VA CRNA thing

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KurtBrie

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So has anyone involved heard anything?
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Wow... it passed unanimously... did the congress even read the comments on the bill? What is ASA doing to stop this? Im strongly considering anesthesia, but this is very disheartening to hear...
 
Members don't see this ad :)
Ah, I see. Thanks for the clarification!
 
I searched that bill and it looks like the 1 year moratorium was removed by the AANA....

The question then is why would we be slipping this into a bill if we secured removing CRNAs from the VA independent practice?

This does not sound good...
 
What? Look at the website, the bill (with the proviso specifically about CRNAs) is on the president's desk. Note there is no clause dictating full practice authority will be granted after a year, so a separate bill stating specifically that would be required to do so.
 
No it isnt.

This is on the AANA facebook page.

Neutral “report” language allowing expanded Veterans access to care through Full Practice Authority for CRNAs and other APRNs to go forward at the U.S. Department of Veterans Affairs is a part of a spending package that cleared a legislative logjam in the U.S. Senate today, Sept. 28, by a 77-21 vote. With the involvement of AANA, CRNAs, and our coalition partners and allies on Capitol Hill, the needed language is associated with the FY 2017 Military Construction and Veterans Affairs appropriations package moving with a short-term “continuing resolution” keeping Uncle Sam open through Dec. 8, 2016. Importantly, the AANA was successful in blocking numerous attempts to include anti-CRNA language to the bill. The next stop for the measure, HR 5325, is the U.S. House which is anticipated to clear it soon for the President’s signature into law.
 
KurtBrie said:
Neutral “report” language allowing expanded Veterans access to care through Full Practice Authority for CRNAs and other APRNs to go forward at the U.S. Department of Veterans Affairs is a part of a spending package that cleared a legislative logjam in the U.S. Senate today, Sept. 28, by a 77-21 vote. With the involvement of AANA, CRNAs, and our coalition partners and allies on Capitol Hill, the needed language is associated with the FY 2017 Military Construction and Veterans Affairs appropriations package moving with a short-term “continuing resolution” keeping Uncle Sam open through Dec. 8, 2016. Importantly, the AANA was successful in blocking numerous attempts to include anti-CRNA language to the bill. The next stop for the measure, HR 5325, is the U.S. House which is anticipated to clear it soon for the President’s signature into law.
Click to expand...

Idk what they're talking about, because HR5325 doesn't seem to say anything about APRN scope, the VA, or anesthesia at all.
https://www.congress.gov/bill/114th-congress/house-bill/5325/text
 
I dont even know what is going on anymore...
 
Members don't see this ad :)
Here is the actual final bill HR5325

http://docs.house.gov/billsthisweek/20160912/H5985.pdf

The provision which stated:

"For one year the VA may not: (1) authorize certified registered nurse anesthetists to practice without the supervision of a physician, or (2) otherwise expand the scope of full practice authority for such anesthetists."

Was removed from the bill, i am told it was at the very end and it is not there now.
 
Kurtbrie, look at the text of HR5985, which I posted at the top of this thread. It includes exactly that provision.
 
Apparently that isnt the final language.

My state rep tells me it was removed in a verbal vote.

teacher2md said:
Kurtbrie, look at the text of HR5985, which I posted at the top of this thread. It includes exactly that provision.
Click to expand...
 
http://www.beckersasc.com/anesthesi...-affect-crnas-predictions-for-the-future.html

How 3 key healthcare trends affect CRNAs & predictions for the future

"It is sad to see our physician colleagues’ professional organizations put ‘incomes’ ahead of ‘outcomes.’"

"the current anesthesia care team model, where there is one anesthesiologist for every four CRNAs, is a healthcare-system albatross which is not tenable to maintain in the future. It is fiscally irresponsible to pay a non-revenue generating anesthesiologist two to three times the salary of a CRNA when the evidence has shown such a provider does not improve quality, outcomes, morbidity or mortality. The future will see an expansion of collaborative anesthesia models where CRNAs and anesthesiologists are doing their own cases and they will be judged on performance and quality metrics, not initials. There will be an expansion of CRNA-only anesthesia services across the country in light of CRNAs near six sigma safety record and ability to provide high-quality, cost-effective anesthesia care. "
 
Carbocation1 said:
http://www.beckersasc.com/anesthesi...-affect-crnas-predictions-for-the-future.html

How 3 key healthcare trends affect CRNAs & predictions for the future

"It is sad to see our physician colleagues’ professional organizations put ‘incomes’ ahead of ‘outcomes.’"

