancy Gutierrez ([email protected]) (602) 926-4134
  9. Representative Laura Terech ([email protected]) (602) 926-3894
  10. Representative Judy Schwiebert ([email protected]) (602) 926-3390
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Anesthesia_Dude said:
God I hate CRNAs. Thank God I never practiced with that scum.
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I practiced parallel to them in AZ in surgery centers. I refuse to supervise them while doing locums; it annoys my recruiters, but I don't care. I did medically direct a few crnas, but mostly I worked with AAs and residents as faculty.

There are multiple reasons I don't work in AZ, but live there, and the crna thing is one of them.
 
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Ashers said:
I practiced parallel to them in AZ in surgery centers. I refuse to supervise them while doing locums; it annoys my recruiters, but I don't care. I did medically direct a few crnas, but mostly I worked with AAs and residents as faculty.

There are multiple reasons I don't work in AZ, but live there, and the crna thing is one of them.
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There are other anesthesiologists that will not work in Arizona for the same reason. Surprisingly, some CRNAs will not practice in Arizona either because of the safety issues due to the lack of anesthesiologist oversight or supervision at the majority of hospitals and ASCs in Arizona.
 
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Ashers said:
Oh I just saw on reddit there is an amendment to this bill by the crnas that they want to supervise CAAs.

CAA thing on Noctor
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Yeah, I can tell you exactly where that came from too. Two of the most rabid anti-CAA nurses are in Arizona. Nurses can't supervise CAAs. Period. They're not anesthesiologists, regardless of what they want to call themselves.

This anti-competitive BS is just so irritating and their hypocrisy is never-ending. There is more than enough business in most places for everyone to have a job and make money. That includes Arizona.

We never stop recruiting. Every hospital/group/practice I'm aware of is hiring. It's not that we don't compensate well. It's that the demand is so high as the desire for our services increases constantly. When I started, we were in the OR only (and ICU in academic centers). 30 years ago we never did GI except to rescue sedation overdoses. 5 years ago we never did any cardiology except for the odd cardioversion a couple times a month. Now we do 100 GI cases on some days, and every TEE and cardioversion that comes through the door.
 
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I’m not even from Arizona but this still pisses me off enough to send an email. That Reddit post had a nice link to a template letter:

Dear Representative XXXXX:

I understand that an amendment may be offered in the Education Committee hearing regarding HB 2457 by Rep. Pingerelli. This amendment would allow certified registered nurse anesthetists (CRNAs) to supervise Certified Anesthesiologist Assistants. I would urge you to vote against this amendment.

CAAs are trained and educated to work under the supervision of a physician anesthesiologist, not a nurse. CAAs and CRNAs are equivalent providers and are recognized as such by the Center for Medicare and Medicaid Services (CMS) which define both as non physician anesthetists.

CMS conditions of participation only allow a physician anesthesiologist to supervise a CAA or CRNA. There is no billing methodology that would allow hospitals to be reimbursed for supervision by a CRNA. No other state law provides for this supervision nor does any other federal program or state Medicaid program.

CRNAs and CAAs work together at hospitals around the country and are used interchangeably in the operating room. The American Society of Anesthesiologists issued a white paper comparing CAA and CRNA education and practice and concluded that "differences do exist between anesthesiologist assistants and nurse anesthetists with regard to the educational program prerequisites, instruction, and requirements for supervision in practice as well as maintenance of certification. These are the result of the different routes that the two professions took toward development, and the stated preference of anesthesiologist assistants to work exclusively on teams with physician anesthesiologists. None of these differences, in the opinion of the Committee, results in significant disparity in knowledge base, technical skills, or quality of care.

CAAs and CRNAs are both advanced practice providers, just like Nurse Practitioners and Physicians Assistants. While the educational pathways are different. CAA programs are affiliated with medical schools and CAAs have to complete all of the prerequisites required for medical school. Having a graduate of a nursing program supervise a graduate of a medical school program is unnecessary and not a precedent that Arizona should set.
 
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"Having a graduate of a nursing program supervise a graduate of a medical school program is unnecessary and not a precedent that Arizona should set."

