Teaching Rule Fixed!!

[toughlife]

---

Members don't see this ad.

NEVER SAY NEVER PEOPLE....

This is a loud and clear message to the AANA that resident physicians are not to be placed in the same level as nurses and the fact that the government has endorsed full funding for teaching anesthesiologists shows we are NOT the same.

Legislative Victory: Senate passes Medicare bill!

H.R. 6331 includes SGR fix, Teaching Rule reform


In dramatic form, the U.S. Senate on Wednesday passed H.R. 6331, the “Medicare Improvements for Patients and Providers Act.” Among many other provisions, the legislation would reverse the massive 10.6% Medicare payment cut that took effect on July 1, and would restore full Medicare payment to anesthesiology teaching programs.

A procedural vote of 69-30 allowed the Senate to pass H.R. 6331 by unanimous consent. The measure must now be signed into law by President Bush, who has indicated that he will veto it. In that scenario, the House and Senate could override a veto by a two-thirds majority of all present and voting members. Based on the vote tally in the House and Senate, both chambers appear to have a sufficient number of votes to override the possible veto.

ASA is extremely pleased that the Senate has passed H.R. 6331, which previously overwhelmingly passed the U.S. House of Representatives by a vote of 355-59.

The bill includes many critical Medicare provisions, several of which are vital to anesthesiology. Of particular importance, the legislation:

Blocks Medicare payment cuts for 18 months through December 31, 2009 and provides a 1.1% positive Medicare payment update for 2009. The bill’s 18-month fix provides time for Congress to develop an alternative update mechanism to address the additional Medicare payment cuts still projected for 2010 and beyond.
Restores full Medicare payment to anesthesiology teaching programs by including the language of S. 2056, authored by Sen. Jay Rockefeller (D-WV) and Sen. Jon Kyl (R-AZ), with bipartisan cosponsorship from 29 additional Senators, as well as H.R. 2053, authored by Rep. Xavier Becerra (D-CA) and Rep. Pete Sessions (R-TX) and cosponsored by 127 additional Representatives.
Extends the 1.0 floor on the work GPCI through December 31, 2009.
Increases the PQRI bonus to 2.0% for 2009 and 2010 for physicians who choose to participate in the program.
ASA is extremely grateful for the leadership of Sens. Harry Reid (D-NV) and Max Baucus (D-MT) for moving this bill through the Senate. On the House side, ASA sincerely appreciates Ways and Means Committee chair Charles Rangel (D-NY) and Energy and Commerce Committee chair John Dingell (D-MI) for authoring H.R. 6331.

Further, ASA commends Component Society leaders, Key Contacts, committee members, officers, and other ASA members who contacted their lawmakers in support of the legislation. ASA is also grateful to the AMA and the entire federation of medicine for their strong efforts supporting this bill.

 

[foxtrot]

This is a short term victory for all physicians, in particular anesthesia--which is nice to see. However, I read today that John McCain did not show up to vote in favor of this vote. Futhermore, he stated that he would oppose the bill. This is somewhat baffling to me since I had been supporting McCain up to this point. I also do not understand why so many of the republicans opposed this bill including the Bush administration. I am starting to rethink the way I am going to vote. Everyone always talks about the democrats wanting to socialize medicine but maybe that is not so much of a true statement anymore. Can anyone shine any light as to why so many republicans were against this bill? Appreciate the input.

 

[deleted126335]

Can anyone shine any light as to why so many republicans were against this bill? Appreciate the input.

Physician lobbying clout is less than it used to be. Republicans want to create the perception of fiscal discipline by voting against SOME spending. Given docs relatively lower clout, we are the sacrifice. Another example, The only tort reform on a federal level has been to the benefit of corporations, tort reform for med mal was carved out.

 

[lord_jeebus]

This is a short term victory for all physicians, in particular anesthesia--which is nice to see. However, I read today that John McCain did not show up to vote in favor of this vote. Futhermore, he stated that he would oppose the bill. This is somewhat baffling to me since I had been supporting McCain up to this point. I also do not understand why so many of the republicans opposed this bill including the Bush administration. I am starting to rethink the way I am going to vote. Everyone always talks about the democrats wanting to socialize medicine but maybe that is not so much of a true statement anymore. Can anyone shine any light as to why so many republicans were against this bill? Appreciate the input.