"the current anesthesia care team model, where there is one anesthesiologist for every four CRNAs, is a healthcare-system albatross which is not tenable to maintain in the future. It is fiscally irresponsible to pay a non-revenue generating anesthesiologist two to three times the salary of a CRNA when the evidence has shown such a provider does not improve quality, outcomes, morbidity or mortality. The future will see an expansion of collaborative anesthesia models where CRNAs and anesthesiologists are doing their own cases and they will be judged on performance and quality metrics, not initials. There will be an expansion of CRNA-only anesthesia services across the country in light of CRNAs near six sigma safety record and ability to provide high-quality, cost-effective anesthesia care. "
Click to expand...

This is hilarious.
Collaborative? Meaning when they get in over their heads, which they will as they do now, they will call the anesthesiologist for a bail out.
These people are frightening. We need a massive PR campaign NOW.
The physicians in congress introduced a bill to stop this. Maybe they can talk some sense into the others who have never seen a mid level in action.
 
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If this does eventually go through down the line, they'll have to be accountable for their own malpractice, right?
 
TheOther said:
If this does eventually go through down the line, they'll have to be accountable for their own malpractice, right?
Click to expand...

There is no "malpractice" per se at the VA. But yes, the CRNA who chooses to practice solo will be accountable for their own malpractice in private practice situations. This is true today as about 15 percent of Crnas practice without an Anesthesiologist's supervision.

The AANA goal is 100 percent autonomous practice for its membership.
 
BLADEMDA said:
There is no "malpractice" per se at the VA. But yes, the CRNA who chooses to practice solo will be accountable for their own malpractice in private practice situations. This is true today as about 15 percent of Crnas practice without an Anesthesiologist's supervision.

The AANA goal is 100 percent autonomous practice for its membership.
Click to expand...


From what I hear, the scuttlebut around the watercooler is that this is a done deal. CRNAS have won its just waitng for the appropriate ink.
 
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criticalelement said:
From what I hear, the scuttlebut around the watercooler is that this is a done deal. CRNAS have won its just waitng for the appropriate ink.
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Oh boy. I know it's hard to be certain what this means for anesthesiologists in the future, but is this a serious enough event for med students to stay away from gas? I'd be lying if I wasn't a tad afraid to come out on the other side of these student loans to find the job market in shambles.
 
Eh, literally every specialty has threats like this. Check out the ED or literally any other forum on SDN, you'll see a lot of the same fears.
 
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criticalelement said:
From what I hear, the scuttlebut around the watercooler is that this is a done deal. CRNAS have won its just waitng for the appropriate ink.
Click to expand...
As predicted by yours truly....
 
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IlDestriero said:
We can keep independent practice out of our own hospitals, but the vets are the big losers here. The oh so healthy and compliant veterans...


--
Il Destriero
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I feel bad for them too. I know some posters here have parents who go to VA hospitals. Let's hope after they kill or maim a few patients there that this whole stupid experiment will be laid to rest for good. It's hard to "collaborate" with an anesthesiologist when they are either not there or taking care of their own patient.
 
Man o War said:
I feel bad for them too. I know some posters here have parents who go to VA hospitals. Let's hope after they kill or maim a few patients there that this whole stupid experiment will be laid to rest for good. It's hard to "collaborate" with an anesthesiologist when they are either not there or taking care of their own patient.
Click to expand...

Hmm... might want to rethink that statement
 
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dr doze said:
Hmm... might want to rethink that statement
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I think you misread what I was saying. Let's hope the people in charge see how stupid this is when something bad happens and don't continue letting it happen- there's no doubt in my mind it will. Nurses are not qualified to care for this patient population on their own. Apparently the powers that be need proof of that before they will listen.
 
AdmiralChz said:
Eh, literally every specialty has threats like this. Check out the ED or literally any other forum on SDN, you'll see a lot of the same fears.
Click to expand...

