Today's WSJ

[deleted126335]

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Robots vs anesthesiologists

article on JNJ Sedasys

http://online.wsj.com/article/SB10001424052702303983904579093252573814132.html

More good news: the article also talks about a device that eliminates the need for anesthesia for ear tube procedures.

 

[aneftp]

Robots vs anesthesiologists

article on JNJ Sedasys

http://online.wsj.com/article/SB10001424052702303983904579093252573814132.html

More good news: the article also talks about a device that eliminates the need for anesthesia for ear tube procedures.

Actually it would eliminate more CRNA gi jobs that have exploded the past 7-8 years at gi only endo centers and hurt these management companies that have and still ignoring oig opinion 12-06.

 

[Ronin786]

Of the comments, this might be the worst one:

No way I would ever let them anesthetize one of my family with a machine and no anesthesiologist or CRNA in the room monitoring.
Too many things can go wrong.

Too much public equating of CRNAs and MDs is going on.

 

[PMPMD]

I would like to see the sources for the graph showing anesthesiologist compensation for common procedures. Who's getting $2k for colonoscopy sedation? 5 units + time (2-3 units) = 7-8 units. How does this equate to $2k? Maybe they're referring to hospital billing.

 

[aneftp]

I would like to see the sources for the graph showing anesthesiologist compensation for common procedures. Who's getting $2k for colonoscopy sedation? 5 units + time (2-3 units) = 7-8 units. How does this equate to $2k? Maybe they're referring to hospital billing.

Very rare for $2000 payment. But I have seen $2000 charges especially if md is medically directing crna and patient ends up getting bill for CRNA and MD.

 

[gas2014]

Follow my logic here:

If the American Board of Nursing has the ability to hand out "Doctor of Nursing Practice in Anesthesia" degrees and fight for complete rights to practice medicine, then the American Board of Anesthesiology should offer a 1-year training course in performing colonoscopies to practicing anesthesiologists.

This, in my opinion, would be the most cost-effective way to run a GI center. The anesthesiologist would perform the screening colonoscopies all day, and the patient would be on the Sedasys system. If any emergencies ensued, the dually-trained anesthesiologist would be able to quickly attend to the problem.

- No gastroenterologists needed anymore
- No CRNA needed to sit on the stool
- Cost effective

What's the problem with my thought process?

 

[BLADEMDA]

Follow my logic here:

If the American Board of Nursing has the ability to hand out "Doctor of Nursing Practice in Anesthesia" degrees and fight for complete rights to practice medicine, then the American Board of Anesthesiology should offer a 1-year training course in performing colonoscopies to practicing anesthesiologists.

This, in my opinion, would be the most cost-effective way to run a GI center. The anesthesiologist would perform the screening colonoscopies all day, and the patient would be on the Sedasys system. If any emergencies ensued, the dually-trained anesthesiologist would be able to quickly attend to the problem.

- No gastroenterologists needed anymore
- No CRNA needed to sit on the stool
- Cost effective

What's the problem with my thought process?

Sorry. But, the other scenario makes more sense. Gi doctor does the 6 month training course (or 6 weeks) and supervises the RN giving the propofol.

The anesthesia fee should be included in the total procedure fee.

 

[Spinach Dip]

Apparently some engineer saw an anesthesiologist sitting down during a procedure, so he said to himself, "Hey, a robot could do that!"

A few years later....

 

[Spinach Dip]

Too much public equating of CRNAs and MDs is going on.

Eh...

I'm not too hot on CRNAs, but I would prefer to have one of them over a robot (or better yet, an RN under supervision of a GI doc).o

 

[BLADEMDA]

Study: Colonoscopies often come with costly, unnecessary sedation



The extra treatment (sedation by anesthesiologist) added an average of about $500 to an insured patient's bill in 2009, and $150 to a Medicare bill. In 2009, about 3 million colonoscopies and other digestive scoping tests were done in low-risk patients but included anesthesia services, amounting to $1 billion in potentially unnecessary costs, the study authors estimated


http://www.cbsnews.com/8301-504763_...-often-come-with-costly-unnecessary-sedation/

 

[aneftp]

Study: Colonoscopies often come with costly, unnecessary sedation



The extra treatment (sedation by anesthesiologist) added an average of about $500 to an insured patient's bill in 2009, and $150 to a Medicare bill. In 2009, about 3 million colonoscopies and other digestive scoping tests were done in low-risk patients but included anesthesia services, amounting to $1 billion in potentially unnecessary costs, the study authors estimated


http://www.cbsnews.com/8301-504763_...-often-come-with-costly-unnecessary-sedation/

I agree. Most colonoscopies do not need propofol.