Republicans want to cut Medicare funding to free up more money to pour into "Medicare Advantage," a giant handout to the worthless middlemen of the HMO industry. It provides government-subsidized healthcare for greater cost than regular Medicare itself (and often with fewer benefits), but because that increased cost provides the societal benefit of 9-figure CEO compensation, it is a top GOP priority.

 

[Ender]

NEVER SAY NEVER PEOPLE....

This is a loud and clear message to the AANA that resident physicians are not to be placed in the same level as nurses and the fact that the government has endorsed full funding for teaching anesthesiologists shows we are NOT the same.

Legislative Victory: Senate passes Medicare bill!

H.R. 6331 includes SGR fix, Teaching Rule reform


In dramatic form, the U.S. Senate on Wednesday passed H.R. 6331, the “Medicare Improvements for Patients and Providers Act.” Among many other provisions, the legislation would reverse the massive 10.6% Medicare payment cut that took effect on July 1, and would restore full Medicare payment to anesthesiology teaching programs.

A procedural vote of 69-30 allowed the Senate to pass H.R. 6331 by unanimous consent. The measure must now be signed into law by President Bush, who has indicated that he will veto it. In that scenario, the House and Senate could override a veto by a two-thirds majority of all present and voting members. Based on the vote tally in the House and Senate, both chambers appear to have a sufficient number of votes to override the possible veto.

ASA is extremely pleased that the Senate has passed H.R. 6331, which previously overwhelmingly passed the U.S. House of Representatives by a vote of 355-59.

The bill includes many critical Medicare provisions, several of which are vital to anesthesiology. Of particular importance, the legislation:

Blocks Medicare payment cuts for 18 months through December 31, 2009 and provides a 1.1% positive Medicare payment update for 2009. The bill’s 18-month fix provides time for Congress to develop an alternative update mechanism to address the additional Medicare payment cuts still projected for 2010 and beyond.
Restores full Medicare payment to anesthesiology teaching programs by including the language of S. 2056, authored by Sen. Jay Rockefeller (D-WV) and Sen. Jon Kyl (R-AZ), with bipartisan cosponsorship from 29 additional Senators, as well as H.R. 2053, authored by Rep. Xavier Becerra (D-CA) and Rep. Pete Sessions (R-TX) and cosponsored by 127 additional Representatives.
Extends the 1.0 floor on the work GPCI through December 31, 2009.
Increases the PQRI bonus to 2.0% for 2009 and 2010 for physicians who choose to participate in the program.
ASA is extremely grateful for the leadership of Sens. Harry Reid (D-NV) and Max Baucus (D-MT) for moving this bill through the Senate. On the House side, ASA sincerely appreciates Ways and Means Committee chair Charles Rangel (D-NY) and Energy and Commerce Committee chair John Dingell (D-MI) for authoring H.R. 6331.

Further, ASA commends Component Society leaders, Key Contacts, committee members, officers, and other ASA members who contacted their lawmakers in support of the legislation. ASA is also grateful to the AMA and the entire federation of medicine for their strong efforts supporting this bill.

This is great news. The best news is that if president bush decides to veto, it should still pass. This is definately a victory for Anesthesiology. It also shows that supporting the ASA PAC pays off. These people are working to help us. Be a contributor to the future of your profession, join the PAC! The more participation we have the more power we have.

Ender

 

[Krafty]

Senate Vote on Doctor Fees Carries Risks for McCain

“Senator John McCain will be on the spot, in person or by his absence, when the Senate takes up a measure today to halt a cut in Medicare payments to doctors.

"Republicans have stalled Democratic-backed legislation to reverse the 10.6 percent cut in doctors' fees by reducing payments to insurance companies instead. Democrats on June 26 fell one senator short of the 60 they will need to force a floor vote. Two senators were absent: Edward Kennedy, a Democrat from Massachusetts who is being treated for brain cancer, and McCain of Arizona, the presumptive Republican presidential nominee.

“For McCain, whose schedule indicates he will campaign today in Pennsylvania and Ohio and whose office won't say whether he'll show up in the Senate, the vote is a political dilemma. “

``In one case McCain could be voting against his party and in the other he could be voting against an issue framed as pro- senior and pro-physician,'' Robert Blendon, a health policy professor at Harvard University's School of Public Health in Boston, said in a telephone interview yesterday.”

 

[toughlife]

This is great news. The best news is that if president bush decides to veto, it should still pass. This is definately a victory for Anesthesiology. It also shows that supporting the ASA PAC pays off. These people are working to help us. Be a contributor to the future of your profession, join the PAC! The more participation we have the more power we have.