I would use stronger wording than "unnecessary."

How about "It is not in the scope of practice of a CRNA midlevel provider to be supervising another midlevel provider which includes an Anesthesiology Assistant, another CRNA, Physician Assistant, and Nurse Practitioner,"
 
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anes12 said:
"Having a graduate of a nursing program supervise a graduate of a medical school program is unnecessary and not a precedent that Arizona should set."

I would use stronger wording than "unnecessary."

How about "It is not in the scope of practice of a CRNA midlevel provider to be supervising another midlevel provider which includes an Anesthesiology Assistant, another CRNA, Physician Assistant, and Nurse Practitioner,"
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Seriously. How about "a nurse is 100% UNqualified to supervise their equivalent practitioner. It is not only inappropriate but would be malpractice and a danger to patients to suggest that they are capable of supervising an equally qualified anesthetist, and excluding a physician from the patient's care. Any legislator who supports this amendment should be held liable for any harm to patients that follows."
 
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Absolutely incredible. The CRNA movement is so mind boggling. In what ways do they think they are more qualified than AA's and are thus able to supervise them? When will the nursing madness end. NURSES AREN'T DOCTORS. If they wanted to be physicians then go to medical school.
 
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This amendment has ulterior financial motives (of course). The purpose of this amendment is the ludicrous idea that CRNA owned businesses/practices who employ CRNAs would also be able to recruit and employ AAs.

It is not about CRNA power to supervise AAs but a desperate measure of CRNA owned practices to hold onto their market share and profits (remember it's all about the money) and to squash any sort of competition that they perceive as a threat to their business relationship with hospitals and surgery centers.
 
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The way I read the change is that it is not anti-CAA. It just makes physician supervision of CAAs unnecessary. The CRNAs are perfectly willing to accept CAAs. They just want to be able to supervise them. Logically it makes sense since CRNAs have gained the right to practice independently without physician supervision in many states. The change is a run around physician supervision. It is a smart strategic maneuver on the part of CRNAs. We should have seen this coming.


Last I checked, there are:

40000+ practicing CRNAs

40000+ practicing anesthesiologists.

700-800 practicing CAAs.
 
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anes12 said:
This amendment has ulterior financial motives (of course). The purpose of this amendment is the ludicrous idea that CRNA owned businesses/practices who employ CRNAs would also be able to recruit and employ AAs.

It is not about CRNA power to supervise AAs but a desperate measure of CRNA owned practices to hold onto their market share and profits (remember it's all about the money) and to squash any sort of competition that they perceive as a threat to their business relationship with hospitals and surgery centers.
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Power to supervise=market share and ability to offer services and negotiate contracts.


I can see the CRNAs argue that the restricting the ability to supervise CAAs to only anesthesiologists is anticompetitive.
 
nimbus said:
I can see the CRNAs argue that the restricting the ability to supervise CAAs to only anesthesiologists is anticompetitive.
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Except it's also the equivalent of saying NPs should supervise PAs. Asinine in every way.
 
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abolt18 said:
Except it's also the equivalent of saying NPs should supervise PAs. Asinine in every way.
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Yes, asinine to you and me. Hopefully also asinine to state legislatures.

But pretend I was a state legislator with no expertise in medicine. CRNA says to me, “I am an independent practitioner and I am already licensed and qualified to practice without any physician supervision. We have a severe staffing shortage. I’d like to hire additional assistants (CAAs) who are not licensed to practice independently to help meet the needs of the people of Arizona. I will closely supervise them.” What’s my reason to vote against that?
 
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nimbus said:
Power to supervise=market share and ability to offer services and negotiate contracts.


I can see the CRNAs argue that the restricting the ability to supervise CAAs to only anesthesiologists is anticompetitive.
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"I can see the CRNAs argue that the restricting the ability to supervise CAAs to only anesthesiologists is anticompetitive."

This is all semantics if CRNAs were to twist words around and come back and say that "restricting the ability to supervise CAAs to only anesthesiologists is anticompetitive." CRNAs can practice independently in Arizona and setup and run their own all-CRNA businesses. The United States is a free market and if new "competition" enters the market, then that is normal.