In other specialties patients get to choose a doctor or a nurse. In anesthesia they get whatever 'provider' the hospital thinks is an acceptable risk.
 
nolagas said:
In other specialties patients get to choose a doctor or a nurse. In anesthesia they get whatever 'provider' the hospital thinks is an acceptable risk.
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I'm confused at this one, what specialties is this for?

I haven't been a patient a lot, but they didn't ask me if I wanted to see an NP vs an MD in the ER for my appendicitis they just sent in the NP. I actually didn't see a physician until the anesthesia team came for the preop/consent.

Also, looks like OP has been banned. Juicy!
 
Man o War said:
I feel bad for them too. I know some posters here have parents who go to VA hospitals. Let's hope after they kill or maim a few patients there that this whole stupid experiment will be laid to rest for good. It's hard to "collaborate" with an anesthesiologist when they are either not there or taking care of their own patient.
Click to expand...

This is an experiment and there will be no measurable difference between anesthesiologist and crna directed care. We have made the delivery of anesthesia very safe and bad outcomes that are due to the anesthetic are quite rare. This is happening in all specialties (except for the surgical specialties, for the time being) and it is just a way to expand the work force and decrease cost. Everything that is being done in healthcare now is about cost containment and this is just one way of doing that. Unless physicians figure out a new role in this healthcare system, the profession as a whole is in danger of extinction in the United States. It will take a few decades, but the profession is definitely in trouble. Why would any smart student who wants to practice pure clinical medicine elect to go through medical school and residency when nursing school provides a cheaper and shorter option?

What is interesting is if you look at the history of anesthesia, ether was a lot safer than chloroform. Why does that matter? Ether was the preferred anesthetic in the United States in the early days, and this made it easier for the delivery of the anesthetic to be performed by a nurse. In contrast, chloroform was the preferred anesthetic in Europe during this time. Chloroform had a lot more problems with dysrhythmias and overdosing compared to ether. Physicians were the ones performing the delivery of the anesthetic in Europe because they needed to be a lot more careful to avoid toxicity and overdosing. By making the delivery of all medical care safer (and more protocolized), we have opened up the door for less knowledgeable practitioners to practice medicine.
 
GravelRider said:
This is an experiment and there will be no measurable difference between anesthesiologist and crna directed care. We have made the delivery of anesthesia very safe and bad outcomes that are due to the anesthetic are quite rare. This is happening in all specialties (except for the surgical specialties, for the time being) and it is just a way to expand the work force and decrease cost. Everything that is being done in healthcare now is about cost containment and this is just one way of doing that. Unless physicians figure out a new role in this healthcare system, the profession as a whole is in danger of extinction in the United States. It will take a few decades, but the profession is definitely in trouble. Why would any smart student who wants to practice pure clinical medicine elect to go through medical school and residency when nursing school provides a cheaper and shorter option?

What is interesting is if you look at the history of anesthesia, ether was a lot safer than chloroform. Why does that matter? Ether was the preferred anesthetic in the United States in the early days, and this made it easier for the delivery of the anesthetic to be performed by a nurse. In contrast, chloroform was the preferred anesthetic in Europe during this time. Chloroform had a lot more problems with dysrhythmias and overdosing compared to ether. Physicians were the ones performing the delivery of the anesthetic in Europe because they needed to be a lot more careful to avoid toxicity and overdosing. By making the delivery of all medical care safer (and more protocolized), we have opened up the door for less knowledgeable practitioners to practice medicine.
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either way, cross the V.A. as a potential place to work.
Folks high up at my state society have told me this issue was put to bed it just has to go through the channels. The crnas have won that battle unfortunately.
 
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criticalelement said:
either way, cross the V.A. as a potential place to work.
Folks high up at my state society have told me this issue was put to bed it just has to go through the channels. The crnas have won that battle unfortunately.
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It was never a matter of "if," but rather a matter of "when."
 
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Consigliere said:
Oh, it's a done deal all right.......be in denial all you want; we have lost this fight. Just one of many....
Click to expand...

Never give up. Never surrender.