Ender

you got it. Only by being politically active via financial support of our ASA PAC will we be able to guarantee a successful future for ourselves and those who will come after us.

 

[UTSouthwestern]

Dear Dr. XXXXXXXX:

Thank you for the opportunity to share my thoughts on the current debate over the rate of Medicare physician reimbursement. I appreciate your input on this important issue.

Well before my election to the United States Senate, I made a commitment to support legislation that would ensure quality health care for all Texans. I have worked closely with physicians, hospitals, patient representatives and others throughout my entire professional life to improve delivery of health care. Shortly after I arrived in the Senate, it became apparent to me that our current physician payment system was deeply flawed. Instead of reforming that system, Congress was engaging in a never-ending series of patchwork fixes that were inefficient and costly, and that caused undue hardship on everyone involved. Rather than joining in that temporary process, I have sought to reform it. This past March, I worked with Congressman Burgess and the Texas Medical Association to introduce the Ensuring the Future Physician Workforce Act. I am currently the only Senator to have offered, in the 110th Congress, a long-term solution for physician payment reform.

As you know, under the current system, the sustainable growth rate (SGR) has done nothing to control costs, does not keep pace with practice expenses, and instead has decreased access and quality. Moreover, I consistently hear from doctors across Texas that the SGR has eroded the physician-patient relationship and discouraged a future generation of physicians. Quite simply, physician payment methodology badly needs to be reformed. The Ensuring the Future Physician Workforce Act would eliminate the SGR and replace it with a formula that more accurately reflects the cost of providing quality care.

While Congress should be focused on a long-term solution, instead it has only sought to apply a band-aid for 18 months, which will leave physicians subject to an even greater 20 percent reimbursement cut in 2010. There have been no Democrat proposals in the 110th Congress to address this issue for the long-term. Instead, they have chosen a tactic of ignore and delay in order to make needed relief to physicians and beneficiaries a political battle.

This year, unlike previous years, the “Doc Fix” legislation brought before the Senate was not the product of bipartisanship. In fact, H.R. 6331 contained provisions that could adversely impact Medicare beneficiaries. For example, H.R. 6331, as drafted, could threaten the growing success of the Medicare Advantage (MA) program by restricting Private Fee-For-Service (PFFS) plans. Some have mischaracterized what the “cuts” to PFFS plans are and that I have chosen to pay insurance companies rather than physicians. That is absolutely untrue. PFFS plans benefit over 50 percent of rural enrollees in MA plans and many urban beneficiaries through increased access to providers, reduced premiums and cost-sharing and enhanced benefits like vision and hearing exams. According to the Congressional Budget Office, more than 2 million seniors (over 50,000 of which reside in Texas) will lose access to their PFFS plans over the next 5 years under the terms of H.R. 6331 as currently written. The savings result not from a “cut” to the payment rate given to PFFS, but from a fundamental change to the way the program is structured, which reverses what PFFS plans were meant to do—provide beneficiaries with more than a one-size fits all Medicare plan. The changes in H.R. 6331 will mean seniors will be forced into traditional Medicare or other more restrictive MA plans.

The reasons I support MA plans as an option for beneficiaries are similar to the reasons I have been one of the few Senate advocates opposing a ban on physician-owned hospitals. Both models are innovative market options that reduce reliance on government-run healthcare; increase competition, choice and access; provide quality care and high customer satisfaction; and help reduce increasing healthcare costs. Just as the physician-ownership community agrees there are steps needed for improvement, the same can be said for the MA PFFS community. However, the rescission of “deeming” by PFFS plans, I worry, is not the proper step to take. It will likely have the same effect as banning “self-referral” by physician-owners: decreased beneficiary access to quality care at a reduced cost. I understand there are deficiencies in the MA program to be addressed, but I strongly believe in its intent. I will be working with beneficiaries and physicians alike to see how we can strengthen, rather than tear apart, this private market option to Medicare.

I am disappointed that Senator Reid, the Democratic Majority Leader, objected to a clean 30 day extension of current law to give us time to work things out. As you know, President Bush has threatened to veto H.R. 6331. It would have made more sense to reach a bipartisan compromise rather than go through a lengthy veto process.

However, the final outcome will be the same—the physician payment cut will be prevented. But, in my view, there is no good reason for physicians and beneficiaries to endure the uncertainty and inconvenience associated with the gamesmanship we saw in the Senate. In light of these developments and in order to avoid a negative impact on beneficiaries and doctors, I am working with the White House to administratively prevent these cuts from going into effect while negotiations continue.