These greed the past 10 years of gi propofol has lead to explosion of side deals to take anesthesia revenue and put it back to gi docs hands.

I believe the time will come for cataract reimbursement in the gi anesthesia world.

 

[Ronin786]

Eh...

I'm not too hot on CRNAs, but I would prefer to have one of them over a robot (or better yet, an RN under supervision of a GI doc).o

Not really, the problem anesthesiology faces right now is that CRNAs have become synonymous with anesthesiologists. The fact that the public is now worrying about their reimbursement gives me pause, especially given how little anyone cared when CRNAs encroached into physician reimbursement.

 

[ProRealDoc]

The low-hanging fruit will be the first to go. I better stick with the sick patients few want to deal with.

 

[BLADEMDA]

I agree. Most colonoscopies do not need propofol.

These greed the past 10 years of gi propofol has lead to explosion of side deals to take anesthesia revenue and put it back to gi docs hands.

I believe the time will come for cataract reimbursement in the gi anesthesia world.

Correct. Nothing in medicine except Derm and specialized dentistry is more lucrative than Gi right now at a surgicenter. They are clearing $800K up to $1.5 million each off the Anesthesia fee, procedure fee and facility fee. They hire A CRNA at $100 an hour and bill for everything

The CRNA isn't saving the system one dime. Instead, they are helping game the system so the Gi docs stay super wealthy and the Anesthesiologist is cut out of the loop. Zero savings.

 

[happygilmore]

Correct. Nothing in medicine except Derm and specialized dentistry is more lucrative than Gi right now at a surgicenter. They are clearing $800K up to $1.5 million each off the Anesthesia fee, procedure fee and facility fee. They hire A CRNA at $100 an hour and bill for everything

The CRNA isn't saving the system one dime. Instead, they are helping game the system so the Gi docs stay super wealthy and the Anesthesiologist is cut out of the loop. Zero savings.

Which is the ridiculous thing. The gov't is so dumb, all the cost savings they try to do is just going to profit the people running businesses.

 

[deleted126335]

Which is the ridiculous thing. The gov't is so dumb, all the cost savings they try to do is just going to profit the people running businesses.

Yup. Employers of physicians are the winners. The goal however is to make all of us employees of the healthcare system, and have the administration figure out how the one check should be spent. The GI docs time will come.

 

[norwood]

So going back to the WSJ article, I have a few questions.

The article states that it's going to be approved for "mild to moderate sedation" in "healthy" patients. Anyone else thinking that this risks the usual inflation in what "moderate" sedation means, and in who qualifies as a "healthy" patient?

 

[BLADEMDA]

So going back to the WSJ article, I have a few questions.

The article states that it's going to be approved for "mild to moderate sedation" in "healthy" patients. Anyone else thinking that this risks the usual inflation in what "moderate" sedation means, and in who qualifies as a "healthy" patient?

So the Gi doc is going to only pay $50 per hour for the machine vs $100 for the CRNA?
This device better be cheap to be competitive against a CRNA at $90 per hour ( some Gi docs only pay $85-90 An hour)

 

[norwood]

So the Gi doc is going to only pay $50 per hour for the machine vs $100 for the CRNA?
This device better be cheap to be competitive against a CRNA at $90 per hour ( some Gi docs only pay $85-90 An hour)

Article seems to say it's $150 per use, which for some GI docs I've worked with would be more like $500 an hour. Johnson & Johnson apparently doesn't sell the machine, but rather charges by the use - it covers upkeep and whatever disposables it uses, but not the propofol itself.

The article discusses having an anesthesiologist or "anesthesia-trained nurse" (author's expression - I don't know whether he meant a CRNA or an RN with experience helping with sedation) on site, but not necessarily in room. This, then, begs the question of how many rooms they could cover at once.

 

[Spinach Dip]

This, then, begs the question of how many rooms they could cover at once.

How about 15?

Gotta raise that bottom line.

 

[pgg]

Study: Colonoscopies often come with costly, unnecessary sedation

I agree. Most colonoscopies do not need propofol.

Unless it's yours or mine ...

 

[deleted126335]

Unless it's yours or mine ...

When I had mine I told the GI doc to do what he usually did. He only uses anesthesia personnel for the sick ones. I had Versed and Fentanyl by the endo nurse. A little uncomfortable, some cramps. Not bad.