Other states have allowed AAs to practice in their states. Why should Arizona be any different?

Attempting to create a caveat of "AAs can come to Arizona but only if CRNAs can supervise them." serves as a deterrent. No AA is going to want to be supervised by a CRNA, so they won't come to work in Arizona.

Again, a sneaky round-about way of creating a barrier to entry for AAs in Arizona: Even though AAs would be allowed to practice in Arizona, no AA is going to come to Arizona to be supervised by a CRNA.
 
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anes12 said:
No AA is going to want to be supervised by a CRNA, so they won't come to work in Arizona.

Again, a sneaky round-about way of creating a barrier to entry for AAs in Arizona: Even though AAs would be allowed to practice in Arizona, no AA is going to come to Arizona to be supervised by a CRNA.
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That’s up to the AAs.

Due to the manpower shortage, the AAs could elect to work only with anesthesiologists. Given their training background, I’m sure that would be their preference.

But money talks. If the CRNA group offers more money and a CRNA led practice is an option in that state, I’m sure some AAs would work with them.

I don’t see it as a barrier to entry for CAAs in Arizona. If anything, it would open up additional opportunities for them. They’d have a choice to work in MD led groups (like Valley/Envision) or in CRNA led groups (like AzAS).
 
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nimbus said:
The way I read the change is that it is not anti-CAA. It just makes physician supervision of CAAs unnecessary. The CRNAs are perfectly willing to accept CAAs. They just want to be able to supervise them. Logically it makes sense since CRNAs have gained the right to practice independently without physician supervision in many states. The change is a run around physician supervision. It is a smart strategic maneuver on the part of CRNAs. We should have seen this coming.


Last I checked, there are:

40000+ practicing CRNAs

40000+ practicing anesthesiologists.

700-800 practicing CAAs.
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I think there are something like 4000-5000 AAs now.

I don't think any AA with any sort of self respect would be supervised by an independently practicing CRNA. Nurse independent practice is antithetical to the physician led team mindset that AAs are trained in and believe in.

Amendments like this have been presented in countless states before. They have never been successful, but it's a low risk high reward play for the state CRNAs to make the underlying bill untenable if the amendment passes. I'm pretty sure the strategy came out of Mike McK and his Anti-AA Task Force inside the AANA.
 
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jwk said:
Yeah, I can tell you exactly where that came from too. Two of the most rabid anti-CAA nurses are in Arizona.
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Endee said:
I think there are something like 4000-5000 AAs now.

I don't think any AA with any sort of self respect would be supervised by an independently practicing CRNA. Nurse independent practice is antithetical to the physician led team mindset that AAs are trained in and believe in.

Amendments like this have been presented in countless states before. They have never been successful, but it's a low risk high reward play for the state CRNAs to make the underlying bill untenable if the amendment passes. I'm pretty sure the strategy came out of Mike McK and his Anti-AA Task Force inside the AANA.
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Bingo.
 
anes12 said:
"I can see the CRNAs argue that the restricting the ability to supervise CAAs to only anesthesiologists is anticompetitive."

This is all semantics if CRNAs were to twist words around and come back and say that "restricting the ability to supervise CAAs to only anesthesiologists is anticompetitive." CRNAs can practice independently in Arizona and setup and run their own all-CRNA businesses. The United States is a free market and if new "competition" enters the market, then that is normal.

Other states have allowed AAs to practice in their states. Why should Arizona be any different?

Attempting to create a caveat of "AAs can come to Arizona but only if CRNAs can supervise them." serves as a deterrent. No AA is going to want to be supervised by a CRNA, so they won't come to work in Arizona.

Again, a sneaky round-about way of creating a barrier to entry for AAs in Arizona: Even though AAs would be allowed to practice in Arizona, no AA is going to come to Arizona to be supervised by a CRNA.
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Happy to say that the supervision amendment in AZ was voted down in committee. :thumbup::thumbup:
 
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What is the status of this bill? Will AAs be permitted to practice in Arizona now?
 
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