I am fully aware that the measures I am now pursuing do not resolve our long-term issues with Medicare. At some early point, the system requires major, long-term reform—a goal that seems out of reach as we struggle to apply yet another patch to this year’s payment problems. I deeply regret the disruption associated with business as usual in Congress again this year, and I pledge that I will continue to be a voice for permanent reform as we move forward, so that this wasteful scenario might be avoided in the future.

Sincerely,

JOHN CORNYN
United States Senator

 

[RickKane]

Maybe now Academic Anesthesiologist will start getting paid what they deserve...or at least a somewhat comparable salary to those in PP.

 

[Planktonmd]

Maybe now Academic Anesthesiologist will start getting paid what they deserve...or at least a somewhat comparable salary to those in PP.

This is not about increasing anyone's pay, it's about trying to keep them from getting a pay cut for a few years.

 

[stewiegriffinFG]

This is not about increasing anyone's pay, it's about trying to keep them from getting a pay cut for a few years.

You missed the part of the teaching rule being fixed.


Were CRNAs also included in the teaching rule fix?

 

[foxtrot]

Dear Dr. XXXXXXXX:

Thank you for the opportunity to share my thoughts on the current debate over the rate of Medicare physician reimbursement. I appreciate your input on this important issue.

Well before my election to the United States Senate, I made a commitment to support legislation that would ensure quality health care for all Texans. I have worked closely with physicians, hospitals, patient representatives and others throughout my entire professional life to improve delivery of health care. Shortly after I arrived in the Senate, it became apparent to me that our current physician payment system was deeply flawed. Instead of reforming that system, Congress was engaging in a never-ending series of patchwork fixes that were inefficient and costly, and that caused undue hardship on everyone involved. Rather than joining in that temporary process, I have sought to reform it. This past March, I worked with Congressman Burgess and the Texas Medical Association to introduce the Ensuring the Future Physician Workforce Act. I am currently the only Senator to have offered, in the 110th Congress, a long-term solution for physician payment reform.

As you know, under the current system, the sustainable growth rate (SGR) has done nothing to control costs, does not keep pace with practice expenses, and instead has decreased access and quality. Moreover, I consistently hear from doctors across Texas that the SGR has eroded the physician-patient relationship and discouraged a future generation of physicians. Quite simply, physician payment methodology badly needs to be reformed. The Ensuring the Future Physician Workforce Act would eliminate the SGR and replace it with a formula that more accurately reflects the cost of providing quality care.

While Congress should be focused on a long-term solution, instead it has only sought to apply a band-aid for 18 months, which will leave physicians subject to an even greater 20 percent reimbursement cut in 2010. There have been no Democrat proposals in the 110th Congress to address this issue for the long-term. Instead, they have chosen a tactic of ignore and delay in order to make needed relief to physicians and beneficiaries a political battle.

This year, unlike previous years, the “Doc Fix” legislation brought before the Senate was not the product of bipartisanship. In fact, H.R. 6331 contained provisions that could adversely impact Medicare beneficiaries. For example, H.R. 6331, as drafted, could threaten the growing success of the Medicare Advantage (MA) program by restricting Private Fee-For-Service (PFFS) plans. Some have mischaracterized what the “cuts” to PFFS plans are and that I have chosen to pay insurance companies rather than physicians. That is absolutely untrue. PFFS plans benefit over 50 percent of rural enrollees in MA plans and many urban beneficiaries through increased access to providers, reduced premiums and cost-sharing and enhanced benefits like vision and hearing exams. According to the Congressional Budget Office, more than 2 million seniors (over 50,000 of which reside in Texas) will lose access to their PFFS plans over the next 5 years under the terms of H.R. 6331 as currently written. The savings result not from a “cut” to the payment rate given to PFFS, but from a fundamental change to the way the program is structured, which reverses what PFFS plans were meant to do—provide beneficiaries with more than a one-size fits all Medicare plan. The changes in H.R. 6331 will mean seniors will be forced into traditional Medicare or other more restrictive MA plans.