-galaxy quest


Sent from my iPhone using SDN mobile app
 
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Consigliere said:
Oh, it's a done deal all right.......be in denial all you want; we have lost this fight. Just one of many....
Click to expand...
My sources inside the system tell me Shulkin had a meeting with most or all if the VA chiefs recently. He originally was going to remove the Crna's from it. But ended up leaving it as is. Saying it wouldn't be implemented unless their is an access issue. Clearly there is no anesthesia Va access issue.

Bottom line. It's still a mess.
 
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aneftp said:
My sources inside the system tell me Shulkin had a meeting with most or all if the VA chiefs recently. He originally was going to remove the Crna's from it. But ended up leaving it as is. Saying it wouldn't be implemented unless their is an access issue. Clearly there is no anesthesia Va access issue.

Bottom line. It's still a mess.
Click to expand...

There is no access issue. They could fire all the crnas and be just fine
 
aneftp said:
My sources inside the system tell me Shulkin had a meeting with most or all if the VA chiefs recently. He originally was going to remove the Crna's from it. But ended up leaving it as is. Saying it wouldn't be implemented unless their is an access issue. Clearly there is no anesthesia Va access issue.

Bottom line. It's still a mess.
Click to expand...

Soon you'll see crna's arguing that they got independent practice rights at the VA and quality and access both improved; even though there will be no change in how things are done. Then that nurse-version of 'proof' will lead to actually changing VA anesthesia staffing.
 
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Psai said:
There is no access issue. They could fire all the crnas and be just fine
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Yup. Crna's have always argued the "access to care" bulletin point.

On this point Crna's cannot trick the public since there are very few anesthesia staffing issues in the throughout the country.
 
depends on budgeting incentives. Suddenly I have fewer $ to work with...It becomes an access issue.
 
AANA represents its constituents better than ASA.
ASA and its state chapters are good at fleecing money but no service. Sorry to bring it up. I paid my dues, but wonder why I should renew
 
Because you have masochistic tendencies? :D

When I see that my state ASA is run by the same academic people as the big ASA... I know nothing good can come from there. We need angry union-type people not resume padders, biters not hand lickers, shrewd but loyal people, the kind of organization that would stand up to a department chair who disciplines a member just because the local CRNAs didn't like it etc. I am not renewing. They don't represent employed anesthesiologists, just the people above them.

The AANA is staffed by Trump-like demagogues, which is exactly how an advocacy organization should be.
 
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FFP said:
Because you have masochistic tendencies? :D

When I see that my state ASA is run by the same academic people as the big ASA... I know nothing good can come from there. We need angry union-type people not resume padders, biters not hand lickers, shrewd but loyal people, the kind of organization that would stand up to a department chair who disciplines a member just because the local CRNAs didn't like it etc. I am not renewing. They don't represent employed anesthesiologists, just the parasites above them.

The AANA is staffed by Trump-like demagogues, which is exactly how an advocacy organization should be.
Click to expand...
Actually these days the ASA mainly represents the AMCs!
 
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If the ASA and ABA were truly concerned about continuing medical education they would open this moca computer simulation courses for free for members? They are greedy and buy one more condo in some hyped up city?

I complained to CSA about anesthesia related issue. They wanted it in writing. They never followed up.
 
CRNA's can practice independently in 25 states. That is not to be overlooked. HOWEVER: The number of CRNA's that want to practice independently are a vocal minority. They have a sweet gig: 40 hours a week, $200k+, attendings have the ultimate responsibility. Why would you give that up?
 
misteratoz said:
CRNA's can practice independently in 25 states. That is not to be overlooked. HOWEVER: The number of CRNA's that want to practice independently are a vocal minority. They have a sweet gig: 40 hours a week, $200k+, attendings have the ultimate responsibility. Why would you give that up?
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They keep chiseling away for more independent full practice authority. That's the AANA ultimate goal.

VA is considered entity of the federal govt. FED rules and regulation trump state rights. Just remember that. Why? Because you can still work with a Virginia medical license in ANY VA HOSPITAL. ANY WHERE IN THE USA.

So same applies to crna practice. Doesn't matter if they can only practice independently in 25 states. Because federal regulation in VA system overrides state independent practice regulation. That's why the big push.
 
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