The reasons I support MA plans as an option for beneficiaries are similar to the reasons I have been one of the few Senate advocates opposing a ban on physician-owned hospitals. Both models are innovative market options that reduce reliance on government-run healthcare; increase competition, choice and access; provide quality care and high customer satisfaction; and help reduce increasing healthcare costs. Just as the physician-ownership community agrees there are steps needed for improvement, the same can be said for the MA PFFS community. However, the rescission of “deeming” by PFFS plans, I worry, is not the proper step to take. It will likely have the same effect as banning “self-referral” by physician-owners: decreased beneficiary access to quality care at a reduced cost. I understand there are deficiencies in the MA program to be addressed, but I strongly believe in its intent. I will be working with beneficiaries and physicians alike to see how we can strengthen, rather than tear apart, this private market option to Medicare.

I am disappointed that Senator Reid, the Democratic Majority Leader, objected to a clean 30 day extension of current law to give us time to work things out. As you know, President Bush has threatened to veto H.R. 6331. It would have made more sense to reach a bipartisan compromise rather than go through a lengthy veto process.

However, the final outcome will be the same—the physician payment cut will be prevented. But, in my view, there is no good reason for physicians and beneficiaries to endure the uncertainty and inconvenience associated with the gamesmanship we saw in the Senate. In light of these developments and in order to avoid a negative impact on beneficiaries and doctors, I am working with the White House to administratively prevent these cuts from going into effect while negotiations continue.

I am fully aware that the measures I am now pursuing do not resolve our long-term issues with Medicare. At some early point, the system requires major, long-term reform—a goal that seems out of reach as we struggle to apply yet another patch to this year’s payment problems. I deeply regret the disruption associated with business as usual in Congress again this year, and I pledge that I will continue to be a voice for permanent reform as we move forward, so that this wasteful scenario might be avoided in the future.

Sincerely,

JOHN CORNYN
United States Senator

Can someone elaborate on the "Medicare Advantage" and the private-fee-for service plans? I don't really know much about this and I bet many physicians and residents out there probably don't either. Thanks

 

[dfk]

You missed the part of the teaching rule being fixed.


Were CRNAs also included in the teaching rule fix?

that's correct.

 

[Planktonmd]

You missed the part of the teaching rule being fixed.

No I did not.
I doubt that any individual anesthesiologist is going to see a pay increase as a result of this bill.
The real gain here is that this bill recognizes that there is a difference between teaching residents and teaching nurses.
It's a small victory but it is a victory.

 

[lord_jeebus]

Can someone elaborate on the "Medicare Advantage" and the private-fee-for service plans? I don't really know much about this and I bet many physicians and residents out there probably don't either. Thanks

Wikipedia has a nice description of the nuts and bolts: http://en.wikipedia.org/wiki/Medicare_(United_States)#Part_C:_Medicare_Advantage_plans

AMA statement to Congress, quite critical and detailed: http://waysandmeans.house.gov/hearings.asp?formmode=view&id=6209

Basically it's a pseudoprivatization of medicare that gives private companies huge amounts of money to provide medical coverage to people that are eligible for medicare, but at an increased cost over the government doing it itself. I say pseudo- because the money still comes from us taxpayers; the main difference is that much of the money that is currently going directly to patient care gets diverted to the private company running the Medicare Advantage plan.

 

[Gardner]

OP writes "This is a loud and clear message to the AANA that resident physicians are not to be placed in the same level as nurses and the fact that the government has endorsed full funding for teaching anesthesiologists shows we are NOT the same. "

What exactly is "the rule"? Were CRNA training programs de-funded? How exactly does the gov't demonstrate that anesthesiologist are NOT the same? Just by virtue of anesth res programs continuing to get funding we have some special endorsement now? Does the language of the bill otherwise state that we are different from CRNAs?

Clarification please.

 

[amyl]

wtf is up with the republicans!?!? wtf, pres bush? not to mention, my interest rate on my education loans is higher than some peoples damn credit cards and that is f---ed up.
hmmmm, interesting about mc cain.
anybody know what obama's stance is on this particular issue?
anybody know how hillary voted?

 

[anesbiz]

As it works out, the AANA and ASA got what they wanted.


So as for the teaching rule here is how it will work.

Before teaching rule:

One Anesthesiologist can supervise 2 SRNAs or 2 Residents however the medicare billing would ONLY be at 50% per case.

OR

One CRNA could supervise 2 SRNAs for the same 50% per case

AFTER teaching rule:

One Anesthesiologist can supervise 2 SRNAs or 2 Residents at 100% medicare billing per case (200%)

same for CRNAs supervising 2 SRNAs.

Hope this is helpful.

 

[vapormania]

As it works out, the AANA and ASA got what they wanted.


So as for the teaching rule here is how it will work.

Before teaching rule:

One Anesthesiologist can supervise 2 SRNAs or 2 Residents however the medicare billing would ONLY be at 50% per case.

OR

One CRNA could supervise 2 SRNAs for the same 50% per case

AFTER teaching rule:

One Anesthesiologist can supervise 2 SRNAs or 2 Residents at 100% medicare billing per case (200%)

same for CRNAs supervising 2 SRNAs.

Hope this is helpful.

So how does this differentiate MDs and CRNAs?

 

[anesbiz]

you are correct, it does not.

 

[vapormania]

you are correct, it does not.

So why did the OP say that it did?

 

[anesbiz]

I dont know

However, the read of the bill is very clear even if its written in an interesting way. As far as the teaching reimbursement Resident = SRNA for reimbursement.

Honestly, thats a GREAT thing. Now, regardless if you are supervising an SRNA or a resident you dont lose any money.

So why did the OP say that it did?

 

[toughlife]

Did you guys forget the AANA's H.R 1932 introduced by Stupak?

 

[anesbiz]

The language of HR 1932 was included in 6331. That is why the AANA is also claiming victory for the teaching rules. It is complicated but how it is written affords the exact same reimbursement.

The original ASA bill was also defeated as the AANA one was.

 

[Surfer]

how is it good when they can train a srna at the same reimbursement as a resident? this will just mean MORE srna's trained, and consequently MORE nurses acting like doctors out in the community.

 

[toughlife]

The goal of the bill was to ensure that an attending supervising residents gets 100% reimbursement when doing so.

Without the rule fix, an attending is forced to split his time between supervising one resident and one CRNA. This was a disincentive to train two residents and an incentive to hire a CRNA to attain maximum reimbursement. This will no longer be the case provided Bush signs the law or that it goes back to congress and his veto is overridden.

 

[anesbiz]

Well, otherwise that would be an anti-competition issue. Since CRNAs can bill exactly the same as Anesthesiologists can for medicare a trainee in either should be billable (as the billing supervising anesthesiologist) the same.

This doesn't mean more SRNA or Anesthesiologists trained it simply means getting paid what we should be for training anyone.

how is it good when they can train a srna at the same reimbursement as a resident? this will just mean MORE srna's trained, and consequently MORE nurses acting like doctors out in the community.

 

[toughlife]

SEC. 139. IMPROVEMENTS FOR MEDICARE ANESTHESIA TEACHING PROGRAMS.

(a) Special Payment Rule for Teaching Anesthesiologists- Section 1848(a) of the Social Security Act (42 U.S.C. 1395w-4(a)), as amended by section 132(b), is amended--

(1) in paragraph (4)(A), by inserting ‘except as provided in paragraph (5),' after ‘anesthesia cases,'; and

(2) by adding at the end the following new paragraph:

‘(6) SPECIAL RULE FOR TEACHING ANESTHESIOLOGISTS- With respect to physicians' services furnished on or after January 1, 2010, in the case of teaching anesthesiologists involved in the training of physician residents in a single anesthesia case or two concurrent anesthesia cases, the fee schedule amount to be applied shall be 100 percent of the fee schedule amount otherwise applicable under this section if the anesthesia services were personally performed by the teaching anesthesiologist alone and paragraph (4) shall not apply if--

‘(A) the teaching anesthesiologist is present during all critical or key portions of the anesthesia service or procedure involved; and

‘(B) the teaching anesthesiologist (or another anesthesiologist with whom the teaching anesthesiologist has entered into an arrangement) is immediately available to furnish anesthesia services during the entire procedure.'.

(b) Treatment of Certified Registered Nurse Anesthetists- With respect to items and services furnished on or after January 1, 2010, the Secretary of Health and Human Services shall make appropriate adjustments to payments under the Medicare program under title XVIII of the Social Security Act for teaching certified registered nurse anesthetists to implement a policy with respect to teaching certified registered nurse anesthetists that--

(1) is consistent with the adjustments made by the special rule for teaching anesthesiologists under section 1848(a)(6) of the Social Security Act, as added by subsection (a); and

(2) maintains the existing payment differences between teaching anesthesiologists and teaching certified registered nurse anesthetists

 

[anesbiz]

Hello tough.

Yes, i understand it reads that way, however, you neglected #1.

is consistent with the adjustments made by the special rule for teaching anesthesiologists under section 1848(a)(6) of the Social Security Act, as added by subsection

#2 does not equivocate to different payment for teaching at all.

In anycase, it seems you do not understand how legislation works. As opposed to me attempting to explain the process (which would be horrible as i only am just understanding it) email the ASA PAC. They will explain it better than I ever could.

 

[amyl]

how come there is reimbursment for teaching srnas but not med students?

 

[stewiegriffinFG]

how come there is reimbursment for teaching srnas but not med students?

The med students don't do the cases.

 

[amyl]

srnas are allowed to run their own cases? really? after how much training are they allowed to do so?

 

[Tenesma]

the republicans are still on our side but they were very carefully bullied into a bad corner by the Democrats, the AARP and the AMA...

what the republicans were trying to do (including the Bush administration) was to force the issue of SGR fix to the floor - the only way this can be done is by either 1) introducing new legislation and praying (and most likely it would get forgotten) or 2) allowing SGR to show its problems and collapse the system, forcing new legislation (and less likely to get forgotten)...

this unfortunately was a bad tactic - as it ended up making the republicans look bad - in an election year (Harry Reid is a good politician and understands this)

the issue with MA plans is somewhat bogus - the republicans like the shift to a more privatized industry for medicare so that they can slowly have the government move out of covering Medicare for everybody - but first they need the MA plans/HMOs to take hold...

i BET that if this had NOT been an election year, we would not have seen an increase in 2009.

the democrats are more interested in not doing anything to fix the problem, because they are more convinced that expanding medicare to everybody would be the easy transition to a universal health care solution...

BUSH/Republicans are still on our side in the long-run, but unfortunately they got their asses handed to them with poor political strategy...

 

[pgg]

NEVER SAY NEVER PEOPLE....

Bush is expected to veto this, right?

Are there enough votes to override the veto?

 

[dfk]

srnas are allowed to run their own cases? really? after how much training are they allowed to do so?

hey amyl,
usually in the senior year, if competent enough, attendings/CRNAs are present for induction (and usually emergence, depending on site).
the clinical hours/case completion varies with each student, but again, running own cases is a decision based on experience/competence of the SRNA according to those precepting them.
it has been known that in the summer of senior's last year, they are able to work with an attending where doc has 2:1 ratio.

 

[anesbiz]

Bush cannot veto as the bill got 2/3 majority.

Bush is expected to veto this, right?

Are there enough votes to override the veto?

 

[anesbiz]

Where I am SRNAs begin doing cases alone at the digression of the anesthesiologists. Essentially, we evaluate them all and decide if they are ready. Generally, this occurs when they are seniors until they graduate, this is the entire last year (to year and a half) of their school.

At that time they are in the OR 50-60 hours a week plus call and run their own rooms at a 1:2 ratio. If the case is a medicare case an anesthesiologist has to be there for emergence and induction in order to meet the 7 TEFRA requirements. Otherwise, someone is in there with them for induction only.

srnas are allowed to run their own cases? really? after how much training are they allowed to do so?

 

[toughlife]

Where I am SRNAs begin doing cases alone at the digression of the anesthesiologists. Essentially, we evaluate them all and decide if they are ready. Generally, this occurs when they are seniors until they graduate, this is the entire last year (to year and a half) of their school.

At that time they are in the OR 50-60 hours a week plus call and run their own rooms at a 1:2 ratio. If the case is a medicare case an anesthesiologist has to be there for emergence and induction in order to meet the 7 TEFRA requirements. Otherwise, someone is in there with them for induction only.

But you are a CRNA, right?

 

[anesbiz]

My status isn't relevant to this conversation, however, to answer the question, no I am not a CRNA or an RN for that matter.

 

[toughlife]

My status isn't relevant to this conversation, however, to answer the question, no I am not a CRNA or an RN for that matter.

Right....

 

[potentagent]

This is not about increasing anyone's pay, it's about trying to keep them from getting a pay cut for a few years.

That is the way I understand it as well.

 

[anesbiz]

Right....

Young resident. As a 20+ year attending at an east coast university hospital where I oversee CRNAs, SRNAs and yes, residents like yourself, im SURE i am more educated about the politics of my chosen profession. You might consider showing some respect. I simply saw the topic while doing a google search and decided to bother to read it. Clearly a mistake wasting my time here.

 

[florida]

Where I trained, in addition to the residency program, we also had a CRNA school. According to US News it is the number 1 CRNA school in the world. The CRNAs there were definately at the forefront for autonomy, expansion of practice, ect. They were all calling themselves doctor. My personal favorite was one we referred to as coach- he had his PhD in kinesiology. So, even in this bastion of CRNA autonomy- the SRNAs were never unsupervised. They always had 1:1 supervision by a CRNA instructor, and 1:2 supervision by an anesthesiologist. Now, I'm sure if the CRNA had a senior student, they probably took many coffee breaks- but we never put RNs on the schedule as the primary anesthesia provider. I realize there are a lot of podunk CRNA schools based out of community hospitals- so it wouldn't surprise me if the private practice anethesiologists found a way to make money supervising RNs running their cases. They would basically be getting coverage without paying for a CRNA. I personally think this is pretty screwed up. But selling out our profession for a buck hasn't stopped anethesiologists in the past.

Where I am SRNAs begin doing cases alone at the digression of the anesthesiologists. Essentially, we evaluate them all and decide if they are ready. Generally, this occurs when they are seniors until they graduate, this is the entire last year (to year and a half) of their school.

At that time they are in the OR 50-60 hours a week plus call and run their own rooms at a 1:2 ratio. If the case is a medicare case an anesthesiologist has to be there for emergence and induction in order to meet the 7 TEFRA requirements. Otherwise, someone is in there with them for induction only.

 

[Kubed]

Young resident. As a 20+ year attending at an east coast university hospital where I oversee CRNAs, SRNAs and yes, residents like yourself, im SURE i am more educated about the politics of my chosen profession. You might consider showing some respect. I simply saw the topic while doing a google search and decided to bother to read it. Clearly a mistake wasting my time here.

I could hear the "hrumph!", the "boy!" and the door slam in this post.

 

[toughlife]

Young resident. As a 20+ year attending at an east coast university hospital where I oversee CRNAs, SRNAs and yes, residents like yourself, im SURE i am more educated about the politics of my chosen profession. You might consider showing some respect. I simply saw the topic while doing a google search and decided to bother to read it. Clearly a mistake wasting my time here.

east coast? 20+ years? CRNA? The only thing you oversee is the clock waiting for 3pm to arrive. Arthur Zwerling or Armygas, is that you?.

 

[pgg]

Where I am SRNAs begin doing cases alone at the digression of the anesthesiologists. Essentially, we evaluate them all and decide if they are ready. Generally, this occurs when they are seniors until they graduate, this is the entire last year (to year and a half) of their school.

The last 18 months of CRNA school constitutes the entirety of their clinical training. The SRNAs here do their classroom time, finish that, show up for their clinical time, and 18 months later they're done.

And you're saying the "entire last year (to year and a half)" of their training they're inducing patients alone?

I'm not quite so quick as toughlife to play the he's-a-CRNA-let's-BURN-HIM card, and I'm inclined to give you the benefit of the doubt ... but I find this claim awfully hard to believe.

 

[Trisomy13]

.

 

[Gern Blansten]

I'm not quite so quick as toughlife to play the he's-a-CRNA-let's-BURN-HIM card, and I'm inclined to give you the benefit of the doubt ... but I find this claim awfully hard to believe.

She turned me into a newt!

 

[starsop93]

How can you thing Bush/Republicans are "on our side"? It was the Democrats who overwhelmingly fought to get this passed! The Republicans were against it and Bush wants to veto it.

Despite whatyou might think, Medicare is not going away anytime soon. Trying to ruin it by forcing physicians to refuse to see Medicare patients is a terrible and callous way to do it. The Democrats are far more likely to make Medicare a financially stable program. The Republicans want to kill it, but don't have the balls to actually defund it. Instead, they will just weaken it and poorly manage it (just like they have done with everything) until nobody can take it anymore. The ones getting the shaft will be patients and physicians.

 

[stewiegriffinFG]

How can you thing Bush/Republicans are "on our side"? It was the Democrats who overwhelmingly fought to get this passed! The Republicans were against it and Bush wants to veto it.

Despite whatyou might think, Medicare is not going away anytime soon. Trying to ruin it by forcing physicians to refuse to see Medicare patients is a terrible and callous way to do it. The Democrats are far more likely to make Medicare a financially stable program. The Republicans want to kill it, but don't have the balls to actually defund it. Instead, they will just weaken it and poorly manage it (just like they have done with everything) until nobody can take it anymore. The ones getting the shaft will be patients and physicians.

You are aware that Medicare Advantage is getting cut as a result of the Democrats plan, which will decrease access for many senior citizens? M.A. plans affect anesthesia reimbursements too.